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Accident: Private Property with no injury

  1. If you need immediate assistance, please call the main number at 860-886-5561 Ext. 6. If this is an emergency, please call 911. If you wish to report activity that is on-going and does not require immediate attention, please complete the form below.
    (Warning: Internet IP addresses are captured when submitting this form. Intentionally completing a form with false information can result in a criminal investigation)
  2. Please complete the form below for non-injury or private property accident reports.
  3. Unit #1/ Vehicle #1
  4. Preferred method of communication*
  5. Were you wearing a seatbelt?*
  6. Passengers in the vehicle?*
  7. Vehicle #1 Owner (If different than Driver)
  8. Vehicle #1 Information
  9. Unit #2/ Vehicle #2
  10. Were you wearing a seatbelt?*
  11. Passengers in the vehicle?*
  12. Vehicle #2 Owner (If different than Driver)
  13. Vehicle #2 Information
  14. By completing this form, I certify that the information contained herin is true, correct, and complete to the best of my knowledge and belief. I further acknowledge that any intentional false statement or misstatement may be a violation of 53a-180c.
    Please type your name below for the purpose of electronically signing this report (CT Sec. 1-272. Legal recognition of electronic records, electronic signatures and electronic contracts).
  15. Leave This Blank:

  16. This field is not part of the form submission.