Department of Administrative Services
DAS Fleet Services- Risk Management
109 SE 13th St
Des Moines, IA 50319
Vehicle Accident Report Form
● Render aid or assistance to the injured (per Iowa Code 321.262).
● The State of Iowa is self-insured. Refer to the insurance card and accident report procedures online
or in your glove box packet. If the accident involves another party, exchange information with the
driver or property owner. Do not admit fault or attempt to settle your claim.
● Call local law enforcement, if a fatality, injury or property damage has occurred, and obtain a police
report. On the Capitol complex, call Iowa State Patrol, Post 16 at 515-281-5608.
● Within the first 24 hours, report accident or damage to DAS Fleet Services (515-281-3162 or
or unavoidable cause MUST be reported to DAS Fleet Services within 24 hours of the incident to
qualify for contingent fund use (per Iowa Code 29C.20).
● For an estimate, locate the nearest contracted auto body repair shop in the Contracted Service
Providers map. A contracted auto body shop within 30 miles should be used if available.
● If towing is necessary, contact DAS Fleet Services (515-281-3162) for assistance. After hours, call
National Automobile Club (NAC) FleetRescue* (866-329-3471) or local law enforcement.
● Within 72 hours, print and submit a completed Accident Report Form, including a cost estimate from
the auto body shop to [email protected].
● Any accident in the State of Iowa that causes death, personal injury, or total property damage of
$1,500 or more must be reported on an Iowa Accident Report Form UNLESS the accident is
investigated by a law enforcement agency and a report is filed. Failure to return an accident report
form within 72 hours may result in suspension of driving privileges.
DAS Fleet Services ● 109 S.E. 13th St. ● Des Moines, IA 50319 ● 515-281-3162
Vehicle Accident Report
Time and location of accident
Accident Date (Mo/Day/Year)
Time
No. of Vehicles
County
State
Vehicle 1 (State vehicle)
Driver’s Name
Work Street Address
Driver’s License No./State
City, State, Zip
Date of Birth
Department
Work Phone
Home Phone
License Plate No.
VIN
Year, Make, Model
Estimate ($) of Damage
Description of Damage
Vehicle 2 (other vehicle) if more than two vehicles-use additional forms
Driver’s Name
Street Address
Driver’s License No./State
City, State, Zip
Date of Birth
Work Phone
Home Phone
License Plate No.
Description of Damage
DAS Fleet Services ● 109 S.E. 13th St. ● Des Moines, IA 50319 ● 515-281-3162
Property Damage other than vehicle (fence, utility pole, etc)
Owner’s Name, Address and Phone
Description of Property Damaged
Injured Persons (attach additional sheets if necessary)
Vehicle No. 1/ Name and Address
Describe Injuries
Vehicle No. 2/ Name and Address
Describe Injuries
Witness
Name
Address/Phone
Name
Address/Phone
Accident Diagram
Complete diagram below, include a description of what happened.
Use the outline below to sketch the scene of your accident,
writing in street or highway names or numbers.
Use number 1 to indicate the State vehicle.
DAS Fleet Services ● 109 S.E. 13th St. ● Des Moines, IA 50319 ● 515-281-3162
Accident Information Exchange Sheet
Other Vehicle information
Driver’s Name
Street Address
Driver Phone
Driver’s License No./State
Vehicle Plate No.
Vehicle year, make, model
VIN
Insurance Company Name
Policy No.
Agent name
Agent phone
Owner’s Name/Address (if
different)
Submit this information along with the accident report to DAS Fleet Service within 72 hours of the accident.
Complete the next section, tear at the dotted line and give to the other party involved.
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State Vehicle Insurance Information
Driver’s Name
Driver’s License No./State
Vehicle Plate No.
Vehicle year, makel, model
VIN
The State of Iowa is self-insured.
If you have any questions regarding an accident, please contact
DAS Fleet Services at 515-281-3162 of [email protected]
DAS Fleet Services ● 109 S.E. 13th St. ● Des Moines, IA 50319 ● 515-281-3162
