# Accident Review Form for NEMT: Decide If a Crash Was Preventable and What Happens Next

Canonical URL: https://nemtguide.com/templates/accident-review-form/ · Updated 2026-10-02

An accident review form records your decision on whether a crash or incident was preventable, why it happened, and what happens next for the driver. Review every crash once the police report, video, and statements are in, whoever was at fault. Brokers count the result: Transdev in Hawaii bars drivers with a preventable major accident or more than two preventable accidents in 3 years.

- Review every crash and incident, even when the other driver was cited, once the police report, video, and statements are in.
- Call a crash preventable when a careful driver could have seen it coming and avoided it without causing a different crash.
- MTM Health presumes your driver was at fault unless you prove otherwise, and it wants the police report to show a no-fault crash.
- Count each finding against every limit you work under, such as Transdev's 3-year limit in Hawaii and MTM Health's 36-month limit.
- Fix the cause with a specific change. OSHA warns that just telling workers to remember a rule is unlikely to prevent the next one.

The incident report says what happened. The accident review decides what it means: whether the crash or incident was preventable, what caused it, how it counts against your driver's limits with each broker, and what changes now. Fill it in a few days after the crash, once the evidence is in, and file it in the driver's file.

## How to use this template

1. **Start from the incident report.** Use the [NEMT incident report form](https://nemtguide.com/templates/nemt-incident-report-form/) on the day of the crash, and send the broker its report on time. This review comes after. For the steps at the scene and the calls to make, see [what to do after a NEMT vehicle accident](https://nemtguide.com/guides/nemt-vehicle-accident/).
2. **Review every crash and incident.** That includes crashes where the other driver was cited, rider falls, and lift or securement problems. The employer guidelines OSHA wrote with NHTSA and NETS say to review all crashes for cause and preventability, regardless of fault.
3. **Gather the evidence in Part 2 before you decide.** Ask for the police report early. Save [dash camera](https://nemtguide.com/guides/nemt-dash-cameras/) footage and GPS data before they record over.
4. **Talk with the driver.** Ask what they saw and did, in order, and listen before you judge. OSHA's guide to incident investigations says a search for someone to blame stops short of the real causes.
5. **Answer the questions in Part 3, then write the finding in Part 4.** Use "undecided" when key evidence is still missing, and set a date to finish.
6. **Count it in Part 5** against every broker and state limit you work under, using each one's own definition.
7. **Fix the cause in Part 6.** Name a specific change, who makes it, and by when.
8. **Go over it with the driver and sign Part 7.** The driver may add comments. Signing shows the driver read the review, not that they agree with it.
9. **File it and carry it forward.** Put a copy in the [driver file](https://nemtguide.com/templates/nemt-driver-file-checklist/), send the broker anything it asks for, and bring the count into the next [driver evaluation](https://nemtguide.com/templates/nemt-driver-evaluation-form/).

## The template

### Part 1: The crash or incident

| Field | Write it here |
|---|---|
| Incident report number, and the date and time of the event | |
| Driver's name and hire date | |
| Vehicle number and plate | |
| Broker, plan, or contract for the trip, and the trip number | |
| Type (collision, backing, struck while parked, rider fall, lift or ramp, securement, other) | |
| Deaths, injuries treated away from the scene, or vehicles towed (how many) | |
| Police agency, report number, and who was cited for what | |
| Date the broker was told, and its case number | |
| Reviewed by (names and roles), and the review date | |

### Part 2: Evidence reviewed

| Evidence | Have it (yes, no, or requested on) | What it shows |
|---|---|---|
| Police crash report | | |
| Tickets issued, and to whom | | |
| Photos of the scene and the vehicles | | |
| Dash camera video, road and cabin | | |
| GPS speed, stops, and times for the trip | | |
| Driver's signed statement | | |
| Rider and witness statements | | |
| The other driver's insurer decision, if known | | |
| Post-accident drug and alcohol test result | | |
| Vehicle check after the crash, and the last service before it | | |
| Driver's hours that day, and the trips done before this one | | |
| Driver's training record (defensive driving, securement) | | |

### Part 3: Could it have been prevented?

| Question | Yes | No | Notes |
|---|---|---|---|
| Was the speed right for the road, weather, light, and traffic? | | | |
| Was there enough following distance to stop in time? | | | |
| Was the vehicle legally stopped or parked when it was hit? | | | |
| Was it hit from behind while moving normally with traffic? | | | |
| Did the driver back up, and if so, check the area or use a spotter first? | | | |
| Did the driver turn, change lanes, or pull out, and check mirrors and blind spots first? | | | |
| Was the driver using a phone or another device? | | | |
| Was the driver tired, or past their usual hours? | | | |
| Did the hazard leave time to react (a car running a light, an animal, debris)? | | | |
| Did a vehicle defect cause or add to it, and was it on the last inspection? | | | |
| For a rider incident: were the boarding, lift, and securement steps followed? | | | |
| Did a tight schedule or a dispatch change push the driver to hurry? | | | |
| Did anything the company controls (training, maintenance, scheduling) play a part? | | | |

### Part 4: Finding

| Question | Answer |
|---|---|
| Our finding: preventable, not preventable, or undecided (waiting for what, and until when) | |
| In one sentence: what the driver could have done, or why nothing would have avoided it | |
| What the company could have done differently, if anything | |
| At fault, chargeable, or preventable under each broker's own definition (name each broker) | |
| An accident under the federal definition (a death, an injury treated away from the scene, or a tow) | |
| The broker's own finding and its date, if it made one | |
| Appeal sent to the broker (date and result) | |

### Part 5: The driver's record after this finding

| Limit you work under | Look-back window | Count, including this one |
|---|---|---|
| Transdev Health Solutions, Hawaii: no preventable major accident, and no more than 2 preventable accidents | 3 years | |
| MTM Health standard agreement: fewer than 2 at-fault accidents with injury or property damage | 36 months | |
| Virginia fee-for-service Medicaid: no more than 2 chargeable accidents or moving violations | 3 years | |
| Your own written policy | | |
| Other broker or plan: | | |
| Company rate: preventable collisions per 100,000 miles, this contract year | 12 months | |

### Part 6: Causes and fixes

| Cause found | Specific fix | Who | Due | Done |
|---|---|---|---|---|
| | | | | |
| | | | | |
| | | | | |

| Follow-up | Write it here |
|---|---|
| Retraining assigned (course, provider, date finished) | |
| Driver off trips while under review (dates), and brokers told | |
| Step taken under your written discipline policy, if any | |
| Vehicle repair or inspection before its next trip | |
| Change to a route, schedule, pickup spot, or procedure | |

### Part 7: Driver's response and signatures

| Field | Write it here |
|---|---|
| Driver's comments | |
| Driver's signature and date | |
| Reviewer's signature and date | |
| Copy filed in the driver file (date) | |

## How to decide if a crash was preventable

FMCSA's safety rating rules give a clear standard to borrow. In plain words: if a driver using normal judgment and foresight could have foreseen the possibility of the crash that happened, and avoided it by taking steps within their control without causing a different mishap, the crash was preventable (49 CFR part 385, Appendix B). The same part defines a preventable accident as one that could have been averted but for an act or failure to act by the motor carrier or the driver (49 CFR 385.3). So a worn brake you never fixed or a schedule that left no time to stop safely can make a crash preventable on the company's part.

Preventable is not the same as legally at fault. FMCSA says its preventability decisions do not establish legal liability or fault. A driver can be hit by a car that ran a red light and still have had time to react, and a driver who was not cited can still have followed too closely.

Brokers write their own definitions, and some put the burden on you:

- **MTM Health.** Its standard agreement (January 1, 2023 version, posted by Pennsylvania) counts an accident as at fault when the driver is cited, negligently contributes to it, or has a single-vehicle crash not caused by equipment. It presumes the driver was at fault unless the driver provides evidence otherwise, and it requires police reports to verify a no-fault accident.
- **CareOregon.** It manages NEMT for three Oregon coordinated care organizations, including Health Share of Oregon's [Ride to Care](https://nemtguide.com/brokers/ride-to-care/), and its manual (version 1.3, February 2024) is the template its brokerages use for provider standards. Under it, brokerages treat every grievance and incident as potentially valid and preventable until documentation proves otherwise. They record each finding and track patterns by provider and driver.

When the evidence is not in yet, write "undecided" and set a date. FMCSA does the same in its own crash reviews: a requester who does not send the documents it asks for within 14 calendar days may get an undecided finding instead of a not preventable one.

## Broker and contract limits that count preventable crashes

The three driver limits below each look back 3 years, but each counts crashes in its own words. Contract standards for paratransit fleets count preventable crashes per 100,000 miles instead.

| Program | What counts | Limit |
|---|---|---|
| Transdev Health Solutions, Hawaii (driver checklist, July 2024) | Preventable accidents | No preventable major accident, and no more than 2 preventable accidents, in 3 years |
| MTM Health standard agreement (January 1, 2023) | At-fault accidents with injury or property damage | 2 or more in 36 months disqualifies the driver |
| Virginia fee-for-service Medicaid (DMAS, updated May 26, 2026) | Chargeable accidents or moving violations | More than 2 in 3 years bars the driver |
| CareOregon brokerages (manual, February 2024) | Collisions | Repeated collisions or one serious one can disqualify at once. One preventable collision, or a series of any kind, can require retraining |
| Access Services, Los Angeles County paratransit (board report, April 27, 2026) | Preventable collisions and preventable incidents per 100,000 miles | 0.85 collisions and 0.25 incidents or fewer |
| Volusia County VoAccess paratransit (contracts approved May 19, 2026) | Preventable accidents per 100,000 miles | No more than 1. A $100 deduction per accident in the quarter, waivable with evidence it was not preventable |

To find your rate, divide preventable collisions by miles driven and multiply by 100,000. Two preventable collisions in 240,000 miles is 0.83 per 100,000: inside Access Services' standard of 0.85, with almost no room left. Access Services' April 2026 board report showed its own service at 0.85 for February 2026 and 0.74 for the fiscal year so far. For more on these contracts, see [ADA paratransit contractor](https://nemtguide.com/guides/ada-paratransit-contractor/).

Transdev's limit sits on the checklist it uses to credential drivers for AlohaCare's rides in Hawaii, so a third preventable crash in 3 years, or one preventable major accident, can take a driver off its roster. See [Transdev Health Solutions](https://nemtguide.com/brokers/transdev-health-solutions/) and the [Hawaii state guide](https://nemtguide.com/states/hawaii/).

## If your vans are commercial motor vehicles

Federal motor carrier rules cover a vehicle used in interstate commerce that is rated at 10,001 pounds or more, or is designed or used to carry more than 8 passengers, driver included, for pay (49 CFR 390.5T). The rules list an exception for "the transportation of human corpses or sick and injured persons" (49 CFR 390.3T), so ask FMCSA whether it covers your trips.

When the rules apply:

- **The accident register.** Keep it for 3 years after each accident (49 CFR 390.15). Only crashes that meet the federal definition in 49 CFR 390.5T go in it; the [NEMT incident report form](https://nemtguide.com/templates/nemt-incident-report-form/) lists what each entry needs. Note the result in Part 4.
- **The Crash Preventability Determination Program.** You or the driver can ask FMCSA, through its DataQs system, to review whether a crash was preventable. FMCSA's December 4, 2024 notice lists 21 eligible crash types for crashes on or after December 1, 2024, up from 16. They include being struck in the rear, being struck while legally stopped or parked, and any other crash where video shows the sequence of events. A complete police accident report is required, and the burden is on you to show the crash was not preventable.
- **What a finding changes.** A crash found not preventable stays listed on FMCSA's public Safety Measurement System in a separate table, but it no longer counts in the carrier's Crash Indicator score. Preventable and undecided crashes still count. Only not preventable findings are noted on the driver's Pre-Employment Screening Program record. For a fatal crash, FMCSA wants the DOT post-accident test results or an explanation of why the tests were not done, and a positive result or a refusal makes the crash preventable.
- **Your safety rating.** In a compliance review of a carrier with two or more recordable accidents in the past 12 months, a rate above 1.7 recordable accidents per million miles for a carrier operating entirely within 100 air miles, or 1.5 for others, rates the accident factor unsatisfactory. FMCSA considers preventability when you contest that with compelling evidence (49 CFR part 385, Appendix B).

## Turning the finding into action

A finding only helps if something changes. OSHA's incident investigation guide (December 2015) says superficial conclusions and weak fixes, such as telling workers to remember a rule, are unlikely to prevent the next incident. Look for the cause behind the cause: the schedule, the route, the training, the vehicle, or the way dispatch works.

- **Set the steps in advance.** The OSHA, NHTSA, and NETS guidelines describe discipline systems that list what happens after a set number of violations or preventable crashes in a set period, with progressive steps when a pattern starts. Write yours in the [driver handbook](https://nemtguide.com/templates/nemt-driver-handbook/) so every driver knows them before a crash.
- **Have a written procedure.** CareOregon's manual says providers shall keep a written collision and incident investigation procedure and follow it for every collision and incident. This form can be the record that you did.
- **Retrain on the skill that failed.** CareOregon's brokerages may order intervention training after one preventable collision or a series of collisions of any kind. Match the course to the cause, such as defensive driving or [wheelchair securement](https://nemtguide.com/guides/wheelchair-securement/).
- **Appeal in writing when you disagree.** If a CareOregon brokerage suspends or disqualifies a driver, you may submit a written appeal, and it reviews the driver's record and your appeal before deciding. Send your Part 2 evidence with it.
- **Send the federal notices when a report is involved.** If a driving record or background report from a screening company is part of the decision to take a driver off trips or end the job, send the letters in the [pre-adverse action notice template](https://nemtguide.com/templates/pre-adverse-action-notice/) first.

## How long to keep accident reviews

Keep each review at least as long as the longest look-back you answer to. Transdev in Hawaii, MTM Health, and Virginia fee-for-service all count crashes over 3 years, and a carrier under FMCSA rules keeps its accident register 3 years after each accident. MTM Health's standard agreement asks for full and complete records of your operations under the agreement for 10 years, or longer if a law or MTM's client requires it. For every record in one schedule, see [NEMT record retention](https://nemtguide.com/guides/nemt-record-retention/).

## Frequently asked questions

### What makes an accident preventable?

FMCSA's test is a good one to borrow: if a driver using normal judgment and foresight could have foreseen the crash and avoided it with steps in their control, without causing a different mishap, it was preventable. Its rules also count a crash as preventable when an act or failure to act by the company, not only the driver, could have averted it.

### Is a preventable accident the same as an at-fault accident?

Not always. FMCSA says its preventability decisions do not establish legal liability or fault, and a police report may cite no one. Brokers use their own terms. MTM Health counts a crash as at fault when the driver was cited, contributed through negligence, or had a single-vehicle crash not caused by equipment. Virginia counts chargeable accidents, and Transdev in Hawaii counts preventable ones.

### Who decides whether a crash was preventable, me or the broker?

Both, for different records. You decide for your own driver file. The broker decides for its network: CareOregon's manual has its brokerages build their own process, and Volusia County's paratransit contract leaves the call on whether a crash costs the contractor money to the county's project manager. If a broker suspends or disqualifies a driver, CareOregon lets you file a written appeal, so keep your evidence.

### How many preventable accidents can a NEMT driver have?

It depends on the contract. Transdev's Hawaii checklist (July 2024) allows no preventable major accident and no more than two preventable accidents in 3 years. MTM Health's standard agreement bars a driver with two or more at-fault accidents with injury or damage in 36 months. Virginia fee-for-service Medicaid bars more than two chargeable accidents or moving violations in 3 years.

### Should I review a crash where my driver was hit from behind?

Yes. The crash guidelines OSHA wrote with NHTSA and NETS say to review every crash for cause and preventability, regardless of fault. FMCSA lists being struck in the rear among the crash types it will review as possibly not preventable, but a sudden stop or a missed mirror check can still make one preventable. CareOregon's manual also allows retraining after a series of collisions, preventable or not.

### How long should I keep accident reviews?

At least as long as the longest look-back you answer to. Transdev, MTM Health, and Virginia all count crashes over 3 years, and carriers under FMCSA rules keep an accident register for 3 years after each accident. MTM Health's standard agreement asks for complete records of your operations under it for 10 years, so keep them that long if you drive its trips.

## Official resources

- [Transdev Health Solutions: Hawaii driver credentialing checklist (preventable accident limits)](https://transdevhealthsolutions.com/alohacare/wp-content/uploads/sites/3/2024/07/TDV_H_Driver-Credentialing-Checklist.pdf)
- [OSHA: Incident [Accident] Investigations, A Guide for Employers](https://www.osha.gov/sites/default/files/IncInvGuide4Empl_Dec2015.pdf)
- [OSHA, NHTSA, and NETS: Guidelines for Employers to Reduce Motor Vehicle Crashes](https://www.osha.gov/sites/default/files/publications/motor_vehicle_guide.pdf)
- [Federal Register: FMCSA Crash Preventability Determination Program, eligible crash types (December 4, 2024)](https://www.federalregister.gov/documents/2024/12/04/2024-28377/crash-preventability-determination-program)
- [CareOregon: Transportation Provider Manual (incident determination, intervention training, appeals)](https://careoregon.org/docs/default-source/nemt/nemt-provider-manual.pdf)