HomeMy WebLinkAboutCity Council Committees - Civil Services Commission - 08/23/1993 .CITY OF KENT
E14PLOYEE'S ACCIDENT/INCIDENT REPORT
This report is to be completed by the employee involved in the
accident/incident that is being reported. Information is to'be recorded
immediately and all forms forwarded to the employee's supervisor to be sent
with supervisor's investigation report.
Name(s) of person(s) Involved Age Address Phone
1. GEORGE E. BURKE 62 1230 S. Central ,Kent 859-3436
2. SHANNON J. SAMMINGTON 11101 SE 208th Apt.1112, 852-6629
3. Kent
Date of Accident/Incident 8/19/93 Time 1345
Vehicle No. 11 (If Applicable)
Location (be specific) Central and Willis St. Kent
• Describe in detail what happened: see reverse
Was your vehicle equipped with seat belts? (If Applicable)
Were you wearing the seat belt? (If Applicable)
USE REVERSE SIDE OF THIS FORM TO PROVIDE DIAGRAM OF COLLISION
What corrective measures, or assistance (if any) did City Employees take:
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WITNESSES:
Name: Dept./Address: Phone:
• Reported by: CC Department:
Supervisor: Date: cj, 23 -,M
SIGNATURE
0322W-11W Rev. 01/87
Accident Description:
On August 19, 1993 at approximately 1345; I rear-ended a 1993
�onda at the corner of Willis and Central in Rent.
Details of accident:
I was in then right lane on Willis to make a right turn onto Central. The
car in front of me stopped for the red light then turned right. By the
time I got to the intersection the light had turned green and I made a right
turn. There was a yellow pickup and a black Honda Accord in front of me.
The pickup stopped abruptly and the Honda also stopped. I hit my brakes
and hit .the Hondas left rear fender. We pulled into the 7-11 store and I
called 911 and had them send a police car to the accident. I then went back
and asked if everyone was okay and the driver and his passenger said they
were okay. When the aid unit came, they checked the driver of the Honda
and they sent him. to Valley General Hospital . Officer Durham took the
accident report.At the time of the accident I was travelling at 5 to
8 miles per hour.
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