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Vehicle Accident Report

  1. Franklin County Public Safety

  2. Franklin County Department of Public Safety
    1488 Franklin Street
    Rocky Mount, VA 24151
    540-483-3091

  3. REPORTING AGENCY'S INFORMATION

  4. ACCIDENT DETAILS

  5. Reported to State Police

  6. OTHER DAMAGED PROPERTY

  7. WITNESSES/PASSENGERS

  8. Witness or Passenger

  9. Vehicle

  10. Witness or Passenger

  11. Vehicle

  12. Witness or Passenger

  13. Vehicle

  14. INJURED

  15. Vehicle

  16. Vehicle

  17. Vehicle

  18. REPORTING

  19. Vehicle ID License Information

    The person filling out this form will need to call in or bring Driver's license numbers for the driver of both vehicles to the Franklin County Department of Public Safety.

  20. Leave This Blank:

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