Homepage Free Minnesota Accident Report PDF Template
Outline

When an accident happens on Minnesota's roads, ensuring that the details are correctly documented is crucial for everyone involved. The Minnesota Motor Vehicle Accident Report form PS 32001 - 08 serves an important role in this process. As a vital tool designed to help improve roadway safety, the form is a mandatory requirement for drivers involved in accidents resulting in property damage of $1,000 or more, or in cases of injury or death. It must be completed and sent to the Driver and Vehicle Services within ten days from the accident. Neglecting to submit this form can lead to misdemeanor charges under Minnesota Statute 169.09, subdivision 7. The report not only aids in the collection of statistical data to support the development of safer roads but also includes sections for detailed information about the accident, like the location, date, time, and details of the vehicles and persons involved. Furthermore, it features a part where drivers can describe the accident in detail and diagram what happened, allowing for a better understanding of the event. The form also provides a way for drivers to include information about their insurance, ensuring that liability information is clear. Importantly, the collected information might be disclosed to involved parties or others as specified by law, although it cannot be used against the person submitting the report in court. This aspect underscores the Minnesota Data Privacy Act's influence on the report's design, aimed at protecting individuals' privacy while facilitating a comprehensive database for enhancing road safety.

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MINNESOTA MOTOR VEHICLE ACCIDENT REPORT

PS 32001 - 08

The information on this report is used to help build safer roads.

Every driver in a crash involving $1,000 or more in property damage, or injury or death, MUST COMPLETE this form and send it to Driver and Vehicle Services within 10 days.

Failure to provide this information is a misdemeanor under Minnesota Statute 169.09, subdivision 7. See reverse side for address and for data privacy information.

A

B

C

DRIVER’S TRAFFIC ACCIDENT REPORT

E-form available at www.mndriveinfo.org

 

 

 

DO NOT DETACH

 

 

DATE OF

MONTH

DAY

YEAR

DAY OF WEEK

TIME

 

 

TOTAL # OF

 

COUNTY

 

 

NAME OF CITY OR TOWNSHIP

 

 

 

 

T

 

ACCIDENT

 

 

 

 

 

 

 

 

 

 

AM

VEHICLES

 

 

 

 

 

CITY

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

PM

INVOLVED

 

 

 

 

 

TWP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

ACCIDENT OCCURRED

LOCATION OF ACCIDENT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

(Choose only one box below

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and proceed to the right)

ON:

 

 

 

 

 

 

 

 

 

 

 

 

 

AT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AT INTERSECTION

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P

 

 

 

 

 

LOCATION OF ACCIDENT:

 

 

 

 

DISTANCE

 

 

DIRECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MILES

N

E

 

 

 

 

 

 

 

A

 

 

NOT AT INTERSECTION

ON:

 

 

 

 

 

 

 

 

 

 

FEET

S

W FROM:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

(Number)

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

IN PARKING LOT

DESCRIBE LOCATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D DRIVER’S FULL NAME

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

INJURY

M

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CODE*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LICENSE NUMBER

 

 

 

 

 

 

 

 

CLASS

 

 

STATE OF ISSUE

 

DATE OF BIRTH

 

SEX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VE

E R

H

V

 

OWNER’S FULL NAME

 

 

ADDRESS

 

CITY

 

STATE

ZIP CODE

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

E

 

 

 

 

 

 

 

 

 

 

 

 

H

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE PLATE NUMBER

YEAR

STATE OF ISSUE

PARTS OF VEHICLE DAMAGED

 

 

 

ESTIMATE COST TO REPAIR

E

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

$

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE (CAR, PICKUP, VAN, SUV, MOTORCYCLE, TRUCK, ETC.)

MAKE

 

MODEL

YEAR

 

COLOR

 

# OF OCCUPANTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IGIVE FULL LIABILITY INSURANCE INFORMATION OR IT WILL BE ASSUMED YOU DID NOT HAVE INSURANCE

N

SPLEASE NAME OF INSURANCE COMPANY (NOT AGENCY)

 

 

U

COPY

Automobile Insurance

 

 

 

 

 

 

 

 

 

 

 

 

MONTH

 

DAY

 

YEAR

 

 

 

MONTH

 

DAY

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

Policy Period: from

 

 

 

 

 

 

 

 

to

 

 

 

 

 

 

 

 

 

 

A

POLICY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

Name of Policy Holder

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Signature X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

OTHER

FULL NAME

 

 

 

ADDRESS

 

 

 

 

 

CITY

 

 

 

 

STATE

ZIP CODE

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CODE*

O

 

R

DRIVER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

DRIVER’S LICENSE NUMBER

 

 

 

 

 

 

CLASS

 

STATE OF ISSUE

 

 

 

DATE OF BIRTH

 

 

 

 

SEX

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

V

OTHER FULL NAME

 

 

 

ADDRESS

 

 

 

 

 

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

HE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

OWNER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE PLATE NUMBER

 

YEAR

STATE OF ISSUE

 

PARTS OF VEHICLE DAMAGED

 

 

 

 

 

 

 

 

ESTIMATE COST TO REPAIR

I

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

C

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE (CAR, PICKUP, VAN, SUV, MOTORCYCLE, TRUCK, ETC.)

MAKE

 

 

MODEL

 

 

 

 

YEAR

 

 

COLOR

 

 

# OF OCCUPANTS

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF MORE THAN TWO VEHICLES - FILL IN SECTION “C” ON SEPARATE FORM AND ATTACH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*SEE CODES ON REVERSE SIDE*

ENTER NUMBER FOR CORRECT RESPONSE IN EACH BOX BELOW

 

 

 

 

TYPE ACCIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLLISION WITH A(N)

 

 

 

 

COLLISION WITH FIXED OBJECT

 

 

 

NON-COLLISION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- MOTOR VEHICLE

 

 

8- DEER

 

21- CONSTRUCTION EQUIPMENT

29- HYDRANT

 

37- EMBANKMENT/DITCH/CURB

51- OVERTURN/ROLLOVER

 

 

 

 

2- PARKED MOTOR VEHICLE

 

9- OTHER ANIMAL

 

22- TRAFFIC SIGNAL

30- TREE/SHRUBBERY

 

38- BUILDING/WALL

52- SUBMERSION

 

 

 

 

3- ROADWAY EQUIPMENT - SNOWPLOW

 

 

 

23- RR CROSSING DEVICE

31- BRIDGE PIERS

 

39- ROCK OUTCROPS

53- FIRE/EXPLOSION

 

 

 

 

4- ROADWAY EQUIPMENT - OTHER

 

12- COLLISION WITH OTHER

 

24- LIGHT POLE

 

32- MEDIAN SAFETY BARRIER

40- PARKING METER

54- JACKKNIFE

 

 

 

 

5- TRAIN

 

 

TYPE OF NON-FIXED OBJECT

 

25- UTILITY POLE

33- CRASH CUSHION

 

41- OTHER FIXED OBJECT

55- LOSS/SPILLAGE NON-HAZ MAT

 

 

 

 

6- PEDALCYCLE, BIKE, ETC.

 

13- OTHER COLLISION TYPE

 

26- SIGN STRUCTURE

34- GUARDRAIL

 

42- UNKNOWN FIXED OBJECT

56- LOSS/SPILLAGE HAZ MAT

 

 

 

 

7- PEDESTRIAN

 

 

 

 

27- MAILBOXES

 

35- FENCE (NON-MEDIAN BARRIER)

 

64- NON-COLLISION OF OTHER TYPE

 

 

 

 

 

 

 

 

 

28- OTHER POLES

36- CULVERT/HEADWALL

 

65- NON-COLLISION OF UNKNOWN TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WORK ZONE (CIRCLE CORRECT RESPONSE)

 

 

 

 

SPEED LIMIT ENTER POSTED SPEED LIMIT ( NOT YOUR TRAVEL SPEED)

 

YES

NO

 

 

 

 

 

 

 

 

DID THE CRASH OCCUR IN A WORK ZONE?

 

 

 

 

 

 

 

 

 

YES

NO

IF YES, WERE WORKERS PRESENT?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEATHER / ATMOSPHERE

5- SLEET/HAIL/FREEZING RAIN

8- SEVERE CROSSWINDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- CLEAR

3- RAIN

6- FOG/SMOG/SMOKE

90- OTHER

 

 

 

 

ROAD SURFACE

 

 

 

 

 

 

2- CLOUDY

4- SNOW

7- BLOWING SAND/DUST/SNOW

 

 

 

 

 

1- DRY

3- SNOW

5- ICE PACKED SNOW

7- MUDDY

9- OILY

 

 

 

 

 

 

 

 

2- WET

4-SLUSH

6- WATER (STANDING/MOVING)

8- DEBRIS

90- OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIGHT CONDITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- DAY LIGHT

 

4- DARK (STREET LIGHTS ON)

7- DARK (UNKNOWN LIGHTING)

 

 

 

 

TRAFFIC CONTROL DEVICE

 

 

 

 

 

2- BEFORE SUNRISE (DAWN)

5- DARK (STREET LIGHTS OFF)

90- OTHER

 

 

 

 

1- TRAFFIC SIGNAL

 

 

7- SCHOOL BUS STOP ARM

 

13- RR OVERHEAD FLASHERS

3- AFTER SUNSET (DUSK)

6- DARK (NO STREET LIGHTS)

 

 

 

 

 

2- OVERHEAD FLASHERS

 

8- SCHOOL ZONE SIGN

 

14- RR OVERHEAD FLASHERS/GATE

 

 

 

 

 

 

 

 

3- STOP SIGN - ALL APPROACHES

 

9- NO PASSING ZONE

 

15- RR SIGN ONLY

 

 

 

 

 

 

 

 

 

4- STOP SIGN - NOT ALL APPROACHES

 

10- RR CROSSING GATE

 

(NO LIGHTS, GATES OR STOP SIGN)

MANNER OF COLLISION

4- RAN OFF ROAD - LEFT SIDE

8- HEAD ON

 

 

 

 

5- YIELD SIGN

 

 

11- RR CROSSING -FLASHING LIGHTS

 

1- REAR END

 

5- RIGHT ANGLE (”T-BONE”)

9- SIDE SWIPE - OPPOSING DIRECTION

 

 

 

 

 

 

 

 

 

 

 

 

6- OFFICER/FLAG PERSON/SCHOOL PATROL

12- RR CROSSING - STOP SIGN

 

90- OTHER

 

2- SIDESWIPE - SAME DIRECTION

6- RIGHT TURN

90- OTHER

 

 

 

 

 

 

 

 

 

98- NOT APPLICABLE

3- LEFT TURN

 

7- RAN OFF ROAD - RIGHT SIDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MY

VEHICLE

OTHER

VEHICLE

ACTIONS / MANEUVERS PRIOR TO ACCIDENT

BY VEHICLE

PARKED VEHICLES

1- GOING STRAIGHT AHEAD

21- PARKED LEGALLY

FOLLOWING ROADWAY

22- PARKED ILLEGALLY

2- WRONG WAY INTO

23- VEHICLE STOPPED

OPPOSING TRAFFIC

OFF ROADWAY

3- RIGHT TURN ON RED

 

4- LEFT TURN ON RED

 

5- MAKING RIGHT TURN

 

6- MAKING LEFT TURN

 

7- MAKING U-TURN

 

8- STARTING FROM PARKED POSITION

 

9- STARTING IN TRAFFIC

 

10- SLOWING IN TRAFFIC

 

11- STOPPED IN TRAFFIC

 

12- ENTERING PARKED POSITION

 

13- AVOID UNIT/OBJECT IN ROAD

 

14- CHANGING LANES

 

15- OVERTAKING/PASSING

 

16- MERGING

 

17- BACKING

 

18- STALLED ON ROADWAY

 

 

 

 

 

 

 

 

 

 

DIRECTION OF TRAVEL PRIOR TO ACCIDENT

BY PEDESTRIAN

 

 

 

 

BY BICYCLIST

1- NORTHBOUND

 

 

 

 

 

 

 

31- CROSSING WITH SIGNAL

 

40- WALKING/RUNNING IN ROAD

51- RIDING WITH TRAFFIC

2- NORTH EASTBOUND

 

 

 

 

 

 

 

32- CROSSING AGAINST SIGNAL

 

AGAINST TRAFFIC

 

52- RIDING AGAINST TRAFFIC

3- EASTBOUND

 

 

 

 

 

 

 

33- DARTING INTO TRAFFIC

 

41- STANDING/LYING IN ROAD

53- MAKING RIGHT TURN

4- SOUTH EASTBOUND

 

 

 

 

 

 

 

34- OTHER IMPROPER CROSSING

 

42- EMERGING FROM BEHIND

54- MAKING LEFT TURN

5- SOUTHBOUND

 

 

 

 

 

 

 

35- CROSSING IN A MARKED CROSSWALK

PARKED VEHICLE

 

55- MAKING U-TURN

6- SOUTH WESTBOUND

 

 

 

 

 

 

 

36- CROSSING (NO SIGNAL OR CROSSWALK)

43- CHILD GETTING ON/OFF SCHOOL BUS

56- RIDING ACROSS ROAD

7- WESTBOUND

 

 

N

 

 

 

37- FAIL TO YIELD RIGHT OF WAY TO TRAFFIC

44- PERSON GETTING ON/OFF VEHICLE

57- SLOWING/STOPPING/STARTING

8- NORTH WESTBOUND

 

 

 

 

 

38- INATTENTION/DISTRACTION

 

45- PUSHING/WORKING ON VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

8

1

2

 

 

39- WALKING/RUNNING IN ROAD WITH TRAFFIC

46- WORKING IN ROADWAY

90- OTHER

 

 

 

 

 

 

 

 

W

 

7

 

 

3

 

E

 

 

 

47- PLAYING IN ROADWAY

 

 

 

 

 

 

 

 

 

6

 

 

4

 

 

 

 

48- NOT IN ROADWAY

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

 

 

 

 

 

CONTINUE

 

WAS THERE A POLICE

 

IF YES, WHAT DEPARTMENT (NAME OF CITY, COUNTY OR STATE PATROL)

 

 

 

 

 

 

 

OFFICER AT THE

 

 

 

 

 

 

 

 

 

 

 

REPORT ON

 

 

 

 

 

 

 

 

 

 

 

 

 

SCENE?

 

 

 

 

 

 

 

 

 

 

 

 

OTHER SIDE

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

MY

VEHICLE

OTHER

As required by Minnesota Data Privacy Act you are hereby informed that the information requested on this form is collected pursuant to statute to provide statistical data on traffic accidents. The time and place of the accident, names of parties involved and insurance information may be disclosed to any person involved in the accident or to others persons as specified by law. This written report cannot be used against you as evidence in any civil or criminal matter and your version of how the accident happened is confidential.

SEAT

TYPE

USE

AIR BAG

EJECT

INJURY

OCCUPANT SEAT POSITION CODES

SAFETY EQUIPMENT TYPE

RESTRAINT DEVICE USED

SAFETY EQUIPMENT USED

EJECTION CODES

INJURY CODES

 

CODES

CODES

CODES

 

 

1- DRIVER

 

 

 

1- TRAPPED, EXTRICATED

K- KILLED

(INCLUDE MOTORCYCLE DRIVER)

1- NO SAFETY EQUIP IN PLACE

1- BELTS NOT USED

1- DEPLOYED-FRONT

(BY MECHANICAL MEANS)

A- INCAPACITATING INJURY

2- FRONT CENTER

 

2- LAP BELT ONLY USED

2- DEPLOYED-SIDE

2- TRAPPED, FREED BY

B- NON-INCAPACITATING INJURY

3- FRONT RIGHT

2- LAP BELT

3- SHOULDER BELT ONLY USED

3- DEPLOYED-FRONT AND SIDE

NON-MECHANICAL MEANS

C- POSSIBLE INJURY

4- SECOND ROW SEAT LEFT

3- SHOULDER BELT

4- LAP AND SHOULDER BELT USED

4- NOT DEPLOYED-SWITCH ON

3- PARTIALLY EJECTED

N- NO APPARENT INJURY

5- SECOND ROW SEAT CENTER

4- LAP & SHOULDER BELT

 

5- NOT DEPLOYED-SWITCH OFF

4- EJECTED

 

6- SECOND ROW SEAT RIGHT

5- CHILD SAFETY SEAT

5- CHILD SEAT NOT USED

6- NOT DEPLOYED- UNKNOWN

 

 

7- THIRD ROW SEAT LEFT

6- CHILD BOOSTER SEAT

6- CHILD SEAT USED IMPROPERLY

IF SWITCH ON OR OFF

5- NOT EJECTED OR TRAPPED

 

8- THIRD ROW SEAT CENTER

 

7- CHILD SEAT USED PROPERLY

 

 

 

9- THIRD ROW SEAT RIGHT

98- NOT APPLICABLE

8- BOOSTER SEAT NOT USED

90- OTHER DEPLOYMENTS

 

 

10- OUTSIDE OF VEHICLE

(MOTORCYCLE,

9- BOOSTER SEAT USED IMPROPERLY

98- NOT APPLICABLE

 

 

11- TRAILING UNIT

SNOWMOBILE, ECT.)

10- BOOSTER SEAT USED PROPERLY

(MOTORCYCLE,

 

 

12- PICKUP TRUCK BED

 

 

SNOWMOBILE, ECT.)

 

 

13- TRUCK CAB SLEEPER SECTION

 

11- HELMET NOT USED

 

 

 

14- PASSENGER IN OTHER POSITION

 

12- HELMET USED

 

 

 

(INCLUDE MOTORCYCLE PASSENGER)

 

 

 

 

 

15- PASSENGER IN UNKNOWN POSITION

 

 

 

 

 

16- FRONT LEFT (NON-DRIVER)

 

 

 

 

 

MY VEHICLE: DRIVER AND PASSENGERS INFORMATION:

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER >>>>>>>>>>>>>>>>>>

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE ACCIDENT IN SUFFICIENT DETAIL BELOW TO DISCLOSE CAUSES.

 

 

 

 

 

 

INDICATE

 

 

 

 

 

 

 

NORTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE WHAT HAPPENED:

 

 

DIAGRAM WHAT HAPPENED:

 

 

 

 

 

BY ARROW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAMAGE TO PROPERTY OTHER THAN VEHICLES: (MAILBOX, FENCE, SIGNPOST, GUARDRAIL, ETC.)

DESCRIBE

NAME OF

PROPERTY

PROPERTY

DAMAGED:

OWNER:

 

 

ESTIMATE COST OF REPAIR

$

SIGN HERE X

SIGNATURE OF PERSON SUBMITTING REPORT IS REQUIRED

ADDRESS

DATE OF REPORT

MAIL THIS REPORT TO:

DVS / ACCIDENT RECORDS

445 MINNESOTA STREET, SUITE 181

ST. PAUL, MN 55101-5181

Document Attributes

Fact Name Detail
Reporting Requirement Drivers must report any crash involving $1,000 or more in property damage, or any injury or death.
Submission Deadline The report must be sent to Driver and Vehicle Services within 10 days after the crash.
Legal Consequence for Non-Compliance Failure to provide the required information is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7.
Data Privacy Information collected is used for traffic accident statistical analysis under the Minnesota Data Privacy Act and cannot be used against the reporter in civil or criminal cases.

How to Fill Out Minnesota Accident Report

Filling out the Minnesota Accident Report form is an important step to take following a vehicular accident, especially when the crash results in $1,000 or more in property damage, or any injuries or fatalities occur. This report must be submitted to Driver and Vehicle Services within 10 days to comply with state law. Any delay or failure to submit this form can lead to a misdemeanor charge. By completing this process thoroughly, individuals contribute to the greater goal of enhancing road safety. Now, let’s guide you through each step required to fill out this form accurately.

  1. Locate the form online at www.mndriveinfo.org or obtain a paper copy if necessary.
  2. Begin by entering the accident date, specifying the month, day, and year, as well as the exact time and day of the week.
  3. Fill in the total number of vehicles involved and specify the county along with the name of the city or township where the accident occurred.
  4. Identify the accident location, choosing between an intersection, not at intersection, or in a parking lot, and provide the detailed location or address.
  5. Next, provide your full name, address, city, state, and zip code.
  6. Enter your driver's license number, the class of license, the state of issue, your date of birth, and sex.
  7. Fill in the vehicle owner's details if different from the driver, including full name, address, city, state, and zip code.
  8. Record the vehicle's license plate number, year, state of issue, parts of the vehicle damaged, and an estimate cost to repair.
  9. Specify the type of vehicle involved (e.g., car, pickup, van, SUV, motorcycle, truck, etc.), make, model, year, and color. Also, note the number of occupants at the time of the accident.
  10. Provide full liability insurance information, including the name of the insurance company (not the agency), policy number, and the policy period dates.
  11. If there is another vehicle involved, repeat steps 5 to 10 for the other driver and their vehicle.
  12. For accidents involving more than two vehicles, fill in section “C” on a separate form and attach it to this report.
  13. Indicate the type of accident by entering the number for the correct response in each box provided (e.g., collision with another motor vehicle, fixed object, etc.).
  14. Circle the correct response if the crash occurred in a work zone and note the posted speed limit at the accident location.
  15. Fill in weather/atmosphere, road surface, and light condition at the time of the accident.
  16. Specify any traffic control device present and the manner of collision.
  17. Document actions/maneuvers prior to the accident by each vehicle, as well as the direction of travel.
  18. If applicable, include information on pedestrian or bicyclist direction of travel and actions prior to the accident.
  19. Note whether there was a police officer at the scene and the department name.
  20. For vehicle occupants, provide details on each including date of birth (or age), seat type use, airbag deployment, ejection, and injury codes.
  21. Describe the accident in detail, providing direction (indicate North by arrow) and diagram what happened. Also, detail damage to property other than vehicles with an estimate cost of repair.
  22. Sign the report and fill in your address and the date of the report.
  23. Mail the completed report to the listed address: DVS / ACCIDENT RECORDS, 445 MINNESOTA STREET, SUITE 181, ST. PAUL, MN 55101-5181.

Once submitted, the information will be used to compile statistical data aiming to improve road safety measures. Remember, this form is confidential and cannot be used against you in any civil or criminal matter. Accurately and promptly completing this report not only fulfills a legal obligation but also contributes to the cause of making roads safer for everyone.

More About Minnesota Accident Report

  1. Who is required to complete the Minnesota Motor Vehicle Accident Report form?

    Any driver involved in a crash in Minnesota that results in either $1,000 or more in property damage, or any injury or death, is obligated to fill out the Minnesota Motor Vehicle Accident Report form. This requirement is in accordance with Minnesota Statute 169.09, subdivision 7, emphasizing the responsibility of each driver to report such accidents to the Driver and Vehicle Services (DVS) within 10 days of the incident.

  2. What is the purpose of this report?

    The primary goal behind gathering information through the Minnesota Motor Vehicle Accident Report is to aid in developing safer roads. The data collected from these reports is analyzed to understand better the factors contributing to road accidents and, as a result, to devise strategies that could prevent future occurrences.

  3. What happens if I fail to submit the report within the 10-day period?

    Failure to submit the required report within the 10-day window after the accident can lead to misdemeanor charges under Minnesota law. This strict deadline underscores the state’s commitment to road safety and the urgency in collecting timely and accurate accident data for analysis.

  4. Is the information I provide on the report kept confidential?

    Yes, the information provided is collected under the Minnesota Data Privacy Act. It is primarily used for statistical analysis aimed at road safety improvements. The specifics of the accident, including the time, place, parties involved, and insurance details, may be disclosed as per statutory requirements. However, the accident report itself is protected from being used against the individual in any civil or criminal proceeding, assuring contributors of their confidentiality and encouraging honest and accurate reporting.

  5. What should I do if the accident involves more than two vehicles?

    If the accident involved more than two vehicles, you should fill out an additional Minnesota Motor Vehicle Accident Report form for the third vehicle and any subsequent ones involved in the incident. Section “C” is where you can add the extra vehicles, ensuring that all necessary details are recorded accurately.

  6. Where do I send the completed Minnesota Motor Vehicle Accident Report form?

    Once the form is filled out entirely, it should be mailed to: DVS / Accident Records, 445 Minnesota Street, Suite 181, St. Paul, MN 55101-5181. This address is also provided on the form, ensuring you have the correct destination for submission.

  7. Can information from this report be used as evidence in court?

    No, the report itself is designed to be confidential with a protective measure in place that prevents it from being used as evidence in any civil or criminal court cases. This provision is meant to encourage full and honest reporting without fear of legal repercussions from the information provided in the report.

Common mistakes

Filling out the Minnesota Accident Report form is a critical step in documenting motor vehicle accidents in the state. However, individuals often make mistakes during this process, which can lead to delays in handling their reports or even legal issues. Here are eight common mistakes made when completing the form:

  1. Lack of detail in describing the accident. Individuals frequently provide insufficient information about how the incident occurred, which can hamper the ability of officials to accurately assess the situation.
  2. Forgetting to choose the correct accident location type. The form requires the selection of whether the accident occurred at an intersection, not at an intersection, in a parking lot, or other, yet this is often overlooked.
  3. Omitting full insurance information. If the insurance company name, policy number, and policy period are not fully provided, it may be assumed that the driver did not have valid insurance coverage at the time of the accident.
  4. Failing to report all vehicles involved. In accidents involving more than two vehicles, an additional section "C" must be filled out and attached, a step that is frequently missed.
  5. Incorrectly reporting the number of occupants or failing to include them at all. The number of people in each vehicle plays a crucial role in understanding the impact and consequences of the accident.
  6. Not specifying the correct type of accident. The form includes options for collision with another motor vehicle, collision with a fixed object, non-collision, and other types, yet these are often inaccurately marked.
  7. Forgetting to sign and date the report. The signature of the person submitting the report is required for validation but is sometimes overlooked.
  8. Incorrectly identifying the parts of the vehicle that were damaged. This mistake can lead to inaccuracies in repair estimates and insurance claims.

Attention to detail and thoroughness in completing the Minnesota Accident Report form can significantly aid in the accurate recording and processing of motor vehicle accidents.

Documents used along the form

When handling the aftermath of a vehicular accident in Minnesota, submitting the Minnesota Motor Vehicle Accident Report is a crucial step. However, to comprehensively address all legal, insurance, and personal record-keeping needs, several other forms and documents are often used in conjunction with this report. Understanding what these documents are and their purpose can significantly streamline the post-accident process, ensuring all necessary steps are taken efficiently.

  • Proof of Insurance: This document provides evidence that the driver has the minimum required insurance. It's crucial for verifying coverage at the time of the accident.
  • Vehicle Registration: This document verifies the ownership of the vehicle involved in the accident. It’s important for both police reports and insurance claims.
  • Driver’s License: A copy of the driver’s license of all parties involved is often required for identification and insurance purposes.
  • Medical Records: If injuries are sustained in the accident, medical records help in documenting the injuries for insurance claims or potential legal action.
  • Photographs: Pictures of the accident scene, including damage to all vehicles involved and any relevant road conditions or signs, serve as key evidence for insurance claims and possible legal considerations.
  • Witness Statements: If there were any witnesses to the accident, their written statements could be crucial in determining the circumstances of the accident.
  • Police Report: A copy of the police report provides an official account of the accident, which is essential for insurance claims and legal matters.
  • Tow Truck Receipt: If a vehicle was towed from the scene, the receipt is useful for insurance reimbursement purposes.
  • Personal Account and Notes: Keeping a personal account of the accident including notes taken at the scene can be helpful for personal records, legal counsel, or insurance claims.

Collectively, these documents form a comprehensive suite of evidence and proof required for navigating the post-accident processes, from insurance claims to legal proceedings. Ensuring that these documents are properly filled, accurately maintained, and readily available can provide peace of mind and a sense of preparedness in the unfortunate event of an accident. It's always advisable to consult with legal or insurance professionals to ensure all necessary documentation is in order and properly utilized.

Similar forms

  • The Texas Peace Officer's Crash Report (CR-3) is similar because it also collects detailed information about motor vehicle accidents for law enforcement, safety analysis, and statistical purposes. Both forms require information about the accident environment (e.g., weather conditions, light conditions, road conditions), vehicle details, driver and passenger information, accident events, and insurance information. The goal is to improve road safety through data collection and analysis.

  • California Traffic Accident Report (SR 1) parallels the Minnesota report by mandating drivers involved in certain accidents to report specifics within a stipulated time frame. It includes details about the accident scenario, participants, and insurance coverage. Both serve as tools for law enforcement and safety agencies to monitor accident patterns and for insurance processing.

  • The Florida Traffic Crash Report is similar in its objective to collect comprehensive data on traffic accidents for use by various stakeholders including law enforcement, traffic safety analysts, and insurers. Like Minnesota's form, it captures information on the crash environment, vehicles, occupants, and the nature of injuries or damages, aiming to facilitate road safety programs and insurance claims.

  • New York Motor Vehicle Accident Reports share similarities as they gather detailed accounts of vehicular accidents, including location, time, conditions contributing to the accident, and participant information. Both states' forms have sections designated for insurance information, aiming to streamline the claims process and aid in statistical analyses for improving road safety.

  • The Illinois Motorist Report (Form SR-1050) is alike because drivers involved in accidents meeting certain criteria must complete and submit this form. It features sections on driver, vehicle, and accident details, similar to Minnesota’s requirements. Both forms aim to compile accident data for statistical analysis, law enforcement review, and insurance record purposes.

  • Michigan Traffic Crash Report is akin to Minnesota’s form in its comprehensive collection of accident-related information for law enforcement and statistical analysis. It details the accident scene, involved parties, and circumstances leading up to the accident, supporting efforts to enhance road safety and inform policy decisions.

  • The Ohio Traffic Crash Report mirrors Minnesota's initiative to document detailed accounts of traffic accidents for law enforcement and safety analysis purposes. It includes sections on the accident context, vehicle specifics, and contributory factors, serving to support accident prevention strategies and insurance processes.

  • Virginia Police Crash Report is similar in its exhaustive capture of accident particulars to aid in road safety measures, law enforcement, and insurance assessments. Both states’ reports demand detailed inputs on the accident scenario, conditions, vehicle, and personal injuries, aiming to gather actionable insights for reducing road accidents.

Dos and Don'ts

When filling out the Minnesota Accident Report form, certain practices should be followed to ensure the process is completed accurately and efficiently. Below are four tips on what to do and four tips on what not to do.

  • Do report the accident if the damage is $1,000 or more, or if there's any injury or death.
  • Do fill out the form completely and truthfully, providing as much detail as possible.
  • Do include full insurance information to avoid assumptions that you were uninsured.
  • Do diagram the accident clearly, indicating the direction of the vehicles with arrows.
  • Don't wait longer than 10 days to submit the form to Driver and Vehicle Services.
  • Don't detach any part of the form before submitting it.
  • Don't leave sections blank. If a section doesn't apply, it's better to write "N/A" than to leave it empty.
  • Don't forget to sign and date the form. An unsigned form could be considered invalid.

Misconceptions

When it comes to navigating the aftermath of a motor vehicle accident in Minnesota, drivers are often required to fill out the Minnesota Accident Report form (PS 32001-08). However, several misconceptions can arise regarding the process and the form itself. By addressing these common misunderstandings, drivers can better manage their reporting responsibilities and ensure compliance with state law.

  • Completing the form is only necessary for serious accidents: A common misconception is that the Minnesota Accident Report form is only needed for accidents involving severe property damage, injuries, or fatalities. In reality, the form must be completed for any crash resulting in $1,000 or more in property damage, or any injury or death, regardless of how minor it may seem. This threshold can easily be met with minimal damage to modern vehicles.

  • The report can be used against you in court: Many people hesitate to fill out the report accurately for fear that it might be used against them in legal proceedings. According to the information provided by the report, the data collected is for statistical purposes to help build safer roads and cannot be used as evidence against the individual in civil or criminal matters. This encourages honest and accurate reporting.

  • If insurance information is incomplete, it's not a big deal: Some individuals believe that partially filled insurance information is acceptable, thinking they can update it later or it's not essential for the report. However, the form explicitly states that full liability insurance information must be provided; otherwise, it will be assumed that the driver did not have insurance at the time of the accident, which can lead to legal penalties.

  • Police on the scene means you don't have to file a report: Another common belief is that if police arrive on the scene and fill out a report, the driver is then exempt from filing the Minnesota Accident Report form. This is not the case; regardless of police involvement, the involved drivers must still complete and send the form to Driver and Vehicle Services within 10 days to comply with state requirements.

  • The form is only for accidents occurring on public roads: Some drivers think that accidents on private property, like parking lots or driveways, do not require the completion of the form. The instructions do not limit the requirement to public roadways; accidents in parking lots or any location that meet the reporting criteria (involving $1,000 or more in property damage, or injury or death) must be reported using the Minnesota Accident Report form.

Understanding the correct procedures and obligations can alleviate some of the stress involved in the aftermath of an accident and ensure drivers remain in good legal standing.

Key takeaways

Filling out the Minnesota Accident Report form is an important step if you've been involved in a vehicle accident that results in injury, death, or property damage of $1,000 or more. Here are some key takeaways to remember:

  • Time-sensitive submission: This form must be completed and sent to Driver and Vehicle Services within 10 days of the accident. Delaying beyond this timeframe could result in legal consequences.
  • Accuracy is critical: Make sure to provide detailed and accurate information about the accident. This includes the exact location, date and time of the accident, detailed descriptions of what happened, and the vehicles involved.
  • Insurance information matters: Providing complete liability insurance information is mandatory. Failure to do so might lead to the assumption that you were not insured at the time of the accident.
  • Privacy protection: The information you provide cannot be used against you in any civil or criminal proceedings. Your account of the accident is kept confidential under the Minnesota Data Privacy Act.
  • Documenting injuries and damage: Use the codes provided on the form to accurately document any injuries and vehicle damage. This includes specifying the type of collision, the condition of the road, and contributing environmental factors.
  • Supporting documents: If more than two vehicles are involved, or if there’s additional relevant information, attach separate sheets or documents along with the completed form.

Remember, filling out this form thoroughly and correctly plays a significant role in ensuring the safety of roads and providing accurate statistical data on traffic accidents. It also helps in processing insurance claims and may assist law enforcement agencies in their investigations.

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