Accident Report

30 V.S.A. § 207 states "The superintendent or manager of any line or plant, subject to supervision under this chapter, shall notify the department in writing of any accident within this state immediately after its occurance, upon such line or plant resulting in the loss of life or injury to any person which shall incapacitate him from engaging in his usual vocations".

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Witnesses

Information for anyone involved or witnessed the incident

Witness 1

Street, City, State, Postal Code

Witness 2

Street, City, State, Postal Code

Witness 3

Street, City, State, Postal Code

Witness 4

Street, City, State, Postal Code