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TRAFFIC CRASH REPORT

LOCAL REPORT # *

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OH-1(Rev.10/99)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVATE

 

 

 

PHOTOS

OH-2

OH-3

OH-1P OTHER

 

 

 

CRASH SEVERITY

 

 

HIT/SKIP

 

 

 

 

PROPERTY

 

 

1 NOT HIT/SKIP

TAKEN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 FATAL

3 PDO

‘X’

 

 

 

 

2 SOLVED

‘X’

 

 

 

 

 

 

 

 

 

 

2 INJURY

4 UNKNOWN

 

 

 

 

 

IF YES

 

 

 

 

 

 

 

 

 

 

IF YES

 

 

 

 

3 UNSOLVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N.C.I.C.# *

TIME OF CRASH

 

DAY OF WEEK

 

 

 

 

 

 

 

 

 

REPORTING AGENCY *

 

# UNITS

CITY *

VILLAGE *

TWP *

NAME (OF CITY, VILLAGE OR TOWNSHIP) *

UNIT ERROR

 

DATE OF CRASH *

98= ANIMAL

99= UNKNOWN

COUNTY # *

LATITUDE

LONGITUDE

CRASH OCCURRED ON

 

TYPE LOCATION POINT USED

PREFIX CRASH LOCATION

TYPE LOC

 

 

 

 

 

1 NAMED STREET

3 NUMBERED ROUTE

 

 

 

 

 

2 NUMBERED STREET

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCEPOINTUSED

AT / REFERENCE

 

 

DIST REFERENCE

DR

PREFIX

REFERENCE

 

REF POINT 01

STATE LINE

 

 

 

 

 

02

INTERSECTION 2 STREETS

 

 

 

 

 

03

COUNTY LINE

LOCAL INFORMATION

04

HOUSE NUMBER

08

PLACE NAME W/O REFERENCE

05

TOWNSHIP BOUNDARY

09

DRIVEWAY

06

MILE POST

10

STREET OR ROUTE W/O

07

CORPORATION LIMIT

 

REFERENCE

UNIT #

A

#OF OCC.

NAME (LAST, FIRST, MIDDLE)

 

ADDRESS (STREET, CITY, STATE, ZIP CODE)

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER

 

DATE OF BIRTH

 

 

AGE

 

SEX

HOME PHONE #

WORK PHONE #

 

DL STATE

DL #

 

LP STATE

LP #

INJURED

1 NONE

4 OTHER

TRANSPORTED BY

INJURED TAKEN TO

 

 

 

 

 

 

TAKEN BY

2 EMS

5

UNKNOWN

 

 

 

 

 

 

 

 

 

3 POLICE

 

 

 

 

Motorist-Motorist/Non

OWNER NAME (IF SAME, WRITE “SAME”)

 

 

ADDRESS (STREET, CITY, STATE, ZIP CODE)

 

 

 

 

YEAR

 

MAKE

MODEL

COLOR

INSURANCE COMPANY

 

 

TOWING SERVICE

OWNER PHONE #

 

OFFENSE CHARGED

 

OFFENSE DESCRIPTION

 

 

 

 

CITATION #

LOCAL

 

 

 

 

 

 

 

 

 

 

 

CODE?

 

 

 

 

 

 

 

 

 

 

 

‘X’

 

 

 

 

 

 

 

 

 

 

 

IF YES

 

B

UNIT #

# OF OCC.

 

 

 

 

 

 

 

 

 

 

NAME

(LAST, FIRST, MIDDLE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (STREET, CITY, STATE, ZIP CODE)

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER

 

DATE OF BIRTH

 

 

AGE

 

SEX

HOME PHONE #

WORK PHONE #

 

DL STATE

DL #

 

LP S

LP #

INJURED

1 NONE

4 OTHER

TRANSPORTED BY

INJURED TAKEN TO

 

 

 

 

TATE

 

 

 

 

 

 

 

TAKEN BY

2 EMS

5

UNKNOWN

 

 

 

 

 

 

 

 

 

3 POLICE

 

 

 

 

 

OWNER NAME (IF SAME, WRITE “SAME”)

 

 

ADDRESS (STREET, CITY, STATE, ZIP CODE)

 

 

 

 

 

YEAR

 

MAKE

MODEL

COLOR

INSURANCE COMPANY

 

 

TOWING SERVICE

OWNER PHONE #

OFFENSE CHARGED

 

OFFENSE DESCRIPTION

 

 

 

CITATION #

 

 

LOCAL

 

 

 

 

 

 

 

 

 

 

 

CODE?

 

 

 

 

 

 

 

 

 

 

 

‘X’

 

 

 

 

 

 

 

 

 

 

 

IF YES

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

UNIT #

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

 

 

 

 

NAME (LAST, FIRST, MIDDLE)

HOME PHONE #

 

 

 

 

 

 

Occupant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (STREET, CITY, STATE, ZIP CODE)

 

 

 

 

INJURED TAKEN BY

TRANSPORTED BY

 

 

 

 

 

1 NONE

4 OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 EMS

5 UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 POLICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNIT #

 

 

 

 

 

 

 

 

 

 

DATE

OF BIRTH

 

 

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME (LAST, FIRST, MIDDLE)

HOME PHONE #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (STREET, CITY, STATE, ZIP CODE)

 

 

 

 

INJURED TAKEN BY

TRANSPORTED BY

 

 

 

 

 

1 NONE

4 OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 EMS

5 UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 POLICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGE

SEX

INJURED TAKEN TO

AGE

SEX

INJURED TAKEN TO

 

SEATING POSITION

 

SAFETYEQUIPMENT

 

AIRBAG

 

 

AIRBAGSWITCH

 

EJECTION

 

01

FRONT – LEFT (MC DRIVER)

 

MOTORIST

 

1

NOT-DEPLOYED

 

 

1

NOT PRESENT

 

1

NOT EJECTED

A

02

FRONT – MIDDLE

A

01

NONE USED

A

2

DEPLOYED-FRONT

A

2

IN ON POSITION

A

2

TOTALLY EJECTED

03

FRONT

– RIGHT

02

SHOULDER BELT ONLY

3

DEPLOYED-SIDE

 

3

IN OFF POSITION

3

PARTIALLY EJECTED

 

 

 

 

 

 

 

04

SECOND – LEFT (MC PASS)

 

03

LAP BELT ONLY

 

4

DEPLOYED BOTH

 

 

4

UNKNOWN

 

4

NOT APPLICABLE

 

05

SECOND – MIDDLE

 

04

SHOULDER/LAP BELT

 

 

FRONT/SIDE

 

 

 

 

 

5

UNKNOWN

B

06 SECOND – RIGHT

B

05 CHILD SAFETY SEAT

B

5

NOT APPLICABLE

 

B

 

 

B

 

 

 

07

THIRD – LEFT

 

06

MC HELMET USED

 

6

UNKNOWN

 

 

 

 

 

 

 

 

 

(MC PASSENGER/SIDE CAR)

 

07

USE UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

08

THIRD

– MIDDLE

 

NON-MOTORIST

 

 

 

 

 

 

 

 

 

 

C

09

THIRD

– RIGHT

C

08

NONE USED

C

 

 

 

C

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

SLEEPER SECTION OF CAB

 

09

HELMET USED

 

 

 

 

 

 

 

 

 

 

 

11

ENCLOSED CARGO AREA

 

10

PROTECTIVE PADS

 

 

 

 

 

 

 

 

 

 

D

12

UNENCLOSED CARGO AREA

D

11

REFLECTIVE CLOTHING

D

 

 

 

D

 

 

D

 

 

13

TRAILING UNIT

12

LIGHTING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BLANK FOR

14

EXTERIOR

 

13

OTHER

 

 

 

 

 

 

 

 

 

 

15

OTHER

 

 

14

UNKNOWN

 

 

 

 

 

 

 

 

 

 

WITNESS

 

 

 

 

 

 

 

 

 

 

 

 

16

NON-MOTORIST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

HSY7001

 

 

 

 

 

 

 

TOP COPY - ODPS

BOTTOM COPY - AGENCY

 

 

 

TRAPPED

1NOT TRAPPED

A2 EXTRICATED BY MECHANICAL MEANS

3FREED BY

BNON-MECHANICAL MEANS

4UNKNOWN

C

D

INJURIES

1NO INJURY

A 2 POSSIBLE

3NON-

INCAPACITATING

4INCAPACITATING

B5 FATAL INJURY

6 UNKNOWN

C

D

SUPPLEMENT *

‘X” IF YES

UNITNUMBERS

DAMAGEAREA

PRE-CRASH ACTIONS

SEQUENCE OF EVENTS

POSTEDSPEED

DRUGTEST STATUS

A

B

 

 

A

B

 

 

 

 

 

A

 

 

B

 

 

 

 

 

 

 

A

 

 

 

 

 

 

B

 

 

A

 

 

 

 

 

B

 

 

 

 

 

 

 

 

MOTORIST

 

 

 

 

 

1

 

1

 

 

 

 

 

 

 

 

 

 

 

 

1

NONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NON-MOTORIST LOCATION

 

 

 

01 MOVEMENTS ESSENTIALLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

EST

R

EFUSED

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAFFICCONTROL

 

 

 

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STRAIGHT AHEAD

 

 

 

 

 

 

 

 

 

3

TEST GIVEN, CONTAMINATED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02 BACKING

 

 

 

 

 

2

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

SAMPLE/UNUSABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 TEST GIVEN, RESULTS KNOWN

 

 

A

B

A

 

 

03 CHANGING LANES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04 OVERTAKING/PASSING

 

 

 

 

 

 

 

A

 

 

 

 

 

 

B

 

5

TEST GIVEN, RESULTS UNKNOWN

01 MARKED CROSSWALK AT

 

 

 

05 TURNING RIGHT

 

 

 

 

 

 

01 NO CONTROLS

 

 

 

 

 

6

UNKNOWN

 

 

 

 

INTERSECTION

 

 

 

06 TURNING LEFT

 

 

 

3

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02 STOP SIGN

 

 

 

 

 

 

 

 

DRUGTESTTYPE

 

02 INTERSECTION/ NO CROSSWALK

 

 

 

07 MAKING U-TURN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

03 YIELD SIGN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

03 NON-INTERSECTION CROSSWALK

 

 

 

08 ENTERING TRAFFIC LANE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04 TRAFFIC SIGNAL

 

 

 

 

 

 

 

 

 

 

 

 

 

04 DRIVEWAY ACCESS CROSSWALK

 

 

 

09 LEAVING TRAFFIC LANE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

4

05 TRAFFIC FLASHERS

 

 

 

 

 

 

 

 

 

 

 

 

05 IN ROADWAY

 

 

 

10 PARKED

 

 

 

 

 

 

 

 

 

 

A

 

 

 

 

 

B

 

 

 

 

 

 

 

 

 

06 SCHOOL ZONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

06 NOT IN ROADWAY

 

 

 

11 SLOWING/STOPPED IN TRAFFIC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NON-COLLISION

 

 

07 RAILROAD CROSSBUCKS

 

 

1

NONE

 

 

 

 

 

07 MEDIAN (BUT NOT SHOULDER)

 

 

 

12 DRIVERLESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

01

OVERTURN/ROLLOVER

 

08 RAILROAD FLASHERS

 

 

 

2

BLOOD

 

 

 

 

 

08 ISLAND

 

 

 

 

13 OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02

FIRE/EXPLOSION

 

 

 

AILROAD

G

ATES

 

 

 

 

3

URINE

 

 

 

 

 

09 SHOULDER

 

B

 

 

14 UNKNOWN

 

 

 

 

 

 

 

09 R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

03

IMMERSION

 

 

 

ONSTRUCTION

B

ARRICADE

 

4

OTHER

 

 

 

 

 

10 SIDEWALK

 

 

 

 

NON-MOTORIST

 

 

 

 

 

 

10 C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04

JACKKNIFE

 

 

11 POLICE OFFICER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11 WITHIN 10 FEET OF ROADWAY

 

 

 

15 ENTERING/CROSSING IN SPECIFIED

 

 

 

 

 

 

 

DRUGTEST1&2 RESULT

 

 

 

05

CARGO/EQUIPMENT LOSS/SHIFT

 

12 PAVEMENT MARKINGS

 

 

 

 

(NOT SHOULDER, MEDIAN,

 

 

 

 

LOCATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

06

EQUIPMENT FAILURE

 

13

CROSSWALK LINES

 

 

 

 

 

 

 

 

 

 

 

 

 

SIDEWALK, ISLAND)

 

 

 

16

WALKING, RUNNING, JOGGING,

 

 

 

 

 

A

 

 

 

 

 

 

B

 

 

 

 

07

SEPARATION OF UNITS

 

14 WALK/DONT WALK SIGNAL

 

 

 

 

 

 

 

 

12 BEYOND 10 FEET OF ROADWAY

 

 

 

 

PLAYING, CYCLING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

08

RAN OFF ROAD RIGHT

 

15 TRAFFIC CONTROL DEVICE INOPERATIVE,

 

 

 

 

 

 

 

 

 

(WITHIN TRAFFICWAY)

 

 

 

17 WORKING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

09

RAN OFF ROAD LEFT

 

 

MISSING, OBSCURED

 

 

 

 

 

 

 

 

 

 

 

 

13 OUTSIDE TRAFFICWAY

 

 

 

18 PUSHING VEHICLE

 

 

 

 

 

 

1

 

2

 

 

 

1

2

 

 

 

 

10

CROSS MEDIAN/CENTERLINE

 

16 OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

14 SHARED USE PATHS OR TRAILS

 

 

 

19 APPROACHING/LEAVING VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11

DOWNHILL RUNAWAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MOSTDAMAGEDAREA

20 PLAYING/WORKING ON VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15 UNKNOWN

 

12

OTHER NON-COLLISION

 

DIRECTION

 

 

 

 

 

 

 

 

1

NONE

 

 

 

 

 

 

 

 

 

 

 

 

21 STANDING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13

UNKNOWN NON-COLLISION

 

 

 

 

 

 

 

 

 

2

MARIJUANA

 

 

 

TYPEOFUNIT

 

 

 

 

 

 

 

 

FROM

TO

 

 

 

 

FROM

TO

 

 

 

 

 

 

 

22 OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLLISIONW/PERSON,VEHICLE,

 

 

 

 

 

3

COCAINE

 

 

 

 

 

 

 

 

 

 

23 UNKNOWN

 

 

 

OROBJECTNOTFIXED

 

 

 

 

 

 

 

 

 

 

 

 

 

4

OPIATES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

B

 

 

 

 

 

 

 

14

PEDESTRIAN

 

 

 

A

 

 

 

 

 

 

 

B

 

 

5

AMPHETAMINES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

B

 

 

 

 

 

 

 

 

 

 

15

PEDALCYCLE

 

 

 

 

 

 

 

 

 

 

 

 

6

PCP

 

 

 

 

 

 

 

 

01 NONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTRIBUTINGCIRCUMSTANCES

16

RAILWAY VEHICLE

 

 

1

NORTH

 

 

 

 

 

 

 

 

 

7

OTHER

 

 

 

 

 

MOTORIST

 

02 CENTER FRONT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17

ANIMAL – FARM

 

 

 

 

 

 

 

 

 

 

 

8 UNKNOWN AT TIME OF REPORTING

 

 

 

 

 

 

 

 

 

 

 

2

SOUTH

 

 

 

 

 

 

 

 

 

01 SUB-COMPACT

03 RIGHT FRONT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18

ANIMAL – DEER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

EAST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02 COMPACT

 

04 RIGHT SIDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE OF INTERSECTION

 

 

 

 

 

 

 

 

 

19

ANIMAL – OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

WEST

 

 

 

 

 

 

 

 

 

 

03 MID SIZE

 

05 RIGHT REAR

 

 

 

A

 

 

 

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20

MOTOR VEHICLE IN TRANSPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

NORTHEAST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04 FULL SIZE

 

06 REAR CENTER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

PARKED MOTOR VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MOTORIST

 

 

 

 

 

6

NORTHWEST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

05 MINIVAN

 

07 LEFT REAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22

WORK ZONE MAINTENANCE EQUIPMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

01 NONE

 

 

 

 

 

7

SOUTHEAST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

06 SPORT UTILITY VEHICLE

08 LEFT SIDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23

OTHER MOVABLE OBJECT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02 FAILURE TO YIELD

 

 

 

8

SOUTHWEST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

07 PICKUP

 

09 LEFT FRONT

 

 

 

 

 

 

 

 

 

 

 

01 NOT AN INTERSECTION

 

 

 

 

24

UNKNOWN MOVABLE OBJECT

 

 

 

 

 

 

 

 

 

 

03 RAN RED LIGHT, OR STOP SIGN

 

9

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

08 PANEL/VAN

10 TOP AND WINDOWS

 

 

 

 

 

 

 

 

02 FOUR-WAY INTERSECTION

COLLISIONWITHFIXEDOBJECT

 

 

 

 

 

 

 

04 EXCEEDED SPEED LIMIT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

09 SINGLE UNIT TRUCK;

11 UNDERCARRIAGE

 

 

 

 

 

 

 

 

 

 

 

 

 

03

T-INTERSECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

05 UNSAFE SPEED

 

 

25

IMPACT ATTENUATOR/CRASH CUSHION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 AXLES, 6 TIRES

12

LOAD/TRAILER

 

 

 

CONDITION

 

 

 

 

 

 

 

 

04

Y-INTERSECTION

 

 

 

 

 

26

BRIDGE OVERHEAD STRUCTURE

 

 

 

 

 

 

 

 

 

 

 

06

IMPROPER TURN

 

 

 

 

 

 

 

 

 

 

 

10 SINGLE UNIT TRUCK; 3+ AXLES

13 TOTAL (ALL AREAS)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

05 TRAFFIC CIRCLE/ROUNDABOUT

 

 

27

BRIDGE PIER OR ABUTMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

07 LEFT OF CENTER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11 TRUCK/TRAILER

14 OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

06 FIVE-POINT, OR MORE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

08 FOLLOWED TOO CLOSELY/ACDA

28

BRIDGE PARAPET

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12 TRUCK TRACTOR (BOBTAIL)

15 UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

07 ON RAMP

 

 

 

 

29

BRIDGE RAIL

 

 

 

A

 

 

 

 

 

 

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

09

IMPROPER LANE CHANGE/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13

TRACTOR/SEMI-TRAILER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

08 OFF RAMP

 

 

 

 

 

 

30

GUARDRAIL FACE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DROVE OFF ROAD/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14 TRACTOR/DOUBLE SHORT

 

 

 

 

 

 

 

1

APPARENTLY NORMAL

 

 

 

09 CROSSOVER

 

 

POINTOFIMPACT

 

 

 

31

GUARDRAIL END

 

 

 

 

 

 

 

 

 

IMPROPER PASSING

 

 

 

 

 

 

 

 

15

TRACTOR/DOUBLE LONG

 

 

 

 

 

2

PHYSICAL IMPAIRMENT

 

 

 

10

DRIVEWAY/ACCESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 IMPROPER BACKING

32

MEDIAN BARRIER

 

 

 

 

 

 

16 FIFTH WHEEL OR

 

 

 

 

 

3

EMOTIONAL

 

 

 

 

 

 

 

11 RAILWAY GRADE CROSSING

 

 

 

33

HIGHWAY TRAFFIC SIGN POST

 

 

 

 

 

 

 

 

 

 

 

11 IMPROPER START FROM PARKED POSITION

 

 

 

 

 

 

 

 

 

CONVERTER DOLLY

 

 

 

 

4

ILLNESS

 

 

 

 

 

 

 

 

12 SHARED-USE PATHS OR TRAILS

 

 

 

 

34

OVERHEAD SIGN POST

 

 

 

 

 

 

 

 

 

 

 

 

 

12 STOPPED OR PARKED ILLEGALLY

 

 

 

 

 

 

 

 

 

17

TRACTOR/TRIPLES

 

A

B

 

5

ELL

A

SLEEP

, F

AINTED

 

ATIGUED

TC

13 UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13 OPERATING VEHICLE IN ERRATIC,

35

LIGHT/LUMINARIES SUPPORT

 

F

 

 

 

 

 

, F

, E

 

 

 

 

 

 

 

 

 

18 MOTORCYCLE

 

 

 

 

6

UNDER THE INFLUENCE OF

 

 

 

 

 

 

 

 

 

 

 

 

 

36

UTILITY POLE

 

 

 

 

 

 

 

 

 

 

 

 

01 NONE

 

 

RECKLESS, CARELESS, NEGLIGENT OR

 

 

 

 

 

 

 

 

 

 

 

 

19 MOTORIZED BICYCLE

 

 

 

 

 

MEDICATIONS/DRUGS/ALCOHOL

 

OCCURRENCE

 

 

 

 

 

 

37

OTHER POST, POLE OR SUPPORT

 

 

 

 

02 CENTER FRONT

 

 

AGGRESSIVE MANNER

 

 

 

 

20 SCHOOL BUS

 

 

7

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

03 RIGHT FRONT

 

 

38 CULVERT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14 SWERVING TO AVOID (DUE TO WIND,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21 CHURCH BUS

 

 

 

8

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04 RIGHT SIDE

 

 

SLIPPERY SURFACE, VEHICLE, OBJECT,

39

CURB

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22 PUBLIC BUS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40

DITCH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

05 RIGHT REAR

 

 

NON-MOTORIST IN ROADWAY, ETC)

 

 

ALCOHOL/DRUG SUSPECTED

 

 

 

 

 

 

 

 

 

 

23 OTHER BUS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

06 REAR CENTER

 

15 FAILURE TO CONTROL

41

EMBANKMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24 POLICE VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

ON ROADWAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

07 LEFT REAR

 

16 VISION OBSTRUCTION

42

FENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25 FIRE TRUCK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

ON SHOULDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

08 LEFT SIDE

 

17 DRIVER INATTENTION

43

MAILBOX

 

 

 

A

 

 

 

 

 

 

B

 

 

 

 

 

26 AMBULANCE/RESCUE

 

 

 

 

 

 

 

 

 

 

 

 

 

3

IN MEDIAN

 

 

 

09 LEFT FRONT

 

44

TREE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18 FATIGUE/ASLEEP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27 TAXI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

ON ROADSIDE

 

 

 

 

 

 

 

 

45

OTHER FIXED OBJECT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 TOP AND WINDOWS

19 OPERATING DEFECTIVE EQUIPMENT

 

1

NONE

 

 

 

 

 

 

 

 

 

 

 

28 MOTOR HOME

 

 

 

 

 

 

 

 

 

 

5

ON GORE

 

 

 

11 UNDERCARRIAGE

 

20 LOAD SHIFTING/FALLING/SPILLING

46

WORK ZONE MAINTENANCE EQUIPMENT

2

YES – ALCOHOL SUSPECTED

 

 

 

 

29 TRAIN

 

 

 

6

OUTSIDE TRAFFICWAY

 

12 LOAD/TRAILER

 

21 OTHER IMPROPER ACTION

47

UNKNOWN FIXED OBJECT

 

3

YES – HBD NOT IMPAIRED

 

30 FARM VEHICLE

 

 

 

7

UNKNOWN

 

 

 

13 TOTAL (ALL AREAS)

22 UNKNOWN

 

 

 

 

48

OTHER

 

 

4

YES – DRUGS SUSPECTED

 

 

 

 

31 FARM EQUIPMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14 OTHER

 

NON-MOTORIST

 

 

49

UNKNOWN

 

 

5

YES – ALCOHOL / DRUGS SUSPECTED

 

 

 

 

 

 

 

 

 

32 SNOWMOBILE

 

 

 

 

 

ROADCONTOUR

 

15 UNKNOWN

 

23 NONE

 

 

 

 

 

 

 

 

 

6

UNKNOWN

 

 

 

 

 

 

 

 

33 CONSTRUCTION EQUIPMENT

 

 

 

 

 

 

FIRSTHARMFUL EVENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24 IMPROPER CROSSING

 

ALCOHOLTESTSTATUS

 

 

 

 

 

 

 

 

 

 

 

 

34 ALL OTHERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACTION

 

25 DARTING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NON-MOTORIST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26 LYING AND/OR ILLEGALLY IN ROADWAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35 ANIMAL W/RIDER

 

 

 

 

A

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27 FAILURE TO YIELD RIGHT OF WAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36 ANIMAL W/BUGGY

 

 

 

 

 

 

 

 

A

 

 

 

 

 

 

B

 

 

 

1

STRAIGHT LEVEL

 

 

A

B

28 NOT VISIBLE (DARK CLOTHING)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37 BICYCLE

 

 

OF THE SEQUENCE OF EVENTS – WHICH

 

 

 

 

 

 

 

 

 

 

 

 

2

STRAIGHT GRADE

 

 

 

29

INATTENTIVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

38 PEDESTRIAN

 

 

 

 

 

 

ONE IS THE FIRST HARMFUL EVENT

(1-4)

1

NONE

 

 

 

 

 

 

 

 

 

3

CURVE LEVEL

 

 

1

NON-CONTACT

 

30 FAILURE TO OBEY TRAFFIC SIGNS,

 

 

 

 

 

 

 

 

 

 

 

 

 

EDALCYCLIST

 

 

 

 

 

2

TEST REFUSED

 

 

 

 

 

4

CURVE GRADE

 

 

39 P

 

2

NON-COLLISION

 

 

SIGNALS, OR OFFICER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40 SKATER

 

 

 

MOSTHARMFUL EVENT

 

3

TEST GIVEN, CONTAMINATED

 

 

 

 

 

 

 

 

 

 

 

3

STRIKING

 

31 WRONG SIDE OF THE ROAD

 

 

 

 

 

 

 

 

 

 

 

41 OTHER-NON MOTORIST

 

 

 

SAMPLE/UNUSABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ROADCONDITIONS

 

4

STRUCK

 

32 OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

42 UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

4

TEST GIVEN, RESULTS KNOWN

 

PRIMARY

 

 

 

SECONDARY

 

5

BOTH STRIKING AND STRUCK

33 UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 TEST GIVEN, RESULTS UNKNOWN

 

 

 

 

 

 

 

 

 

 

INEMERGENCYRESPONSE

6

UNKNOWN

 

 

 

 

 

 

 

 

 

A

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLEDEFECT

 

 

OF THE SEQUENCE OF EVENTS – WHICH

ALCOHOL

TEST TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CODEONLYIF‘19’

 

ONE IS THE MOST HARMFUL EVENT (1-4)

 

 

 

 

 

 

 

 

 

 

 

 

 

A

B

 

 

 

SELECTEDABOVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

01 D

 

 

 

 

 

 

 

 

 

 

 

STRIKINGVEHICLE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02 WET

 

 

 

 

 

 

1

NO

 

 

 

 

 

 

 

 

 

SPEED DETECTED

 

 

 

A

 

 

 

 

 

 

B

 

 

 

03 SNOW

 

 

 

 

 

 

OVERRIDE/UNDERRIDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04

ICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

NONE

 

 

 

4

BREATH

 

 

 

 

 

 

 

 

3

UNKNOWN

 

 

 

 

 

 

A

 

 

 

B

 

 

 

 

 

 

 

 

05 SAND, MUD, DIRT, OIL, GRAVEL

 

 

 

 

 

 

 

 

 

 

 

 

 

2

BLOOD

 

 

 

5

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

06 WATER (STANDING, MOVING)

 

 

 

 

 

A

B

 

 

 

 

 

 

 

 

A

B

 

3

URINE

 

 

 

 

 

 

 

 

 

DAMAGESCALE

 

01 T

S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

07 SLUSH

 

 

 

 

 

 

 

 

 

 

 

URN

IGNALS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**

 

 

 

 

 

 

 

 

 

 

02 HEAD LAMPS

 

 

1

STATED

 

 

ALCOHOLTESTRESULT

 

 

08 D

 

 

 

 

 

 

 

 

 

 

1 NO UNDERRIDE OR OVERRIDE

 

 

 

 

 

 

 

 

 

 

 

 

EBRIS

 

 

 

 

 

 

 

 

03

TAIL LAMPS

 

 

 

2

ESTIMATED SPEED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

09

UT

, H

OLES

 

UMPS

NEVEN

 

 

 

 

2

UNDERRIDE, COMPARTMENT

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

R

 

 

, B

, U

 

 

 

 

04

BRAKES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAVEMENT **

 

 

 

A

B

 

INTRUSION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

05 STEERING

 

 

 

 

SPEED

 

 

 

 

 

 

 

 

A

 

 

 

10 OTHER

 

 

 

 

 

 

3

UNDERRIDE, NO COMPARTMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

06 TIRE BLOWOUT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11 UNKNOWN

 

 

 

 

 

 

 

 

INTRUSION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

NONE

 

 

 

07 WORN OR SLICK TIRES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* *SECONDARY ROAD CONDITIONS ONLY

 

4

UNDERRIDE, COMPARTMENT

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

2

NON-FUNCTIONAL DAMAGE

08 TRAILER EQUIPMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTRUSION UNKNOWN

 

A

 

 

 

 

 

 

 

 

 

B

 

 

 

 

 

 

 

 

 

 

 

 

3

FUNCTIONAL DAMAGE

 

 

DEFECTIVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

OVERRIDE, MOTOR VEHICLE IN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ISABLING

AMAGE

09 MOTOR TROUBLE

 

 

 

 

 

 

 

 

 

LOCAL REPORT # *

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

D

 

D

 

TRANSPORT

 

 

ISABLED

F

ROM

P

RIOR

 

 

 

SUPPLEMENT

 

 

 

 

 

 

 

 

 

 

 

 

5

SEVERE

 

6

OVERRIDE, OTHER VEHICLE

10 D

 

 

 

 

B

 

‘X” IF YES *

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

UNKNOWN

 

 

CRASH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11 OTHER DEFECTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOP COPY - ODPS BOTTOM COPY - AGENCY

Narrative

MANNEROFCOLLISIONORIMPACT

SCHOOLBUSRELATED

Diagram

Writean“N”

 

 

 

 

 

 

 

onthecompass

 

 

 

 

 

 

 

diagramtoindicate

 

 

 

 

 

 

 

thedirectionof

 

 

 

 

1

NO

 

north.

1

 

NOT COLLISION BETWEEN

 

 

 

 

TWO VEHICLES IN TRANSPORT

2

YES, DIRECTLY INVOLVED

 

 

2

 

REAR-END

3

YES, INDIRECTLY INVOLVED

 

 

3

 

HEAD-ON

 

4

UNKNOWN

 

 

4

REAR-TO-REAR

WORKZONERELATED

 

 

5

 

BACKING

 

 

 

 

 

 

 

 

 

6

 

ANGLE

 

 

 

 

 

7 SIDESWIPE, SAME DIRECTION

 

 

 

 

8 SIDESWIPE, OPPOSITE DIRECTION

 

 

 

 

9

 

UNKNOWN

1

NO

 

 

 

 

 

 

 

 

 

 

 

 

2

YES

 

 

WEATHER

 

3

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

TYPEOFWORKZONE

 

 

01 CLEAR

 

 

 

 

 

02 CLOUDY

 

1

LANE CLOSURE

 

 

03

FOG, SMOG, SMOKE

2

LANE SHIFT/CROSSOVER

 

 

04 RAIN

 

3

WORK ON SHOULDER OR MEDIAN

 

 

05

SLEET, HAIL (FREEZING RAIN DRIZZLE)

4

INTERMITTENT/ MOVING WORK

 

 

06 SNOW

 

5

OTHER

 

 

07 SEVERE CROSSWINDS

LOCATIONOFCRASH IN

 

 

08

BLOWING SAND,SOIL, DIRT,SNOW

 

 

WORKZONE

 

 

09 OTHER

 

 

 

 

 

10 UNKNOWN

 

 

 

 

LIGHTCONDITIONS

 

 

 

 

PRIMARY

SECONDARY

1

BEFORE FIRST WORK ZONE

 

 

 

 

 

 

 

 

 

 

 

 

 

WARNING SIGN

 

 

 

 

 

 

2

ADVANCE WARNING AREA

 

 

1

 

DAYLIGHT

 

3

TRANSITION AREA

 

 

 

 

4

ACTIVITY AREA

 

 

2

 

DAWN

 

 

 

 

 

 

 

 

 

3

 

DUSK

 

WORKERSPRESENT

 

 

4

 

DARK – LIGHTED ROADWAY

 

 

 

 

5

 

DARK –NOT LIGHTED

 

 

 

 

6

 

DARK – UNKNOWN LIGHTING

 

 

 

 

7

 

GLARE

 

 

 

 

 

8

 

OTHER

 

1

NO

 

 

9

 

UNKNOWN

2

YES

 

 

 

 

 

 

3

UNKNOWN

 

 

 

Truck/Bus

THE CRASH INVOLVED ONE OR MORE OF THE FOLLOWING:

A THE CRASH RESULTED IN ONE OR MORE OF THE FOLLOWING:

 

 

A TRUCK (MOTOR VEHICLE) WITH A GVWR MORE THAN 10,000 POUNDS; OR

N

A FATALITY; OR

 

 

 

 

A TRUCK (MOTOR VEHICLE) WITH A HAZARDOUS MATERIALS PLACARD; OR

AN INJURY REQUIRING TRANSPORTATION FOR IMMEDIATE MEDICAL TREATMENT; OR

 

 

 

 

D

 

UNIT #

A BUS DESIGNED FOR AT LEAST 8 PERSONS, INCLUDING DRIVER .

AT LEAST ONE VEHICLE WAS TOWED DUE TO DISABLING DAMAGE OR REQUIRED INTERVENING ASSISTANCE BEFORE PROCEEDING UNDER ITS OWN POWER.

 

 

 

 

 

 

 

 

 

COMPANY (FROM SHIPPING PAPERS)

 

 

COMPANY PHONE

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (STREET, CITY, ST, ZIP CODE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

US DOT

 

 

 

 

 

 

ICC MC

 

 

PUCO

 

 

TRAILER LP ST.

TRAILER LP YEAR

TRAILER LP #

 

PLACARD #

# DIA.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CARGOBODYTYPE01

 

 

 

 

 

 

 

 

 

 

 

 

 

Weight (GVWR)

CDLClass

 

 

Hazardous

 

Hazardous

 

NOT APPLICABLE

 

05

POLE

09

CONCRETE MIXER

 

1

CLASS A

MaterialsPlacard

 

 

 

MaterialReleased

02

BUS (9-15 INCLUDING DRIVER)

06

CARGO TANK

10

UTO

T

RANSPORTER

1

LESS/EQUAL 10,000

2

CLASS B

1

NO

1

NO

A

 

2

10,001 - 26,000

03

V

AN

/E

NCLOSED

B

OX

07

LATBED

11

ARBAGE EFUSE

3

LASS

C

2

YES

2

YES

 

 

 

 

F

G

 

/R

 

 

 

C

04

G

RAIN

/C

HIPS RAVEL

08

UMP

12

THER

 

3

MORE THAN 26,000

4

CLASS M

3

UNKNOWN

3

NOT APPLICABLE

 

 

/G

 

 

D

O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13

UNKNOWN

 

 

 

5

CLASS D

 

 

4

UNKNOWN

Police Action

DATE CRASH REPORTED

TIME REC CALL

OFFICERS NAME *

DISPATCH

BADGE # *

ARRIVEDCLEAREDOTHERTOTAL MINUTES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHECKED BY

 

DATE REPORT FILED

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REPORTTAKENBY

1 POLICE AGENCY

REPORTTAKEN AT

1 SCENE

 

 

LOCAL REPORT #

*

SUPPLEMENT

*

 

 

2 MOTORIST

 

 

 

2 STATION

‘X” IF YES

 

 

 

 

 

 

 

 

 

 

3 OTHER

 

 

 

 

 

 

 

TOP COPY - ODPS

BOTTOM COPY - AGENCY

 

 

 

Document Properties

Fact Name Description
Form Identifier The Ohio Traffic Crash Report form is designated as OH-1, revised in October 1999.
Governing Law This form is governed by Ohio Revised Code Section 5502.11, which mandates reporting of traffic crashes.
Crash Severity Options Reportable crash severity options include fatal, injury, and property damage only (PDO).
Data Collection The form collects crucial data such as time of crash, location, and involved parties' information.
Witness Information Witness details can be included, enhancing the report's comprehensiveness and reliability.

Documents used along the form

The Ohio Traffic Crash Report form is essential for documenting incidents on the road. However, several other forms and documents are often used in conjunction with this report to provide a comprehensive overview of the crash. Below is a list of commonly associated documents.

  • Incident Report: This document provides detailed information about the circumstances surrounding the crash, including witness statements and police observations. It serves as a supplementary record to the Traffic Crash Report.
  • Insurance Claim Form: Following a traffic accident, this form is necessary for filing claims with insurance companies. It outlines the details of the crash and the damages incurred, facilitating the claims process.
  • Medical Records: If there are injuries resulting from the crash, medical records will document the treatment received. These records are crucial for any personal injury claims and for establishing the extent of injuries sustained.
  • Witness Statements: These are written accounts from individuals who witnessed the crash. They can provide valuable insights and corroborate details in the Traffic Crash Report, helping to clarify the events that transpired.

Collecting and maintaining these documents is vital for ensuring a thorough understanding of the traffic incident. Proper documentation can significantly impact insurance claims and legal proceedings.

Guidelines on Filling in Ohio Traffic Crash Report

Filling out the Ohio Traffic Crash Report form is a critical step following a traffic incident. Accurate and timely completion of this form can aid in investigations and insurance claims. Ensure all sections are filled out completely and correctly to avoid delays in processing.

  1. Obtain the Form: Access the Ohio Traffic Crash Report form online or request a physical copy from your local law enforcement agency.
  2. Fill in Local Report Number: Enter the local report number in the designated field at the top of the form.
  3. Indicate Crash Severity: Select the appropriate severity level of the crash: fatal, injury, property damage only, etc.
  4. Provide Time and Date of Crash: Record the exact time and date when the crash occurred.
  5. Specify the Day of the Week: Indicate which day of the week the crash took place.
  6. Identify the Reporting Agency: Write down the name of the agency that is handling the report.
  7. Detail Crash Location: Fill in the crash location, including city, village, or township, and any reference points if applicable.
  8. List Involved Vehicles: For each vehicle, provide details including owner’s name, address, vehicle year, make, model, color, and insurance information.
  9. Document Injuries: Record information about any injured parties, including their names, addresses, and the nature of their injuries.
  10. Describe Circumstances: Fill out the sections regarding pre-crash actions, sequence of events, and contributing circumstances.
  11. Complete Witness Information: If there were witnesses, provide their names and contact details.
  12. Sign and Date the Form: Ensure that the report is signed and dated by the person completing it.

Once the form is completed, it should be submitted to the appropriate law enforcement agency or authority. Keep a copy for your records, as it may be needed for insurance purposes or legal proceedings. Timely submission is essential to ensure that all parties involved can proceed with their claims or investigations without unnecessary delays.

Common mistakes

Filling out the Ohio Traffic Crash Report form can be a daunting task, and mistakes can lead to complications later on. One common error occurs when individuals fail to include all necessary information. For instance, omitting the exact time and date of the crash can create confusion regarding the circumstances surrounding the incident. Every detail counts, and leaving out even a minor piece of information can delay the processing of the report.

Another frequent mistake involves incorrectly identifying the crash location. People may mislabel the type of street or intersection where the accident occurred. Accurate location details are crucial, as they help law enforcement and insurance companies understand the context of the crash. Failing to specify whether it happened on a numbered route or a named street can lead to complications in the investigation.

Many individuals also neglect to provide complete details about all vehicles involved in the crash. This includes not only the make and model but also the license plate numbers and insurance information. Incomplete vehicle information can hinder the ability to resolve claims and determine liability. It's essential to ensure that every vehicle involved is fully documented.

In addition, people often overlook the importance of documenting injuries accurately. Misreporting the severity of injuries or failing to mention all injured parties can lead to disputes later on. It is vital to be thorough in this section, as it may affect insurance claims and legal proceedings.

Another common error is failing to note witness information. Witnesses can provide valuable insights into the events leading up to the crash. Not recording their names and contact details can result in lost opportunities to gather additional evidence that may support one’s case.

Additionally, some individuals mistakenly assume that all required fields are optional. Every section of the form is important, and skipping questions can lead to delays or issues in processing the report. It is best practice to fill out every applicable field to ensure a comprehensive report.

Moreover, individuals sometimes misinterpret the definitions of various terms on the form. For example, understanding the difference between “hit and skip” and “not hit” is crucial. Misunderstanding these terms can lead to incorrect selections, which may affect the investigation's outcome.

Finally, people often forget to review their completed forms for accuracy before submission. Simple typographical errors or incorrect information can significantly impact the report's validity. Taking a moment to double-check all entries can save time and prevent potential complications down the line.

FAQ

  1. What is the purpose of the Ohio Traffic Crash Report form?

    The Ohio Traffic Crash Report form is used to document details surrounding a traffic accident that occurs within the state. This report captures essential information such as the time and location of the crash, involved parties, vehicle details, and any injuries sustained. It serves as an official record that can be referenced by law enforcement, insurance companies, and other parties involved in the accident.

  2. Who is required to fill out the Ohio Traffic Crash Report?

    Typically, law enforcement officers are responsible for completing the Ohio Traffic Crash Report when they respond to an accident. However, if no officer is present, involved parties may need to fill out the report themselves. It is crucial to ensure that all relevant information is accurately recorded to facilitate any subsequent investigations or insurance claims.

  3. What information do I need to provide on the form?

    When filling out the Ohio Traffic Crash Report, you will need to provide various details, including:

    • The date and time of the crash.
    • The location of the incident, including street names and any relevant landmarks.
    • Information about all vehicles involved, such as make, model, and license plate numbers.
    • Details about the drivers and passengers, including names, addresses, and any injuries sustained.
    • Witness information, if available.

    Completing this information accurately is vital for processing claims and determining fault.

  4. What should I do if I need to make corrections to the report?

    If you notice any errors on the Ohio Traffic Crash Report after it has been submitted, it is important to act quickly. Contact the reporting agency or the law enforcement office that handled the report. They can guide you through the process of making corrections, which may involve submitting a supplemental report or amendment to the original document.

  5. How can I obtain a copy of the Ohio Traffic Crash Report?

    To obtain a copy of the Ohio Traffic Crash Report, you can typically request it through the law enforcement agency that completed the report. Many agencies offer online access to reports, while others may require you to visit in person or submit a written request. Be prepared to provide details such as the date of the accident and the names of those involved to facilitate the retrieval process.