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In the event of a motor vehicle accident in Minnesota involving $1,000 or more in property damage, or resulting in injury or death, drivers are mandated to complete the Minnesota Motor Vehicle Accident Report form, PS 32001 - 08, and submit it to the Driver and Vehicle Services within a deadline of 10 days. This requirement underscores the state's commitment to road safety by using the collected information to enhance traffic conditions and prevent future accidents. Failure to comply with this directive constitutes a misdemeanor under Minnesota Statute 169.09, subdivision 7, highlighting the seriousness with which the state treats such events. The form provides a comprehensive framework for documenting vital details about the accident, including the date, time, location, driver and vehicle information, specifics of the crash, weather conditions, and a section for a narrative and diagrammatic explanation of the event. Additionally, it adheres to the Minnesota Data Privacy Act, reassuring submitters that the information provided will be used purely for statistical analysis while protecting their personal details from being used against them in legal proceedings. Drivers are also reminded to give a complete account of their liability insurance; otherwise, it might be assumed that they were uninsured at the time of the accident. This form serves as a crucial tool in the broader effort to understand and mitigate the impacts of road accidents in Minnesota.

Minnesota Accident Report Example

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

Form Characteristics

Fact Name Detail
Reporting Requirement Every driver involved in a crash with $1,000 or more in property damage, or injury or death, must complete the Minnesota Motor Vehicle Accident Report.
Submission Deadline The completed form must be sent to Driver and Vehicle Services within 10 days of the accident.
Legal Consequence for Non-Compliance Failure to provide this information is a misdemeanor under Minnesota Statute 169.09, subdivision 7.
Data Privacy The information collected on the form is used for statistical data on traffic accidents and is protected under the Minnesota Data Privacy Act.

Steps to Writing Minnesota Accident Report

When involved in a crash in Minnesota with $1,000 or more in property damage, or any injury or death, it's crucial to complete and submit the Minnesota Motor Vehicle Accident Report to Driver and Vehicle Services within 10 days. This action not only fulfills legal obligations but also contributes to road safety initiatives by providing vital data for improvements. Failure to do so is considered a misdemeanor. Understanding how to properly fill out this form ensures the process is smooth and compliant with state laws.

  1. Visit www.mndriveinfo.org to access the E-form version of the Minnesota Motor Vehicle Accident Report (PS 32001 - 08).
  2. Enter the accident details including Date (Month/Day/Year), Day of Week, Time (AM/PM), and the Total Number of Vehicles Involved.
  3. Specify the Accident Location by choosing the correct option and providing the required information such as County, City or Township, and precise location details based on whether it was at an intersection, not at an intersection, or in a parking lot.
  4. Fill in Driver's Information including full name, address, license number, state of issue, date of birth, sex, and the vehicle details: owner's name, license plate number, vehicle type, make, model, year, color, and number of occupants.
  5. Provide detailed Insurance Information, including the name of the insurance company (not agency), policy number, and policy period dates.
  6. In the section allocated for Other Vehicle(s), if applicable, repeat step 4 with the other driver’s and vehicle's information.
  7. For accidents involving more than two vehicles, fill out section “C” on a separate form and attach it to the original report.
  8. Identify the Type of Accident by entering the number for the correct response regarding the collision type, and if the crash occurred in a work zone, including speed limits and weather/atmosphere conditions.
  9. Highlight the Traffic Control Device present and the Manner of Collision by indicating the specific circumstances.
  10. Describe actions and maneuvers prior to the accident for both your vehicle and any other vehicle(s) involved.
  11. Fill in the direction of travel prior to the accident for any pedestrians or bicyclists involved.
  12. Complete the section about police presence at the scene by indicating whether an officer was there and what department they were from.
  13. Under the Occupant Information section for your vehicle, provide detailed information for the driver and any passengers including date of birth or age, sex, seat type, use of safety equipment, airbag deployment, ejection from the vehicle, and injury, if any.
  14. Describe the accident in detail in the provided space, including a diagram if necessary, and list any damage to property other than vehicles involved.
  15. Sign the form, indicating your acknowledgement and the accuracy of the information provided. Add your address and the date of the report.
  16. Mail the completed form to DVS / Accident Records, 445 Minnesota Street, Suite 181, St. Paul, MN 55101-5181.

Upon submitting the form, your report will be reviewed by the Driver and Vehicle Services division to ensure all necessary information has been provided and to process the data for statistical use. Keep a copy of the form for your records. Remember, this report cannot be used against you in any civil or criminal matter, as protected under the Minnesota Data Privacy Act.

Listed Questions and Answers

FAQ: Minnesota Accident Report Form

  1. Who needs to fill out the Minnesota Motor Vehicle Accident Report form?

    All drivers involved in an accident that results in either injury, death, or property damage totaling $1,000 or more are required to complete the Minnesota Motor Vehicle Accident Report form.

  2. What is the deadline for submitting the accident report form in Minnesota?

    The completed accident report form must be submitted to the Driver and Vehicle Services (DVS) within 10 days of the accident.

  3. What are the consequences of not reporting an accident in Minnesota?

    Failure to submit the accident report form for a qualifying event is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7. Such an offense could result in criminal charges.

  4. Can the information on the accident report form be used against me in court?

    No, the information you provide on the accident report form is collected for statistical purposes related to road safety and cannot be used against you as evidence in any civil or criminal matter. Additionally, your account of how the accident happened is considered confidential.

  5. What should I do if there were more than two vehicles involved in the accident?

    If the accident involved more than two vehicles, you must fill out Section “C” on an additional form for each vehicle beyond the first two and attach it to the main form.

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

    The completed form should be mailed to: DVS / Accident Records, 445 Minnesota Street, Suite 181, St. Paul, MN 55101-5181.

  7. Is there an electronic version of the Minnesota Accident Report form available?

    Yes, an electronic version of the form, known as the E-form, is available online at www.mndriveinfo.org. Using the electronic version may simplify the submission process and ensure quicker delivery to the DVS.

Accurately completing and promptly submitting the Minnesota Accident Report form is crucial for all drivers involved in significant accidents. Complying with this requirement not only adheres to state laws but also contributes to efforts aimed at making roads safer for everyone.

Common mistakes

  1. One common error is not filling in all the required fields with the correct information. This includes details like the date, time, and location of the accident, as well as personal information such as full name, address, driver's license number, and insurance details. Omitting or inaccurately providing any of this information can lead to delays or complications in processing the accident report.

  2. Incorrectly identifying the location of the accident is another mistake. The form requires the driver to specify whether the incident occurred at an intersection or not and to provide precise location details, including street names or road numbers and the distance and direction from specific landmarks. Confusion or vague descriptions in this section can hinder proper documentation and analysis of the event.

  3. Failing to give complete insurance information is a significant oversight. If the driver does not provide the name of the insurance company, policy number, and policy period, it might be assumed that the driver did not have valid insurance at the time of the accident. This assumption can lead to legal and financial repercussions.

  4. Another mistake involves inaccurately describing or leaving out details of the vehicle damage. The form asks for an estimate of the cost to repair the vehicle and requires information about the parts of the vehicle that were damaged. Failure to accurately estimate the damage or omitting this information can affect claims processing.

  5. Misrepresenting or failing to document the accident circumstances and the vehicles' maneuvers before the accident is a common error. This part of the report provides essential insights into how the accident occurred and helps determine fault and liability. Incorrect or incomplete descriptions can compromise the accuracy of the report.

  6. Not using the provided codes for injury severity, type of crash, vehicle maneuvers, traffic conditions, and weather conditions is another frequent mistake. These codes help standardize reports for statistical analysis and clarity. Misinterpreting these codes or neglecting to use them can lead to misunderstandings about the accident's severity and conditions.

  7. Finally, not signing or dating the report is a critical oversight that can invalidate the submission. The signature attests to the accuracy of the information provided and is a legal requirement for processing the accident report. Failing to sign or incorrectly dating the report can lead to its rejection and potential legal penalties.

Documents used along the form

When dealing with an automobile accident in Minnesota, especially one requiring the completion of the Minnesota Motor Vehicle Accident Report, it's important to be prepared with all necessary documentation for a comprehensive claim or report. Alongside the accident report, several other forms and documents are frequently required to fully process incidents, claims, or legal matters related to the event.

  • Proof of Insurance: Documentation verifying that the vehicle involved in the accident was insured at the time of the mishap. This often needs to include policy numbers and coverage details.
  • Medical Records: If injuries occurred as a result of the accident, detailed medical records and bills related to the treatment of these injuries are crucial.
  • Witness Statements: Written accounts from people who observed the accident can be crucial for establishing the facts around the incident.
  • Photographs of the Accident Scene: Pictures can provide clear evidence of road conditions, vehicle positions, and property damage at the accident scene.
  • Repair Estimates: Professional assessments of the damage to the vehicles involved, outlining the cost of necessary repairs.
  • Police Report: An official report filed by the police provides an authoritative account of the accident and may include determinations of fault.
  • Driver's License Information: Copies of the driver's licenses of all parties involved in the accident.
  • Vehicle Registration: Documentation proving the current registration status of the vehicle(s) involved in the accident.

Having these documents readily available can significantly streamline the process of reporting an accident, dealing with insurance companies, and addressing any legal implications. Proper documentation supports the facts of the case and ensures that all parties involved have a clear understanding of the circumstances and outcomes of the accident.

Similar forms

The Minnesota Motor Vehicle Accident Report form shares similarities with other official reports and documentation used in various sectors and circumstances. These documents, while tailored to their specific contexts, follow a general pattern of collecting detailed information for the purpose of analysis, accountability, regulation, or law enforcement. Below are nine documents that are similar to the Minnesota Accident Report form in their structure and purpose.

One example is the Police Incident Report, used by law enforcement to document the details of a crime or incident. Like the accident report, it gathers comprehensive information about the parties involved, the location, and the specifics of the event. This information is crucial for both the investigation process and as a record for future reference.

Another related document is the Workers' Compensation Claim form. Workers who get injured on the job fill out this form to report the incident. It captures personal information, details of the injury, and circumstances leading to the incident, paralleling the structured data collection seen in the accident report to determine eligibility for compensation benefits.

Similarly, the OSHA (Occupational Safety and Health Administration) Accident Report form is used in workplaces to report incidents that result in injury, illness, or death. This form helps in analyzing workplace safety and health conditions, underlining the importance of gathering detailed accounts of incidents, akin to the vehicle accident report’s role in road safety analysis.

The Insurance Claims Form is also akin to the accident report, as it is used by policyholders to report incidents covered by their insurance policy. It collects detailed information about the incident, damage, and parties involved, essential for claim processing and determination of liability or coverage, illustrating the focus on contractual and financial accountability similar to assessing road incidents.

A Flight Incident Report, used by the aviation industry, records occurrences on board or involving aircraft that may affect safety. Much like the road accident report, it compiles comprehensive details about the incident to improve future safety protocols and for regulatory compliance.

The Maritime Accident Report, used for incidents at sea, collects exhaustive information about maritime accidents, including vessel details, crew information, and the sequence of events leading to the incident. This detailed documentation aids in enhancing maritime safety and navigating regulatory requirements, mirroring the road accident report's objectives on waterways.

Another comparable document is the FDA (Food and Drug Administration) Adverse Event Reporting form, which documents adverse reactions or quality issues with FDA-regulated products. This form's systematic collection of detailed incident information is vital for public health safety, akin to how accident reports support road user safety.

The Product Safety Complaint form, used by consumers to report unsafe products, also shares similarities. It details the product fault, the incident, and any injuries, providing essential data for safety standards and recalls, emphasizing the role of detailed reports in consumer protection, like the accident report's role in vehicular safety.

Lastly, the Environmental Incident Report form, used to document incidents impacting the environment, like pollution or wildlife disturbances, collects details about the incident's nature, cause, and effects. This parallels the accident report's goal of collecting data to prevent future occurrences and manage risks, focusing on environmental protection.

Overall, while each document serves a specific sector or purpose, their fundamental similarity lies in their structured approach to gather detailed and specific information following incidents. This data collection is crucial for analysis, decision-making, policy formulation, and enforcement in their respective fields, much like the Minnesota Motor Vehicle Accident Report form's role in road safety and legal compliance.

Dos and Don'ts

When you're involved in a motor vehicle accident in Minnesota and there's $1,000 or more in property damage, or anyone is injured or dies, it's crucial to fill out the Minnesota Accident Report Form correctly. Here are some essential dos and don'ts to help you through the process:

    Do:
  • Report the accident promptly. Fill out and send the form to Driver and Vehicle Services within 10 days of the accident. Timeliness is crucial to ensure all details are accurate and fresh in your memory.
  • Provide detailed information. Include specifics about the accident's location, the number of vehicles involved, and a thorough description of what happened. Ambiguities can delay processing and could impact any findings.
  • Be honest. Accurate reporting of the circumstances and your actions is vital. This honesty also extends to injuries and damages.
  • Include insurance information. Make sure to give full liability insurance details. An omission might mistakenly suggest you weren't insured at the time of the accident.
  • Review for accuracy. Before submission, double-check all entered information for errors or omissions. This check includes verifying personal information, accident details, and insurance specifics.
    Don't:
  • Delay in submitting the form. Failing to send the report within 10 days can lead to penalties under Minnesota law. A misdemeanor charge is possible if this deadline isn't met.
  • Skip details. Leaving out important information regarding the accident's context, vehicle damage, or personal injuries can complicate the assessment for safer roads and legal purposes.
  • Guess or estimate details. If you're unsure about certain aspects, such as the exact speed or distance, look for any available evidence or witnesses instead of guessing. Incorrect information can be misleading.
  • Forget about other involved parties. If more than two vehicles are involved, use additional forms as needed. Ensure every affected party and vehicle is accounted for in your report.
  • Use the form as evidence against others. Remember, this report is for statistical data and safety improvements. It's not meant to be used as evidence in civil or criminal matters against others involved in the accident.

Misconceptions

Many individuals have misunderstandings regarding the Minnesota Motor Vehicle Accident Report form, which can lead to confusion and errors when attempting to comply with state requirements after a vehicle collision. Here are six common misconceptions:

  • Insurance proof isn't necessary at the time of the report. Contrary to some beliefs, failure to provide full liability insurance information on the report might lead others to assume you were uninsured at the time of the accident. This could bear significant legal and financial consequences.
  • The report is only for major accidents. In reality, any crash involving $1,000 or more in property damage, or any injury or death, requires completion and submission of this form, not just those perceived as severe.
  • Submitting the report is optional. Minnesota law mandates that the driver involved in such accidents must complete and send this form to Driver and Vehicle Services within 10 days. Failure to do so is classified as a misdemeanor.
  • The information can be used against you in court. The information provided on the form is used for statistical data to enhance road safety and is protected by the Minnesota Data Privacy Act. The details of the report, including your version of how the accident occurred, are confidential and cannot be used as evidence in any civil or criminal matter against you.
  • Only the vehicle driver needs to fill out the form. Although the driver is responsible for reporting, information about every vehicle and individual involved (including passengers) must be included to accurately report the circumstances and consequences of the accident.
  • All sections must be filled for every accident. The form's design allows for different types of collisions and scenarios. Depending on the nature of the accident, not every section will be relevant. The most important aspect is to provide a comprehensive account of the event, including any injuries, damages, and the involvement of other entities such as pedestrians or fixed objects.

It’s essential for drivers in Minnesota to understand how to correctly complete and submit the Accident Report form to ensure compliance with state laws, protect themselves legally, and contribute to the overall safety of Minnesota roads.

Key takeaways

Understanding and accurately completing the Minnesota Accident Report form is crucial for all drivers involved in a crash that results in $1,000 or more in property damage, or any injury or death. Here are key takeaways to guide you through the process:

  • All involved drivers must fill out and submit the form to Driver and Vehicle Services within 10 days of the accident.
  • Failing to provide the completed form is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7.
  • The information furnished on the form assists in the development of safer roadways by informing statistical analysis and infrastructure improvements.
  • The form requires detailed information about the accident, including the location, date, time, and conditions under which the accident occurred.
  • It's important to accurately describe the accident and damage to vehicles, as well as provide a comprehensive list of all involved parties’ names, addresses, and insurance details.
  • Incorrect or incomplete insurance information can lead to the assumption that the involved party did not have insurance coverage.
  • The form includes sections for documenting the type of accident, weather conditions, road surface conditions, and the manner of collision, which help in understanding the factors contributing to the accident.
  • Personal information, such as names and insurance details, may be disclosed to those involved in the accident or other authorized individuals as specified by law, in accordance with the Minnesota Data Privacy Act.
  • Submitting this form does not expose the individual to civil or criminal liability from the report's contents; the account of how the accident occurred is kept confidential.

Ensuring the Minnesota Accident Report form is fully and accurately completed not only fulfills a legal obligation but also contributes to road safety improvements that can prevent future accidents.

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