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STATE OF CALIFORNIA − GENERAL SERVICES − RISK AND INSURANCE MANAGEMENT
STATE DRIVER ACCIDENT REVIEW
STD. 274 (REV. 1/2003)
PLEASE PRINT OR TYPE
SUPERVISOR'S REVIEW - FOR DEPARTMENTAL ACCIDENT PREVENTION
PURPOSE: To have supervisor investigate each driver accident, report facts and circumstances, confirm that the State
vehicle was used on State business, and initiate or recommend action to achieve accident prevention.
HOW: Use sources of information listed on the back of this form. Report on all accidents, regardless of who was hurt,
what property was damaged, or who was responsible. (SAM 2430)
WHO: SUPERVISOR who authorized the employee to drive on State business must prepare this report, code the type
of accident, and forward it to the reviewing officer/safety coordinator within five days from the date of the
accident. Attach STD. 274 to the departmental copies of STD. 270 (if applicable). If STD. 270 is not required,
send a copy of STD. 274 to the Office of Risk and Insurance Management, Health and Safety Unit.
REVIEWING OFFICER: You are responsible for the quality (accuracy and completeness) of the supervisor's report and to
4. HOW DID ACCIDENT OCCUR ?
initiate follow-up action.
5. HAT DRIVING RULES, VEHICLE LAWS OR VIOLATIONS CONTRIBUTED TO THE CAUSE OF THE ACCIDENT?
6. SUPERVISOR'S ACTION TAKEN, OR RECOMMENDATION FOR SUPERIORS TO PUT INTO EFFECT. (SEE BACK FOR SUGGESTIONS)
DATE
7. IGNATURE AND TITLE OF SUPERVISOR
1. DRIVER'S NAME 2. ORGANIZATION UNIT AND DEPARTMENT 3. DATE OF ACCIDENT
W
S
8. REVIEWING OFFICER:
I CONCUR OR I DO NOT CONCUR WITH SUPERVISOR
MY EVALUATION AND ACTION TAKEN:
9. HOW WAS THE DRIVER INFORMED OF YOUR EVALUATION AND FOLLOW-UP ACTION:
10. IGNATURE AND TITLE OF REVIEWER
DATE
DATE
VERBAL DISCUSSION WRITTEN MEMO VERBAL AND WRITTEN
S
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STATE OF CALIFORNIA − GENERAL SERVICES − RISK AND INSURANCE MANAGEMENT
STATE DRIVER ACCIDENT REVIEW
STD. 274 (REV. 1/2003) (REVERSE)
SOURCES OF INFORMATION INVESTIGATED BY SUPERVISOR
IN ADDITION TO STD. 270 PREPARED BY DRIVER
DID YOU ?
YES NO
¤ QUESTION STATE DRIVER
¤ GO TO SCENE OF ACCIDENT
¤ CLOSELY EXAMINE SEAT BELTS AND SAFETY
EQUIPMENT
¤ EXAMINE MECHANICAL DEFECTS
¤ READ POLICE REPORT AND CITATIONS
¤ REVIEW DL-254, ABSTRACT OF LICENSE RECORDS
DEPARTMENT OF MOTOR VEHICLES
¤ REVIEW DRIVER'S FILE -- DEPARTMENT RECORDS
¤ ASK ABOUT ANY DISTRACTIONS OR ATTENTION
DIVERTERS, PRIOR TO ACCIDENT (i.e., cellphone, eating,
reaching, talking)
¤ CONSIDER, WAS OUR DRIVER INFLUENCED BY
FATIGUE, ILLNESS, MEDICINE OR ALCOHOL?
IF YES, EXPLAIN
SOME ACTION SUGGESTIONS AND RECOMMENDATIONS
(EXPLAIN ON OTHER SIDE)
DRIVER HABITS NEED TO BE OBSERVED IN
TRAFFIC
OUR DRIVER WAS A CONTRIBUTING FACTOR
(memo to driver)
FURTHER TRAINING BE PROVIDED
(when, by whom and type)
DEPARTMENTAL POLICY OR LOCAL RULES BE
MODIFIED
DRIVER BE DISCIPLINED (special action suggested)
ASK ACCIDENT REVIEW BOARD TO ADVISE
SUPERVISOR
NO FURTHER PERSONNEL ACTION BE TAKEN
RECOMMEND REMOVAL FROM DRIVING STATUS
DISCUSS CUMULATIVE DRIVER RECORD
RECOMMEND NEW OR CHANGE OF TRAFFIC FLOW
CHANGE OR IMPROVE EQUIPMENT
ASK FOR EXPERT CONSULTATION
GIVE DATE OF DEFENSIVE DRIVER TRAINING
DATE
¤ ORIENTATION - DEPARTMENT POLICIES AND
RULES
¤ CLASSROOM DEFENSIVE DRIVER TRAINING
¤ BEHIND-THE-WHEEL TRAINING
¤ SPECIAL MOBILE EQUIPMENT TRAINING
SUPERVISOR -- CLASSIFY FOR DEPARTMENTAL REPORTING
TYPE OF VEHICLE ACCIDENT:
COLLISION WITH OTHER VEHICLE
SOLO ACCIDENT
1. Evasive maneuver
2. Lost control
3. Hit other vehicle in rear
4. Hit from rear
5. Proceeding straight
6. Crossed into opposing lanes
7. Changing lanes
8. Making right turn
9. Making left turn
10. Backing
11. Mechanical failure
12. Collision with bicycle
13. Evasive maneuver
14. Lost control
15. Collided with stationary object
16. Backing
17. Runaway vehicle
18. Lost load
19. Mechanical failure
20. Struck or was struck by animal
STRIKING PEDESTRIAN
21. In a crosswalk
22. Not in a crosswalk
23. While backing
MISCELLANEOUS ACCIDENT
24. Explain
Yes No
WAS ACCIDENT PREVENTABLE BY STATE DRIVER ?
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Completed 1 July 2020

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