Test Accident Form
Report of Personal Injury or Damage to Property
(for use by all Utilities except Railroads, Street Railroads and Motor Carriers)
Instructions: In the event of more than one person being involved in the same accident, fill out a separate form for each person. Submit this report to the Public Service Commission within ten days of the date of the accident.
* Additional information, photographs, sketch of accident, emergency responder reports, etc. in support of this notification may be emailed to email@example.com