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It captures vehicle and district driver information such as identification numbers, license data, speed at impact, vehicle damage status, passenger counts, towing details, and primary cause codes for both district and claimant vehicles. It also records claimant information, injury codes, injury conditions, collision insurance and deductible, and additional claimant entries to support accurate documentation and follow-up.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/motor-vehicle-accident-report-form/252886/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/motor-vehicle-accident-report-form/252886.png","ImageObject",442,249,{"name":88,"@type":89},"Maeve","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-27","2026-09-13",true,{"@type":98,"interactionType":99,"userInteractionCount":15},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What key incident details are required on the form?","Question",{"text":108,"@type":109},"The form requires date and time of accident, location, accident type, traffic conditions and controls, road surface and condition, road type, light conditions, and weather. These are selected using checkboxes and coded options.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How are the primary causes of the accident recorded?",{"text":113,"@type":109},"The form includes a “PRIMARY CAUSE OF ACCIDENT” section where users insert one code for the district vehicle and one code for the claimant vehicle. Codes cover items like speed, signal problems, defective brakes, officer controls, and driver inattention.",{"name":115,"@type":106,"acceptedAnswer":116},"What information is collected about injuries and vehicles?",{"text":117,"@type":109},"Injury sections require selecting injury codes for the claimant and selecting the claimant condition (e.g., fatigued, ill, physical defect, asleep, ability impaired). Vehicle damage status, speed at impact, skid mark details, and vehicle type are also recorded, along with passenger counts.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},252886,1789263304,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":15,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":9},5909877438554,"https://ap-avatar.wpscdn.com/avatar/5600025385ad2bf12a7?_k=1778553567797529272","Motor Vehicle Accident Report Form  \n\n| PHONE \\# | AGENCY CONTACT INFORMATION | AGENCY |\n| --- | --- | --- |\n\n\n| DATE OF ACCIDENT | TIME OF ACCIDENT AM:\u003Cbr>PM: | LOCATION ACCIDENT OCCURED:  NE  NW\u003Cbr> SE  SW\u003Cbr>  ft of  \u003Cbr>Street Street | STATE |\n| --- | --- | --- | --- |\n\n\n| TYPE OF ACCIDENT (check one )\u003Cbr>  00 Collision of vehicles   01 Collision with fixed object   02 On board school bus   03 Boarding/Alighting\u003Cbr>  04 Pedestrian\u003Cbr>__ 05 Fatality | TRAFFIC CONDITIONS (check one)\u003Cbr>  00 Unknown\u003Cbr>  01 Heavy\u003Cbr>  02 Medium\u003Cbr>  03 Light | TRAFFIC CONTROLS\u003Cbr>(check one)\u003Cbr>  00 Unknown   05 Flashing Light   01 Yield Sign   06 Stop Sign\u003Cbr>  02 Signal   07 None\u003Cbr>  03 Officer   08 Other  \u003Cbr>  04 Turn Restricted | ROAD SURFACE (check one)\u003Cbr>  00 Unknown\u003Cbr>  01 Concrete\u003Cbr>  02 Asphalt\u003Cbr>  03 Light\u003Cbr>  04 Gravel\u003Cbr>  05 Dirt 06 Other | ROAD CONDITION (check one)   01 Unknown\u003Cbr>__ 02 Repairing\u003Cbr>  03 Dry\u003Cbr>  04 Wet\u003Cbr>  05 Ice |\n| --- | --- | --- | --- | --- |\n\n\n| ROAD TYPE\u003Cbr>(check one )\u003Cbr>  00 Straight   05 Underpass\u003Cbr>  01 Curve   06 Ramp\u003Cbr>  02 Level   07 Bridge\u003Cbr>  03 Grade   08 Divided\u003Cbr>  04 Crest | LIGHT CONDITIONS (check one )\u003Cbr>  00 Unknown\u003Cbr>  01 Dawn/Dusk\u003Cbr>  02 Dark\u003Cbr>  03 Daylight | STREET LIGHTS (check one )\u003Cbr>  00 Unknown\u003Cbr>  01 Defective street light(s)__ 02 No street light(s)   03 Street light(s) on\u003Cbr>  04 Street light(s) off | WEATHER (check ALL that apply )\u003Cbr>  00 Unknown   03 Rain\u003Cbr>  01 Fog/Midst   04 Snow\u003Cbr>  02 Clear   05 Sleet |\n| --- | --- | --- | --- |\n| Total \\# of Vehicles Involved:   |  |  |  |\n\n\n| District Driver & Vehicle Information\u003Cbr>District Vehicle No.   \\# of Passengers in District Vehicle:   \\# of Passengers Injured in District Vehicle:  \u003Cbr>District Operator (Last Name, First Name, M.I.) Age Sex Full or Part-time (FT or PT) Driver Injured: Yes or No\u003Cbr>\u003Cbr>Drivers License \\#   License State:   Home Phone \\#: ( )   -   Cell Phone \\#: ( )   -  \u003Cbr>\u003Cbr>Vehicle Model/Year Make Body Style Tag \\#/State/Year Vehicle Color Vehicle Damaged: Yes or No |  |\n| --- | --- |\n| Speed at time of Impact:   mph Skid Mark Details:  \u003Cbr>\u003Cbr>Vehicle Driven Away: Yes or No Vehicle left at scene: Yes or No If towed, to where:   |  |\n| DRIVER CONDITION\u003Cbr>(check ALL that apply)\u003Cbr>  00 Fatigued\u003Cbr>  01 Ill\u003Cbr>  02 Physical defect\u003Cbr>  03 Asleep\u003Cbr>  04 Normal\u003Cbr>  05 Unknown\u003Cbr>  06 Ability Impaired\u003Cbr>  07 Ability not impaired | PRIMARY CAUSE OF ACCIDENT:\u003Cbr>Insert ONE code from below for DISTRICT vehicle here:  Insert ONE code from below for CLAIMANT vehicle here: \u003Cbr>  00 Speed   08 Flashing light   16 Other Defects   22 Defective light(s)\u003Cbr>  01 Defective brakes   09 Directional light   17 Pedestrian Violation   23 Pedestrian drunk\u003Cbr>  02 Signal   10 Stop Sign   18 Driver inattention   24 Road defects\u003Cbr>  03 Auto right of way   11 Alcohol influence   19 Cell Phone   25 Driver vision obstructed\u003Cbr>  04 Pedestrian right of way   12 Improper lane change   20 Failure to set parking brake   26 Other:  \u003Cbr>  05 Improper Turn   13 One way street-wrong way   21 Opened door in traffic  \u003Cbr>  06 Yield Sign   14 Wrong side of street   22 Drug influence  \u003Cbr>  07 Stop/Go light   15 Improper starting   23 Backing   |\n\n\n| Claimant Information\u003Cbr>Claimant (Last Name, First Name, M.I.) Age Sex Estimated Damage\u003Cbr>       $  \u003Cbr>Home Address Business Address\u003Cbr>Drivers License \\#/State   Home Phone \\#: ( )   -   Alternate Phone \\#: ( )   -   |\n| --- |\n| Vehicle Model/Year:   Tag \\#/State/Year:   Make:   Vehicle Color:  \u003Cbr>Body Style:  \u003Cbr>\\# of Passengers in Claimant Vehicle:   \\# of Passengers Injured in Claimant Vehicle:  \u003Cbr>Do you have Collision Insurance?   Yes  No Amount of Deductible $  |\n| Vehicle Damaged: Yes or No Speed at time of Impact:   mph Skid Mark Details:  \u003Cbr>Was vehicle driven away? Yes or No Was vehicle left at the scene? Yes or No If towed, to where:  \u003Cbr>Tow Co. Info.   |\n| INJURY CODE (check ALL that apply) CLAIMANT CONDITION (check one)\u003Cbr>  00 Fatal   01 Disabling   02 ","cbCaipfJnJmdRZeD","https://ap.wps.com/l/cbCaipfJnJmdRZeD","pdf",39724,"English","# Incident Overview\n## Accident Classification and Conditions\n# Driver and Vehicle Information\n## District Driver & Vehicle Details\n## Claimant Information and Insurance\n# Injury and Vehicle Damage Reporting\n## Injury Codes and Claimant Condition\n## Vehicle Type and Actions","[{\"question\":\"What key incident details are required on the form?\",\"answer\":\"The form requires date and time of accident, location, accident type, traffic conditions and controls, road surface and condition, road type, light conditions, and weather. These are selected using checkboxes and coded options.\"},{\"question\":\"How are the primary causes of the accident recorded?\",\"answer\":\"The form includes a “PRIMARY CAUSE OF ACCIDENT” section where users insert one code for the district vehicle and one code for the claimant vehicle. Codes cover items like speed, signal problems, defective brakes, officer controls, and driver inattention.\"},{\"question\":\"What information is collected about injuries and vehicles?\",\"answer\":\"Injury sections require selecting injury codes for the claimant and selecting the claimant condition (e.g., fatigued, ill, physical defect, asleep, ability impaired). Vehicle damage status, speed at impact, skid mark details, and vehicle type are also recorded, along with passenger counts.\"}]","Motor Vehicle Accident Report Form | PDF"]