Free Oregon Dmv Accident Report PDF Form

Free Oregon Dmv Accident Report PDF Form

The Oregon DMV Accident Report form, officially named the Oregon Traffic Crash and Insurance Report, is a crucial document for drivers involved in a traffic crash under certain conditions in Oregon. It is mandatory for drivers to file this report with the DMV if the damage to any vehicle or property exceeds $2,500, if there is any injury regardless of its severity, if any vehicle is towed from the scene due to damage, or in the unfortunate event of a death. The state law mandates the submission of this report within 72 hours of the incident to avoid possible suspension of driving privileges.

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In the event of a traffic incident in Oregon that results in significant vehicle damage, injury, or worse, understanding the Oregon DMV Accident Report form is crucial. This form not only serves as a mandatory step for drivers involved in accidents that meet certain criteria but also plays a vital role in the aftermath of the incident. Whether it's a collision resulting in over $2,500 damage to your vehicle, someone else's property, any physical injury regardless of its severity, the towing of a vehicle due to damages, or a tragic fatality, this form becomes a necessity. Oregon law stipulates a 72-hour window post-accident for the submission of this report, warning that a delay or failure to do so could lead to the suspension of driving privileges. It's important to note that this requirement holds regardless of the driver's state of residence or if a police report has already been filed. The form does not assign fault but does contribute to the official driving record of those involved, provided the vehicle wasn’t parked. It comes with a comprehensive set of instructions emphasizing the importance of thoroughness in filling it out—everything from ensuring the insurance section is complete to avoid suspension, to detailing the crash in writing, and properly noting every bit of information about additional vehicles and drivers involved if applicable. Additional protocols are in place for commercial motor vehicle operators and those who find their vehicle "totaled" as per Oregon law, with specific instructions to be followed. The completion and submission process allows for multiple avenues including email, fax, mail, or in-person delivery, underscoring the importance of keeping a personal copy of the report and submission proof. The form underscores the principle that while accidents are unfortunate, the manner in which they are reported and documented is paramount for all parties involved.

Document Example

OREGON TRAFFIC CRASH AND INSURANCE REPORT

Tear this sheet off your report, read and carefully follow the directions.

ONLY drivers involved in a crash resulting in any of the following MUST file a Crash & Insurance Report:

Damage to your vehicle is over $2500

Damage to any one person’s property over $2500

Injury (No matter how minor)

Any vehicle has damage over $2500 and any vehicle is

Death

towed from the scene as a result of damages

Oregon law requires these reports be filed within 72 hours of the crash. If you are not able to file within the 72 hours, submit it as soon as possible. If you fail to report the crash to DMV, it may result in suspension of your driving privileges. If the police department files a police report, you are still required to file your own Crash and Insurance Report with DMV. When required to report, even if you are licensed in another state, or you are not an Oregon resident, you still must file a report with Oregon DMV. DMV does not determine fault in a crash, but does post the crash to the driving record of those drivers required to report, unless the vehicle is parked. If you have questions, please call DMV Crash Reporting Unit at (503) 945-5098.

INSTRUCTIONS

PRINT OR TYPE ALL INFORMATION. (Use black or dark blue ink and press firmly.)

Complete both sides of the form.

If additional vehicles were involved in the crash, complete the attached Supplemental Report (Form 735-32B), or on a blank piece of paper, write all the information as requested in Section 4, the “Other Driver” Section.

DMV Headquarters will verify the insurance information submitted. Complete the insurance section or a suspension of your driving privileges may occur.

SECTION 1

DATE, LOCATION AND TIME — Clearly identify the date, location and time of the crash. The correct date, location and time is critical to processing your report. If you are unsure of the county, contact any local law enforcement agency for assistance.

SECTION 2

Your vehicle is Vehicle #1. Complete ALL fields. Provide Insurance company name (not agent), policy number, and Vehicle identification number (VIN). Failure to provide complete insurance and vehicle information may result in DMV issuing Notice of Suspension due to incomplete information.

SECTION 3

Failure to complete this section may result in DMV sending Notice of Suspension for failure to file a report. Principle purpose of driving and being paid to drive does not mean driving to reach a destination to perform a service. Property: Includes, but is not limited to, fixed or real property, landscaping, signs, parked vehicles, and animals.

COMMERCIAL MOTOR VEHICLE OPERATORS: In addition to this report, Oregon Administrative Rule requires that Form

735-9229, Motor Carrier Crash Report, MUST be filed within 30 days of a commercial motor vehicle crash when there is a FATALITY, INJURY (requiring treatment away from the scene), or when a vehicle is TOWED from the scene because of disabling damage. Form 735-9229 (attached on back) MUST be submitted with Oregon Traffic Crash and Insurance Report (Form 735-32) to DMV. Call (503) 986-3507 for questions regarding the Motor Carrier Crash Report.

You may now file the Motor Carrier Crash Report at: www.oregontruckingonline.com/cf/MCAD/pubMetaEntry/accidentRpt/

SECTION 4

OTHER VEHICLE (# 2) — Completion of this information will help DMV match all driver's crash reports more efficiently. If additional vehicles were involved in the crash, complete attached Supplemental Report (Form 735-32B).

SECTION 5

DESCRIPTION AND SIGNATURE — Describe what happened. It is important for you to sign and date the form. Only a family member may sign and date this form on behalf of a driver when the driver is incapacitated or physically unable to sign. No other signatures will be accepted.

COMPLETING AND FILING REPORT

HOW TO SUBMIT A REPORT TO DMV:

Email to OregonDMVAccidents@odot.oregon.gov

Fax to 503-945-5267

Mail to DMV Crash Reporting Unit 1905 Lana Ave NE, Salem, Oregon 97314

Deliver to a DMV office

Keep a copy of the report and documentation that shows when you submitted your report to Oregon DMV. Under ORS 802.220(5), DMV is not authorized to provide you with a copy of the report that you file. If submitting by:

Email, DMV sends an autoreply that your email was received. Save that autoreply.

Fax, many fax machines provide the option to generate a fax confirmation report. Save that report.

DMV Field Office, request and save that receipt.

PURSUANT TO OREGON INSURANCE LAW, AN INSURANCE COMPANY CAN NOT REQUIRE REPAIRS BE MADE TO A MOTOR VEHICLE BY A PARTICULAR PERSON OR REPAIR SHOP.

735-32 (3-23)

STK# 300009

INSTRUCTIONS

TOTALED VEHICLE NOTICE

DEFINITIONS AND INSTRUCTIONS FOR TOTALED VEHICLES

IF YOUR CRASH HAS RESULTED IN A “TOTALED” VEHICLE, YOU ARE REQUIRED BY LAW TO

FOLLOW APPROPRIATE INSTRUCTIONS IN THIS NOTICE.

DEFINITION OF “TOTALED” VEHICLE

“Totaled Vehicle” or “Totaled” as defined in Oregon law (ORS 801.527) means:

A vehicle that is declared a total loss by an insurer who is obligated to cover the loss or a vehicle that the insurer takes possession of or title to.

A vehicle that has sustained damage that is not covered by an insurer and the estimated cost to repair the vehicle is equal to at least 80% of the retail market value prior to the damage. “Retail market value” is defined as the amount shown in publications used by financial institutions (banks or lenders) in this state.

A vehicle that is stolen, if it is not recovered within 30 days of theft and the loss is not covered by an insurer. In this situation, you must notify DMV within 60 days of the theft.

FOLLOW THESE INSTRUCTIONS IF YOUR VEHICLE IS TOTALED

If your vehicle is totaled, in addition to completing the crash report, follow the instruction that is applicable to your case. Either:

1.SURRENDER the title to the insurer if the damage is covered by an insurer who declares the vehicle to be a “total loss,” and the insurer takes possession of the vehicle; or

2.SURRENDER the title to DMV and apply for salvage title if the damage is covered by an insurer who declares the vehicle to be a “total loss,” but you keep possession of the vehicle; or

3.SURRENDER the title to DMV and apply for salvage title if the damage was not covered by an insurer and the estimated cost of repair is at least 80% of the retail market value of the vehicle before the damage; or

4.NOTIFY DMV that your vehicle has been totaled if, for some reason, you are unable to obtain the title for surrender. You must provide DMV with a signed statement which includes:

A description of the vehicle which includes the year model, make, plate number and vehicle identification number.

A statement indicating the vehicle has been totaled.

A statement that you are unable to obtain the title and why.

DO NOT SUBMIT THE TITLE WITH THE CRASH REPORT. You can obtain the Application for Salvage Title (Form 735-229) from any DMV office, by calling (503) 945-5000, or on-line at www.oregondmv.com. Application instructions and fee information are on the back of the form 735-229. If you have questions about salvage titles, call (503) 945-5122.

NOTE: It is a Class A misdemeanor with a penalty of imprisonment and/or fine if you fail to comply with the above requirements. (ORS 819.012)

OREGON TRAFFIC CRASH AND INSURANCE REPORT

COMPLETE BOTH SIDES

Print Form

Reset Form

Complete this form if the traffic crash occurred on a highway or premise open to the public and meets at least one of the reporting requirements outlined in Section 3. Failure to report when required may result in DMV issuing Notice of Suspension. Call 503-945-5098 for assistance in completing the report.

SECTION 1

CRASH DATE

DAY OF WEEK TIME OF DAY

 

COUNTY

 

 

 

 

 

DMV USE ONLY

 

 

 

M T W TH F

AM

 

 

 

 

 

CRASH REF # _________________________________ ALIR

INS CO

 

S SN

PM

 

 

 

 

 

ROAD ON WHICH CRASH OCCURRED (Name of street, road or route )

MILE POST

 

TYPE OF CRASH - The crash involved one or more of the following:

(Mark all that apply)

 

 

 

 

 

 

 

 

Two vehicles

ATV / Snowmobile

Parked vehicle

NAME OF NEAREST INTERSECTING ROAD

WITHIN

FEET

N

S

E

W

More than two vehicles

Motorcycle

Overturned vehicle

Motor Home / RV

 

 

NEAR

MILES

N

S

E

W

Fatality

Animal

 

 

 

Motorized Scooter

 

NAME OF NEAREST CITY / TOWN

WITHIN

FEET

N

S

E

W

Bicycle

Personal (assisted)

Fixed object / property

 

 

NEAR

MILES

N

S

E

W

Pedestrian

mobility device

Other ____________________

 

 

Train

SECTION 2 (YOUR INFORMATION)

Complete ALL fields. Failure to provide complete information may result in DMV issuing Notice of Suspension.

DRIVER’S LAST NAME

FIRST NAME

MIDDLE NAME

DRIVER’S LICENSE NUMBER

STATE DATE OF BIRTH

GENDER

 

 

 

M

F

X

DRIVER’S RESIDENCE ADDRESS

CITY

STATE

ZIP CODE

CHECK BOX

 

 

 

 

IF ADDRESS

MAILING ADDRESS (IF DIFFERENT THAN RESIDENCE)

CITY

STATE

ZIP CODE

CHANGE

 

 

VEHICLE OWNER’S NAME AND ADDRESS

 

CITY

STATE

ZIP CODE

SAME

 

 

 

 

RENTAL?

 

 

 

 

INSURANCE COMPANY NAME (NOT AGENT) AND ADDRESS

CITY

STATE

ZIP CODE

POLICY NUMBER

VEHICLE IDENTIFICATION NUMBER

 

STATE VEHICLE PLATE NUMBER

YEAR MAKE & MODEL

Check all statements that apply:

SECTION 3

Damage to your vehicle was more than $2500.

Damage to any one person’s property (other than vehicle) was more than $2500.

Your vehicle was towed from the scene as a result of damages.

You or passengers in your vehicle were injured.

Collision with a parked vehicle.

The crash occurred while you were driving your employer’s vehicle.

You were driving on your job and being paid for the principal purpose of driving.

You were being paid to drive and/or deliver persons or property.

You were operating a government owned vehicle marked for transporting mail in accordance with government rules. You were operating an authorized emergency vehicle.

The crash occurred in a work or maintenance zone. ORS 811.230

 

 

 

A police officer came to the scene.

City

County

State Police

Name of police department: __________________________

You were operating a commercial motor vehicle requiring you to have a commercial driver license. You were transporting hazardous material.

A citation was issued to you. The citation was: ________________________________________________________

SECTION 4 (OTHER VEHICLE # 2)

DRIVER’S NAME (LAST, FIRST, MIDDLE)

DRIVER’S LICENSE NUMBER

STATE

DATE OF BIRTH

GENDER

 

 

 

 

 

M F X

 

 

 

 

 

 

DRIVER’S ADDRESS

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

VEHICLE OWNER’S NAME AND ADDRESS

CITY

 

STATE

ZIP CODE

 

SAME

INSURANCE COMPANY NAME (NOT AGENT) AND ADDRESS

 

POLICY NUMBER

VEHICLE IDENTIFICATION NUMBER

STATE VEHICLE PLATE NUMBER YEAR MAKE & MODEL

IF ADDITIONAL VEHICLES WERE INVOLVED IN THE CRASH, USE ATTACHED SUPPLEMENTAL REPORT (Form 735-32B).

DESCRIBE WHAT HAPPENED: (IF MORE SPACE IS NEEDED, SUBMIT ADDITIONAL PAGE)

5

 

 

SECTION

I certify all information given on this report is true and accurate to the best of my knowledge.

 

 

SIGNATURE OF PERSON MAKING REPORT

PRINTED NAME OF PERSON MAKING REPORT

 

X

REASON DRIVER IS UNABLE TO SIGN REPORT

 

IF NOT DRIVER’S SIGNATURE, STATE RELATIONSHIP

735-32 (3-23) COMPLETE THE OTHER SIDE OF THIS PAGE

DMV COPY

DAYTIME PHONE #

 

DATE SIGNED

 

(

)

 

 

 

 

 

 

PHONE NUMBER OF DRIVER

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

STK# 300009

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEATHER CONDITIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

YOU INTENDED TO...

YOUR VEHICLE

 

 

 

 

 

 

 

 

 

 

YOUR RESIDENCE

 

 

Go straight ahead

 

 

Passenger car, pickup, van

 

 

 

Clear

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Local resident

 

 

 

 

 

Make right turn

 

 

 

Military vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Raining

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(within 25 miles of crash site)

 

 

Make left turn

 

 

 

Taxicab

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Snowing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residing elsewhere in state

 

 

Make “U” turn

 

 

 

Emergency vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fog

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Non–resident of this state:

 

 

Back–Up

 

 

 

Any of the above and trailer

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

College student

 

 

Enter driveway (also

 

 

Private or public agency

 

 

 

 

 

 

 

ROAD SURFACE

 

 

 

 

 

 

Military

 

 

 

 

 

mark left or right turn)

 

 

transit vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dry

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Temporary job

 

 

 

 

 

Remain stopped in traffic

 

 

Bus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOU WERE HEADED

 

 

Enter parked position

 

 

School bus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Snowy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

North

 

East

 

 

 

 

 

Slow or Stop

 

 

 

Other publicly-owned veh.

 

 

 

 

 

 

Icy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

South

 

West

 

 

 

 

 

Leave driveway (also

 

 

Motorcycle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On: ____________________

 

 

mark left or right turn)

 

 

Motor Home / RV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIGHT CONDITIONS

 

 

 

 

Start in traffic lane

 

 

Motor–scooter/bike

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Daylight

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(name of street, road or route)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER DRIVER WAS HEADED

 

 

Leave parked position

 

 

Personal (assisted) mobility device

 

 

 

Dawn or dusk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

North

 

East

 

 

 

 

 

 

 

Truck tractor & semi trailer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Remain parked

 

 

 

 

 

 

Darkness (lighted)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

South

 

West

 

 

 

 

 

Overtake and pass

 

 

Truck/truck tractor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Darkness (unlighted)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other truck combination

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On: ____________________

 

 

 

 

 

 

 

 

 

Farm tractor/farm equip.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(name of street, road or route)

 

WITNESS INFORMATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If this crash involved a pedestrian or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

bicyclist, complete the following:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PEDESTRIAN NAME

 

BICYCLIST NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pedestrian or bicyclist was going:

 

 

 

 

 

 

 

OCCUPANT INJURY AND SAFETY EQUIPMENT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

 

 

 

 

S

 

E

W

 

 

SAFETY EQUIPMENT CODES

 

 

 

 

INJURY CODE FOR OCCUPANTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALONG OR ACROSS: (name of street, road or route)

 

 

WRITE one of the codes (0–10) in column C

 

WRITE one of the codes (1–5) in column D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0 No seat belt available

 

 

 

 

1

Fatal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From:

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Seat belt available but NOT used

 

 

 

 

2

Suspected Serious: severe laceration, broken

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 Seat belt available and in use

 

 

 

 

 

or distorted limb, crush injury, significant burns,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 Child restraint device available but NOT used

 

 

unconsciousness, paralysis

 

 

 

 

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

4 Child restraint device in use

 

 

 

 

3 Suspected Minor: lump, abrasions, bruises,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 Child restraint device not available

 

 

 

 

 

minor lacerations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXAMPLE: (From: NE corner To: SE corner (or) From: East side To: West side, etc.)

 

 

6 Helmet NOT in use

 

 

 

 

4 Possible

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

Helmet in use

 

 

 

 

 

5 No apparent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender and age of pedestrian / bicyclist:

 

 

8

Air bag deployed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

 

X

Age: _____

 

 

 

 

 

9

Air bag available - NOT deployed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

Air bag NOT available

 

 

 

 

GENDER CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Extent of pedestrian / bicyclist injury:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WRITE M, F or X in column A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fatal

 

 

 

 

 

Complaint of Pain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SEAT

 

 

OCCUPANTS' NAMES

(your vehicle)

 

 

 

A

 

 

B

 

C

 

 

D

 

 

 

 

 

 

 

 

 

Suspected Serious

No apparent injury

 

 

POSITION

 

 

GENDER

 

 

AGE

 

SFTY

AIR

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EQP

BAG

 

 

 

 

 

 

 

 

Visible injury

 

 

(or none noted)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pedestrian / bicyclist action: (mark one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRONT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CENTER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Crossing at intersection or crosswalk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRONT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Crossing not at intersection or crosswalk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MIDDLE

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Walking / riding in roadway with traffic

 

 

 

 

 

LEFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Walking / riding in roadway against traffic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MIDDLE

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CENTER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Standing in roadway

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MIDDLE

*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pushing or working on vehicles in roadway

 

 

RIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other working in road

 

 

 

 

 

 

 

 

REAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Playing in road

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hitchhiking

 

 

 

 

 

 

 

 

 

 

CENTER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Not in roadway

 

 

 

 

 

 

 

 

RIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other________________________________

 

 

 

 

*Use only for vehicles with middle row of seats (i.e., vans, SUVs, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(specify)

 

 

 

 

Vehicle Damage

 

 

 

 

 

 

Diagram

 

Number each vehicle:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

street,

route)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRONT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Show path by:

 

 

 

 

 

 

 

 

 

 

 

 

U

 

 

 

 

 

 

 

(nameof roador

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Show pedestrian/bicyclist by:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Show railroad tracks by:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USE ARROW TO SHOW

Vehicle towed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Show fixed object by:

 

 

 

 

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST IMPACT (SHADE

Rollover

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IN DAMAGED AREA)

Under car

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Totaled

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Vehicle (No. 1) damage: $ __________ .

 

 

 

 

 

 

 

 

(name of street,

 

 

 

 

 

 

 

 

 

 

 

(name of street,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

road or route)

 

 

 

 

 

 

 

 

 

 

 

 

 

road or route)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPLEMENTAL REPORT

OREGON TRAFFIC CRASH

Supplemental for more than two drivers involved in the crash.

Attach this form to your OREGON TRAFFIC CRASH AND INSURANCE REPORT.

 

CRASH DATE

DAY OF WEEK

TIME OF DAY

AM

COUNTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M T W TH F

 

 

 

 

DO NOT WRITE

 

 

 

 

 

 

 

 

 

 

 

 

S SN

 

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IN THIS SPACE

 

 

 

 

 

 

 

 

 

 

ROAD ON WHICH CRASH OCCURRED (Name of street, road or route )

MILE POST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

#3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

 

 

 

DRIVER’S LICENSE NUMBER

 

STATE

 

DATE OF BIRTH

GENDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S ADDRESS

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE OWNER’S NAME AND ADDRESS

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

SAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

#4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

 

 

 

DRIVER’S LICENSE NUMBER

 

STATE

 

DATE OF BIRTH

GENDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S ADDRESS

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE OWNER’S NAME AND ADDRESS

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

SAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

#5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

 

 

 

DRIVER’S LICENSE NUMBER

 

STATE

 

DATE OF BIRTH

GENDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S ADDRESS

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE OWNER’S NAME AND ADDRESS

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

SAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

#6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

 

 

 

DRIVER’S LICENSE NUMBER

 

STATE

 

DATE OF BIRTH

GENDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S ADDRESS

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE OWNER’S NAME AND ADDRESS

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

SAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

#7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE IDENTIFICATION NUMBER

 

 

 

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

 

 

 

DRIVER’S LICENSE NUMBER

 

STATE

 

DATE OF BIRTH

GENDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S ADDRESS

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE OWNER’S NAME AND ADDRESS

 

 

 

CITY

 

 

STATE

ZIP CODE

 

 

 

 

 

SAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

735-32B (3-23)

SUPPLEMENTAL REPORT – USE IF MORE THAN TWO VEHICLES

CRASH ANALYSIS & REPORTING UNIT OREGON DEPARTMENT OF TRANSPORTATION POLICY, DATA & ANALYSIS DIVISION

555 13th ST NE STE 2 SALEM OR 97301 TELEPHONE 503-986-3507 FAX 503-986-3592

MOTOR CARRIER CRASH REPORT

(For CMV Drivers Only)

INSTRUCTIONS: IF YOU CHECKED A BOX UNDER THE QUALIFYING VEHICLE COLUMN AND A BOX UNDER THE CRITERIA COLUMN, COMPLETE THE MOTOR CARRIER CRASH REPORT AND SUBMIT TO THE ADDRESS SHOWN ABOVE. IF YOU HAVE ANY QUESTIONS REGARDING FILLING

OUT THE MOTOR CARRIER CRASH REPORT, PLEASE CALL (503) 986-3507. www.oregontruckingonline.com/cf/MCAD/pubMetaEntry/accidentRpt/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QUALIFYING VEHICLE

 

 

 

 

 

 

 

 

 

CRITERIA

 

 

 

 

 

 

 

 

 

 

 

COMMERCIAL TRUCK (GVWR OVER 10,000 LBS OR ACTUAL WT

 

ANY PERSON SUSTAINING A FATALITY (WITHIN 30 DAYS OF THE

 

AT TIME OF CRASH EVEN IF GVWR IS SET UNDER 10,000 LBS )

 

 

 

CRASH)

 

 

 

 

 

 

 

 

 

 

 

HAZARDOUS MATERIAL PLACARD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANY PERSON SUSTAINING INJURIES REQUIRING TREATMENT AWAY

 

COMMERCIAL BUS (DESIGNED FOR 8 OR MORE PASSENGERS)

 

 

 

FROM THE SCENE

 

 

 

 

 

 

 

 

 

FARM TRUCK INTERSTATE (OVER 10,000 LBS.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANY VEHICLE INCURRING DISABLING DAMAGE REQUIRING

 

FARM TRUCK FOR-HIRE (4 OR MORE AXLES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REMOVAL FROM THE SCENE BY A TOW TRUCK OR ANOTHER

 

FARM TRUCK TOWING TRIPLE TRAILERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MOTOR VEHICLE

 

 

 

 

 

 

 

 

 

FARM TRUCK (OVER 80,000 LBS.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MOTOR CARRIER NAME

 

 

 

 

 

 

 

 

US DOT NUMBER

 

 

 

 

AUTHORITY/FILE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

STATE

 

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER NAME (LAST, FIRST, MIDDLE)

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

 

 

LENGTH OF EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MONTHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YEARS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CDL / DL NUMBER

 

 

STATE

 

 

 

 

 

LICENSE CLASS

 

 

 

 

 

EXPIRATION DATE OF MEDICAL CERTIFICATE

 

 

 

 

 

 

 

 

 

 

 

A

B

C

D

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE THE FOLLOWING TWO QUESTIONS AS IF DOING A RECAP OF HOURS IN TIME DOCUMENTS AT TIME OF THE CRASH.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AT TIME OF THE CRASH, TOTAL HOURS

 

 

 

 

TOTAL HOURS ON DUTY DURING THE PREVIOUS

 

 

7 CONSECUTIVE DAYS ____________

 

DRIVING SINCE LAST OFF-DUTY PERIOD.

 

 

 

 

(FILL OUT ONE ONLY, BASED ON TIME DOCUMENTS)

 

 

8 CONSECUTIVE DAYS ____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOES YOUR DRIVER HAVE A MEDICAL WAIVER

 

 

 

TYPE OF WAIVER (SIGHT, DIABETES, AMPUTEE, ETC.)

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER INJURY INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR DRIVER KILLED

 

YOUR DRIVER INJURED

 

 

RELIEF DRIVER KILLED

RELIEF DRIVER INJURED

 

TOTAL NUMBER OF PASSENGERS

 

YES

NO

 

YES

NO

 

YES

NO

 

YES

NO

 

_____KILLED

_____ INJURED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER DRIVER INJURY INFORMATION

TOTAL NUMBER OF OTHER DRIVERS

_____KILLED

_____ INJURED

TOTAL NUMBER OF OTHER PASSENGERS

 

TOTAL NUMBER OF PEDESTRIANS

 

TOTAL NUMBER OF BICYCLISTS

_____KILLED

_____ INJURED

 

_____KILLED

_____ INJURED

 

_____KILLED

_____ INJURED

 

 

 

 

 

 

 

 

OTHER MOTOR CARRIER INFORMATION (IF 2 OR MORE MOTOR CARRIERS WERE INVOLVED)

MOTOR CARRIER NAME

VEHICLE LICENSE # AND STATE

DRIVER'S NAME

DRIVER'S LICENSE # AND STATE

MOTOR CARRIER VEHICLE INFORMATION

YEAR

MAKE

UNIT NUMBER

LICENSE PLATE # & STATE - TRUCK/TRACTOR/BUS

TOTAL NO. OF AXLES

 

INCLUDING TRAILERS

 

 

 

TRACTOR TYPE (SELECT APPROPRIATE TYPE)

 

 

 

 

 

 

1

 

 

 

 

5

Standard

 

 

 

9

Heavy Haul

 

Triples (tractor with 3 trailers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

Tractor/Semi Trailer

 

 

 

 

Bus/Van (8 or more

 

 

 

 

 

 

 

 

 

 

2

 

Triples (truck with 2 trailers)

 

 

Straight Truck

 

 

10

 

 

 

 

 

 

 

3

 

 

 

 

7

 

 

 

11

passenger capacity)

 

 

 

 

 

 

 

 

Straight truck-full trailer

 

 

 

 

 

Auto/Pickup

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

Doubles (any)

 

 

8

Saddlemount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

735-9229 (3-23)

COMPLETE REVERSE SIDE

 

 

 

 

 

 

 

SUPPLEMENTAL – MOTOR CARRIER CRASH REPORT

TRAILER TYPE (CHECK ONE)

 

VAN

 

FLATBED

 

TANKER

 

 

CONTAINER

 

 

POLE/LOG

 

DUMP

 

 

BELLY-DUMP

 

 

CAR CARRIER

 

LIVESTOCK

 

 

 

 

 

 

 

 

 

 

 

 

 

MOBILE HOME TOTER

 

PASSENGER

 

DROP-BOX

 

GARBAGE

 

 

BULK-HOPPER

 

 

 

MIXER

 

SADDLEMOUNT

 

 

 

 

 

 

 

 

 

 

 

WRECKER

 

FIXED LOAD

 

HEAVY HAUL

 

 

UTILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMODITY INFORMATION

COMMODITY BEING TRANSPORTED AT TIME OF CRASH

WAS A HAZARDOUS COMMODITY BEING HAULED

YES NO

WAS HAZARDOUS MATERIAL RELEASED FROM THE VEHICLE CARGO(NOT A FUEL RELEASE)

YES NO

HAZARD CLASS

CRASH INFORMATION

LOCATION OF CRASH (NEAREST CITY OR TOWN)

 

HIGHWAY AND MILEPOINT/STREET/COUNTY ROAD

 

DIRECTION OF YOUR VEHICLE (CHECK)

 

 

 

 

 

 

 

 

 

N

S

E

W

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF CRASH

TIME

 

 

AM

DAY OF THE WEEK (CHECK ONE)

 

 

 

 

 

 

 

 

 

 

PM

MON

TUES WED THU

FRI

SAT

SUN

CONDITIONS AT TIME OF CRASH

 

 

 

 

 

 

 

 

 

 

 

 

 

WEATHER (CHECK ONE)

1. CLEAR

2. RAIN

3. SNOW

4. CLOUDY

5. SLEET

6. FOG

7. OTHER

 

 

ROAD SURFACE (CHECK ONE)

1. DRY

2. WET

3. SNOWY

4. ICY

5. OTHER

 

 

 

 

 

 

 

 

LIGHT CONDITION (CHECK ONE)

1. DAY

2. DAWN

3. DUSK

4. ARTIFICIAL LIGHTS

5. DARK

6. OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE WHAT HAPPENED BY CHECKING ALL BOXES THAT APPLY. YOUR VEHICLE IS ALWAYS NO.1. IF OTHER VEHICLES WERE INVOLVED, COMPLETE COLUMNS 2 & 3 TO CORRESPOND TO THE ACTIONS OF THE SAME NUMBERED VEHICLES LISTED ABOVE UNDER "OTHER DRIVER INFORMATION".

VEHICLES 1 2 3

ACTION

SLOWING - STOPPING

STOPPED

REAR-END

BACKING

MAKING RIGHT TURN

MAKING LEFT TURN

MAKING U TURN

PROCEEDING STRAIGHT

INTERSECTION

ENTERING TRAFFIC (FROM SHOULDER, MEDIAN, PARKING STRIP OR PRIVATE DRIVE)

VEHICLES 1 2 3

ACTION

PASSING

CHANGING LANES

SIDESWIPE

HEAD-ON

SKIDDING

VEHICLE OUT OF CONTROL

ROLL-AWAY

CONTROLLED RR CROSSING

UNCONTROLLED RR CROSSING

RAN OFF ROAD

VEHICLES 1 2 3

ACTION

JACKKNIFE

OVERTURN

SEPARATION OF UNITS

FIRE

EXPLOSION

CARGO SHIFT

CARGO SPILL (HAZARDOUS)

CARGO SPILL (NON-HAZARDOUS)

OTHER (DEER, GUARDRAIL, ETC)

DID YOUR VEHICLE STRIKE A PARKED VEHICLE

YES NO

WAS YOUR PARKED VEHICLE STRUCK BY ANOTHER VEHICLE

YES NO

DESCRIPTION OF CRASH (BY CARRIER OR DRIVER)

NAME AND TITLE OF PERSON SIGNING REPORT

TELEPHONE NUMBER(S)

 

 

SIGNATURE I CERTIFY THE INFORMATION PROVIDED IS TRUE AND ACCURATE

DATE

X

 

File Features

# Fact
1 The Oregon DMV Accident Report Form must be filed by drivers involved in crashes resulting in over $2,500 in damage to a vehicle or property, injury, death, or when a vehicle is towed due to damage.
2 Reports are required by Oregon law to be filed within 72 hours of the crash.
3 Failure to file the report may lead to the suspension of driving privileges.
4 Regardless of whether a police report is filed, involved drivers must still submit their own Crash and Insurance Report to the DMV.
5 The DMV does not determine fault but will post the crash to the driving records of those required to report.
6 The form requires detailed information on the crash, including the date, location, time, involved vehicles, insurance information, and a description of the incident.
7 Commercial motor vehicle operators have additional reporting requirements under the Oregon Administrative Rule if there is a fatality, injury, or serious vehicle damage.
8 The form stipulates specific instructions for drivers whose vehicles are considered "totaled" according to Oregon law (ORS 801.527).
9 Drivers can submit the form via email, fax, mail, or in-person at a DMV office.
10 Oregon insurance law prohibits insurance companies from requiring repairs to be made by a particular person or repair shop.

Oregon Dmv Accident Report: Usage Guide

Filling out the Oregon DMV Accident Report form is a critical step in the aftermath of a vehicle incident, whether it involves damage, injury, or both. Oregon law mandates the submission of this form under certain circumstances, such as when damage to your vehicle or any single person's property exceeds $2500, anyone is injured no matter how minor it seems, any vehicle is towed due to damage, or in the unfortunate event of a death occurring. The form must be submitted within 72 hours of the accident, and failure to do so could result in the suspension of driving privileges. Let's go through how to properly fill out this form to ensure all requirements are met and your submission is accepted by the DMV.

  1. General Information: Use black or dark-blue ink to complete the form. Press firmly to ensure all information is legible.
  2. Section 1: Fill out the crash date, day of the week, time of day, and the county where the incident occurred. Include the road name and closest intersecting road or nearest city/town to specify the location accurately.
  3. Section 2 (Your Information): Write down your full name, driver's license number, date of birth, gender, and complete address. Under vehicle information, include the insurance company name, policy number, vehicle identification number (VIN), state, and vehicle plate number.
  4. Section 3: Check all statements that apply to your situation, including details about vehicle damage, injury, towing, employment-related driving, or if your vehicle was a government or commercial motor vehicle.
  5. Section 4 (Other Vehicle #2): If another vehicle was involved, input the driver's name, license number, date of birth, gender, and address. Provide the same type of insurance and vehicle information as in Section 2. Use a supplemental report form (Form 735-32B) for additional vehicles involved.
  6. Section 5 (Description and Signature): Describe the accident in detail. It's essential to include how the crash occurred, noting the direction of each vehicle, actions leading up to the accident, and any other relevant details. Sign and date the form. If you're unable to sign, a family member may sign on your behalf—state their relationship to you.
  7. Submitting the Report: Decide whether you're sending the form via email, fax, mail, or delivering it to a DMG office. Keep a copy of the report and documentation indicating when and how you submitted the form to the DMV.

After submitting the Oregon DMV Accident Report form, ensure you save any confirmation if submitted electronically or keep the receipt if submitted in person. This documentation may be necessary later for insurance purposes or in legal proceedings. It's also a good idea to follow up with the DMV to confirm your report was processed and to inquire about any next steps, especially if your driving privileges could be at risk.

Crucial Points on Oregon Dmv Accident Report

What incidents require me to file an Oregon DMV Accident Report?

The law in Oregon mandates that drivers must file an Accident Report with the DMV if any of the following conditions apply to their crash:

  • Damage to your vehicle exceeds $2500.
  • Damage to someone else's property is over $2500.
  • Any person, including yourself, is injured no matter how minor the injuries.
  • Any vehicle involved is so damaged that it requires towing from the scene.
  • A fatality occurs as a result of the accident.

When must the Oregon DMV Accident Report be filed?

The report must be filed within 72 hours of the crash. If it's not possible to file within this period, it should be submitted as soon as possible. Delaying beyond this timeframe can result in suspension of driving privileges.

If the police filed a report, do I still need to file one with the DMV?

Yes, even if the police have filed a report, you're still required to file your own Crash and Insurance Report with the Oregon DMV.

How can I submit my Accident Report to the Oregon DMV?

You have several options for submitting your report:

  • Email to OregonDMVAccidents@odot.oregon.gov
  • Fax to 503-945-5267
  • Mail to DMV Crash Reporting Unit, 1905 Lana Ave NE, Salem, Oregon 97314
  • Deliver in person to a DMV office

Remember to keep a copy of the report and any confirmation of submission for your records.

What if I didn't complete all sections of the report?

Incomplete information can lead to a Notice of Suspension from the DMV. It's crucial to fill out both sides of the form fully, including all details about insurance, vehicles involved, and the crash itself.

What happens if my vehicle is declared "totaled"?

If your vehicle is considered "totaled" after an accident, you must follow specific instructions:

  1. If an insurer covers the damage and declares a total loss, surrender the title to the insurer.
  2. If you keep a vehicle declared a total loss by an insurer, surrender the title to the DMV and apply for a salvage title.
  3. If damage is not covered by an insurer and repair costs are at least 80% of the vehicle's market value before the damage, surrender the title to the DMV and apply for a salvage title.
  4. If unable to obtain the title for any reason, notify the DMV with a signed statement detailing the situation.

What should I do if I'm not an Oregon resident but had an accident in Oregon?

If you are not a resident of Oregon but are involved in a crash in the state that meets the reporting criteria, you are still required to file an Oregon Traffic Crash and Insurance Report with the DMV.

Are there any special instructions for commercial motor vehicle operators?

Yes. If you are operating a commercial motor vehicle and involved in a crash resulting in fatalities, injuries requiring treatment away from the scene, or a vehicle is towed due to disabling damage, you must also fill out a Motor Carrier Crash Report (Form 735-9229) within 30 days of the incident, in addition to the standard Traffic Crash and Insurance Report.

What if additional vehicles were involved in the crash?

If more than two vehicles were involved in the crash, use the attached Supplemental Report (Form 735-32B), or write the information on a separate piece of paper as indicated in the "Other Driver" Section 4 of the form.

What happens if I fail to file a report?

Failing to file a report when required can lead to suspension of your driving privileges. It's important to file within the specified 72-hour period, or as soon as possible if delays prevent timely filing.

Common mistakes

Filling out an Oregon DMV Accident Report form accurately and completely is crucial for individuals involved in a traffic accident within the state. Unfortunately, many people make mistakes during this process, which can lead to delays, inaccuracies in records, or even legal and financial complications. Below are six common errors to avoid:

  1. Not reporting within the required timeframe: Oregon law mandates that the Crash & Insurance Report be filed within 72 hours of the accident. Delaying beyond this period can result in the suspension of driving privileges.

  2. Incomplete sections or missing information: Every section of the form is important. Failing to fill out any part, especially the insurance section, can lead to a suspension notice from the DMV due to incomplete information.

  3. Incorrectly identifying the accident date, location, and time in Section 1: Accurate details are crucial for processing your report. Incorrect or vague information can hinder the DMV's ability to properly document the incident.

  4. Omitting details about additional vehicles involved: If more than two vehicles were involved, it's necessary to complete a Supplemental Report (Form 735-32B) or provide the information on a separate sheet of paper as instructed. Neglecting to do so can lead to incomplete reporting.

  5. Failing to properly describe the accident in Section 5: A detailed and clear description of what happened is essential for the DMV's records. Vague or incomplete descriptions can lead to misunderstandings or inaccuracies in the report.

  6. Submitting the report without a signature and date: The form must be signed and dated to validate the information provided. In cases where the driver is incapacitated, a family member may sign on their behalf, but no other signatures are acceptable.

It is essential for individuals to carefully read the instructions and follow them closely to avoid these common mistakes. Doing so ensures that the report is accepted and processed in a timely manner, which is beneficial for all parties involved. Keeping a copy of the submitted report and any confirmation of submission (such as email autoreplies or fax confirmation reports) is also advisable for personal records.

Documents used along the form

When dealing with an Oregon DMV Accident Report, several other forms and documents might also be necessary to ensure a comprehensive and compliant approach to incident reporting and subsequent tasks. Below is an overview of each document and its purpose.

  • Insurance Claim Form: This document is filed with one's insurance company to initiate a claim process for damages or injury resulting from the accident. It details the incident and requests compensation based on the insurance policy coverage.
  • Medical Records Release Form: In cases of injury, this form authorizes the release of medical records to insurance companies for the purpose of validating injuries and treatment resulting from the accident.
  • Vehicle Repair Estimates: Obtained from auto repair shops, these estimates outline the cost of repairs needed for a vehicle damaged in the accident. They are crucial for insurance claims and personal records.
  • Witness Statements: Written accounts from witnesses of the accident can provide additional insights into how the accident occurred, which can be critical for insurance claims and potential legal proceedings.
  • Police Report Request Form: If law enforcement was involved, a copy of the police report can be requested for personal records, insurance, or legal needs. These reports often contain an officer's assessment of the accident and may assign fault.
  • Personal Injury Log: A document maintained by the injured party detailing their injuries, treatment, recovery process, and how the injuries have impacted their daily life. This can be vital for legal claims and insurance settlements.
  • Motor Carrier Crash Report (Form 735-9229): Specifically for commercial vehicle operators, this form is required in addition to the Oregon Traffic Crash and Insurance Report if the crash involved a commercial motor vehicle and resulted in fatalities, injuries, or disabling damage.

These documents collectively provide a comprehensive record of the accident and its aftermath. It's essential to gather and organize these documents promptly to facilitate the insurance claims process and, if necessary, legal actions. Accurate and thorough documentation can significantly impact the outcome of these processes.

Similar forms

The Oregon DMV Accident Report form shares similarities with various other legal and insurance documents, each serving a unique purpose but comparable in certain aspects.

One similar document is the Police Accident Report. Filed by law enforcement officers who respond to the scene, this report details the officer’s observations of the crash, including damages and possible contributing factors. While the Oregon DMV Accident Report is self-reported by the drivers involved, both documents serve to officially record the event and its circumstances.

Another document resembling the Oregon DMV Accident Report is the Insurance Claim Form. Drivers involved in an accident must often fill out this form for their insurance company. Like the DMV report, it includes details about the crash, the extent of damage, and personal information. Both are crucial for the initiation of the insurance claims process.

The Personal Injury Claim Form, used when an individual seeks compensation for injuries sustained in an accident, also bears resemblance. It requires detailed information about the accident and the injuries, similar to the injury reporting section of the DMV Accident Report, to support the claim.

Vehicle Damage Assessment Forms, typically used by insurance companies or auto repair shops, focus on assessing the extent and cost of damage to a vehicle. While more narrowly focused, these forms share the objective of documenting the financial impact of an accident, akin to the damage assessment in the Oregon DMV Accident Report.

The Motor Carrier Crash Report form is specifically required for commercial vehicle incidents in Oregon and must be filed along with the DMV Accident Report in certain cases. Both forms collect detailed information about the crash but the Motor Carrier version includes aspects relevant to commercial transport regulations.

The Application for Salvage Title, necessary when a vehicle is deemed a total loss (or "totaled"), shares the aftermath process of a significant accident. The DMV Accident Report can trigger the need for a Salvage Title application if the vehicle is beyond repair, linking these documents in the post-accident resolution process.

Driver’s Exchange of Information Form, often completed at the accident scene, allows involved parties to share essential information for insurance purposes. While not as comprehensive as the DMV Accident Report, it serves as an immediate way to document and exchange crucial details necessary for all subsequent reports and claims.

The SR-22 Certificate of Financial Responsibility is required for drivers to reinstate their driving privileges after suspensions not directly related to an accident. However, failure to file an Accident Report can lead to a suspension requiring an SR-22 filing, intertwining their purposes in maintaining or restoring legal driving status.

Lastly, the Notice of Suspension by DMV, which might be issued if a driver fails to submit their Accident Report, represents a legal consequence stemming from negligence in following post-accident obligations. While one is a mandatory form post-accident, the other is a possible outcome of failing to comply with that mandate.

Dos and Don'ts

Filing an Oregon DMV Accident Report accurately and promptly is essential. Following the guidelines can ensure that your report is properly processed and that you avoid potential penalties. Here are critical dos and don’ts you should be aware of:

Things You Should Do

  • Report promptly: Ensure the report is filed within 72 hours of the accident, as required by Oregon law. If this timeframe is not feasible, submit it as soon as you can.
  • Provide complete and accurate information: Fill out every section of the form thoroughly. Use black or dark blue ink and press firmly to ensure legibility. Your information should reflect the crash accurately to prevent any misunderstandings.
  • Include detailed vehicle and insurance information: It is vital to provide the full details of the involved vehicle(s) and your insurance coverage. Failure to do so can lead to a Notice of Suspension.
  • Describe the accident clearly: When detailing the crash in Section 5, be precise and comprehensive about what happened. This description is vital for the DMV's records.
  • Sign and date the form: Your signature validates the report. If the driver is unable to sign due to physical incapacitation, a family member can sign on their behalf. No other signatures will be accepted.
  • Keep a copy of the submitted report: After submitting your report to the DMV via email, fax, mail, or in person, ensure you retain a copy for your records. This proof of submission may be required in the future.

Things You Shouldn't Do

  • Avoid leaving sections incomplete: Failing to fill out any part of the report can result in a Notice of Suspension. Each section gathers crucial data, so it's important to provide as much information as possible.
  • Don’t provide false information: All information on the report should be truthful and accurate to the best of your knowledge. Providing false information may lead to penalties.
  • Don’t miss out on detailing all vehicles involved: If the accident involved more than two vehicles, use the attached Supplemental Report (Form 735-32B) to ensure all vehicles are accounted for.
  • Don’t forget to describe the crash location and time correctly: Accurately identifying the crash date, time, and location is critical for the processing of your report. Make sure these details are correct.
  • Avoid submitting without checking for errors: Review your completed form for any mistakes or omissions before submitting. This check can prevent delays in your report’s processing.
  • Don’t disregard the requirement to report: Even if a police report is filed, you must still submit your own Crash and Insurance Report to the DMV. Non-compliance can result in suspension of driving privileges.

Misconceptions

Misunderstandings about the Oregon DMV Accident Report form can complicate an already stressful situation for those involved in a traffic crash. By clarifying these misconceptions, individuals can better navigate the process of reporting their accident to the Oregon Department of Motor Vehicles (DMV). Below are five common misconceptions and the truths behind them:

  • If the police report the accident, I don't need to file an Oregon DMV Accident Report form. This is a misunderstanding. Even if a police report is filed, drivers involved in a crash that meets certain criteria – such as damage over $2,500 to any vehicle or property, injury, death, or any vehicle towed from the scene – are still required to submit their own report to the DMV within 72 hours.

  • The DMV will use the report to determine who was at fault in the crash. The Oregon DMV does not determine fault when processing these accident reports. The DMV's role is to maintain records, which include posting the crash to the driving records of those drivers required to report. Fault is determined by insurance companies or through legal proceedings if necessary.

  • Completing the report partially is sufficient. Failing to complete all sections of the DMV Accident Report form can lead to a Notice of Suspension. It's crucial to provide detailed and accurate information on both sides of the form, including full insurance details and any other vehicles involved.

  • If my vehicle is "totaled," I should submit the title with my crash report. If your vehicle is considered "totaled," you should not submit the title with your crash report. Instead, follow the specific instructions for totaled vehicles, which may include surrendering the title to the insurer or the DMV, or notifying the DMV if obtaining the title is not possible.

  • I can get a copy of my report from the DMV after I file it. Under ORS 802.220(5), the Oregon DMV is not authorized to provide you with a copy of the accident report you file. It's important to keep a copy of the report and any confirmation of submission for your records.

Understanding these key aspects of the Oregon DMV Accident Report process helps ensure that individuals comply with legal requirements and support the accurate documentation of traffic crashes within the state.

Key takeaways

Filling out the Oregon DMV Accident Report form correctly is vital for drivers involved in a traffic crash. Here are some key takeaways to guide you through the process:

  • The report is mandatory for crashes involving injury, death, vehicle damage over $2,500, or towed vehicles due to damage.
  • Oregon law stipulates the report must be filed within 72 hours of the incident. Filing late can lead to a suspension of driving privileges.
  • Even if a police report is filed, drivers must still submit this form to the DMV.
  • Complete accuracy and providing all requested information, including insurance details, on both sides of the form are crucial to avoid penalties.
  • If additional vehicles are involved, use the Supplemental Report (Form 735-32B) to provide details on other drivers and vehicles.
  • Be clear and detailed in the description of the accident when completing section 5 of the form. This includes signing and dating the form properly.
  • For "totaled" vehicles, follow specific instructions based on whether an insurer covers the loss or if the vehicle's repair costs exceed a certain value of its retail market value.

Remember, the DMV uses this report to document the crash but does not determine fault. It is recommended to keep a copy of the report and any submission confirmation as a record. If you have questions or need further assistance, the DMV Crash Reporting Unit is available to help.

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