Minnesota Accident Report Template Access Minnesota Accident Report Editor Now

Minnesota Accident Report Template

The Minnesota Accident Report form, officially known as Minnesota Motor Vehicle Accident Report PS 32001 - 08, plays a crucial role in enhancing road safety. It is a mandatory document for drivers involved in crashes that result in property damage of $1,000 or more, or in cases of injury or death, requiring submission to Driver and Vehicle Services within 10 days. Failing to submit this form is considered a misdemeanor, highlighting the importance of accurately and promptly reporting the incident.

To ensure you're contributing to the safety of Minnesota's roads and adhering to state requirements, click the button below to learn more about how to fill out and submit the Minnesota Accident Report form.

Access Minnesota Accident Report Editor Now
Table of Contents

In Minnesota, the aftermath of a motor vehicle accident can be as challenging as the event itself, especially when it comes to navigating legal requirements. The Minnesota Motor Vehicle Accident Report form, identified by its code PS 32001 - 08, serves a critical purpose in this process. It's designed not just for record-keeping but also for improving road safety by collecting data on traffic accidents. This form must be completed by every driver involved in a crash that results in $1,000 or more in property damage or any injury or death. The report must then be submitted to the Driver and Vehicle Services within ten days of the incident. Neglecting to fill out this form is considered a misdemeanor, highlighting the state's seriousness about gathering accurate accident data. The form itself requests detailed information, including personal details of the drivers involved, descriptions of the vehicles, the accident's circumstances, and insurance information. Importantly, it also asks for a narrative of how the accident happened and a diagram if possible, which helps in understanding the dynamics of the crash. It specifies that this information aids in building safer roads and outlines the legalities of data privacy concerning the report, reassuring drivers that the details provided cannot be used against them in civil or criminal matters, thus emphasizing both the importance of compliance for public safety and the protection of individual rights.

Form Preview

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 Breakdown

Fact Name Description
Form Identification Minnesota Motor Vehicle Accident Report PS 32001-08
Purpose Information from this report is used to help construct safer roads.
Reporting Requirement Drivers involved in a crash with $1,000 or more in property damage, or any injury or death, must complete and send this form to Driver and Vehicle Services within 10 days.
Penalty for Non-Compliance Failure to provide the required information is classified as a misdemeanor under Minnesota Statute 169.09, subdivision 7.
Online Submission An electronic version of the form is available at www.mndriveinfo.org.
Data Privacy As stated by the Minnesota Data Privacy Act, information collected is for statistical data on traffic accidents, with certain disclosures allowed by law, and cannot be used against the individual in any civil or criminal matter.

Guidelines on Filling in Minnesota Accident Report

When involved in a vehicle accident in Minnesota that results in property damage of $1,000 or more, injury, or death, it's necessary to complete the Minnesota Motor Vehicle Accident Report form. This documentation is crucial for building safer roads and infrastructure by providing vital data to the Driver and Vehicle Services (DVS). The law mandates that this form be submitted within 10 days of the accident, and failing to do so can lead to misdemeanor charges. It's important to fill out this form accurately to ensure all details about the crash are correctly reported. The information you provide will contribute to traffic safety research and may also be used in legal or insurance matters, although it cannot be used against you in civil or criminal proceedings. Here is a step-by-step guide to completing this form.

  1. Accident Information: Start by filling out the basic details of the accident including the date, time (AM/PM), number of vehicles involved, and the accident's location. Indicate whether the accident occurred in the city, township (TWP), or county.
  2. Location Details: Mark whether the incident occurred at an intersection, not at an intersection, or in a parking lot. Specify the exact location using the provided fields for street names or road numbers, and include distance and direction if applicable.
  3. Driver Information: Provide the complete name, address, and contact information of the driver involved in the accident. Include driver’s license number, class, state of issuance, date of birth, and sex.
  4. Vehicle and Owner Details: Enter the vehicle's make, model, year, color, license plate number, state of issue, and estimate the cost of repairs. Also, include the full name and address of the vehicle’s owner if different from the driver.
  5. Insurance Information: It's crucial to provide accurate insurance details, including the insurance company name, policy number, and the policy period. Omitting this information might lead to an assumption of no insurance coverage.
  6. Accident Description: Check the appropriate box that describes the accident type, such as collision with another motor vehicle, fixed object, or non-collision incident. Also, specify if the crash occurred in a work zone, the speed limit, weather conditions, road surface, and light conditions.
  7. Traffic Control and Collision Details: Indicate the type of traffic control device present and the manner of collision according to the details given. If applicable, include information about any work zone, weather, road surface, and light conditions.
  8. Vehicle Actions/Maneuvers Prior to Accident: Mark actions or maneuvers taken by the vehicle(s) involved just before the accident. Be accurate in detailing the direction of travel or any specific movements.
  9. Police and Report Details: State whether a police officer was at the scene and fill in the police department's name if applicable.
  10. Involvement and Injury Information: For each person in the vehicle, provide details about their position in the car, use of safety equipment, and if any injuries were sustained.
  11. Description and Diagram of Accident: Use the space provided to accurately describe the accident and draw a diagram to represent how the incident occurred. Indicate the compass direction (North, South, etc.) with an arrow.
  12. Damage to Property: If applicable, list any non-vehicle property damaged in the accident, the owner's name, and the estimated cost of repair.
  13. Signature and Submission: Sign the report to verify that the information provided is accurate and submit it to the DVS Accident Records at the address provided on the form. Remember, the signature of the person submitting the report is required.

Filling out the Minnesota Motor Vehicle Accident Report form with attention to detail and accuracy is essential for road safety analytics and legal compliance. Prompt submission of this completed document ensures that necessary measures can be taken to investigate and, where possible, prevent future incidents.

Learn More on Minnesota Accident Report

Minnesota Accident Report Form FAQ

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

Any driver involved in a crash resulting in either $1,000 or more in property damage, personal injury, or death must complete the Minnesota Motor Vehicle Accident Report form.

Where can I find the Minnesota Accident Report form?

The form is available online at www.mndriveinfo.org or you can obtain a physical copy from the Driver and Vehicle Services (DVS) or local police stations.

What is the deadline to submit the Minnesota Accident Report form?

The form must be submitted to the Driver and Vehicle Services within 10 days from the date of the accident.

What happens if I don't submit the form on time?

Failing to submit the form within the 10-day period is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7. This could potentially lead to legal penalties.

Can the information I provide in the report be used against me?

No, the information collected on this form is used for statistical data regarding traffic accidents. Your personal account of the accident is kept confidential and cannot be used against you in any civil or criminal proceedings.

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

If the accident involved more than two vehicles, you should fill in section “C” on a separate form for each additional vehicle and attach it to your original report.

Do I need to report an accident that occurred in a parking lot?

Yes, if the accident meets the criteria of involving $1,000 or more in property damage, injury, or death, it must be reported, regardless of whether it occurred on a public street or in a parking lot.

What information will I need to complete the report?

You will need detailed information about the accident, including but not limited to:

  • Exact location and time of the accident
  • Names, addresses, and insurance details of the drivers involved
  • Description of the accident and vehicles involved
  • Estimates of property damage

Is it mandatory to draw a diagram of the accident?

While the form provides space for a diagram, it's highly recommended to include one as it helps in understanding the dynamics of the accident. However, if you're unable to draw a diagram, providing a detailed written description is essential.

Where do I send my completed Minnesota Accident Report form?

After completing the form, mail it to the DVS/Accident Records at the address provided:
DVS / Accident Records
445 Minnesota Street, Suite 181
St. Paul, MN 55101-5181.

Common mistakes

When filling out the Minnesota Accident Report form, individuals often encounter complexities, leading to mistakes that can affect the accuracy and completeness of the report. Recognizing and avoiding these common errors can significantly improve the quality of the information provided to Driver and Vehicle Services. Here are six common mistakes:

  1. Not reporting within the required timeframe: The form must be submitted within 10 days following an accident if it involves $1,000 or more in property damage, or if there is injury or death. Delaying submission can lead to legal consequences under Minnesota Statute 169.09, subdivision 7.

  2. Omitting details about the accident's location: It's crucial to specify whether the crash occurred at an intersection or not and to provide exact street names or road numbers. Accurate location data is essential for analysis aimed at making roads safer.

  3. Failing to provide complete insurance information: If the insurance company name (not agency) or policy number is left blank, it may be assumed that the vehicle was uninsured. This might complicate issues related to coverage and liabilities.

  4. Inaccurate or incomplete descriptions of the accident: Individuals must describe the accident in detail, including how it happened. This description is vital for understanding the circumstances that led to the accident and for determining responsibility.

  5. Incorrectly identifying the type of accident: The form requires selecting the type of collision from a given list. Choosing the wrong type can misrepresent the nature of the accident and affect subsequent analyses and investigations.

  6. Leaving the driver and passenger section incomplete: Every individual in the vehicle needs to be listed, along with their seat positions and any injuries sustained. Missing or incorrect information here might lead to inaccurate records of the accident's impact on those involved.

To ensure the accuracy and completeness of the Minnesota Accident Report form, individuals should carefully review each section, provide precise details as required, and comply with the submission deadline. Taking these steps helps facilitate a thorough evaluation of the accident and contributes to the statewide efforts in building safer roads.

Documents used along the form

When an individual is involved in a motor vehicle accident in Minnesota, promptly completing and submitting the Minnesota Accident Report form is key. However, to fully document the incident and its aftermath, several other forms and documents might be necessary. These additional documents help in ensuring that all aspects of the accident, from damage assessment to insurance claims, are thoroughly addressed.

  • Insurance Claim Form: This form is submitted to your insurance company to initiate a claim. It details the accident and requests compensation for damages or injuries.
  • Medical Records Release Form: After an accident, this form authorizes healthcare providers to release your medical records to insurers or attorneys, proving injury and treatment.
  • Vehicle Damage Estimate: Obtained from a mechanic or auto body shop, this document provides an estimate of the repair costs for vehicles damaged in the accident.
  • Witness Statement Form: Witnesses to the accident can provide statements on this form, documenting their account of the incident, which can be crucial for insurance claims or legal actions.
  • Police Report Request Form: If the police investigated the accident, this form is used to request a copy of their report, providing an official account of the incident.
  • Photographs of the Accident Scene and Damages: Visual evidence of the accident scene and damages to vehicles or property, supporting claims and reports.
  • Personal Injury Log: A document where the injured party keeps detailed records of their injuries, treatment, and recovery progress.
  • Release of Liability Form: This form, signed by the parties involved, releases each other from future claims related to the accident once a settlement is reached.

In navigating the aftermath of a motor vehicle accident, being prepared with the correct forms and documents can significantly streamline the process of recovery and compensation. Equipping yourself with these essential documents not only aids in the immediate response following an accident but also assists in the meticulous documentation needed for any subsequent legal or insurance procedures.

Similar forms

  • The California Traffic Accident Report shares similarities with the Minnesota Accident Report form in that both require detailed information about the accident, including the date, location, and how the accident occurred. They also collect data on the vehicles involved, such as make, model, and year, along with driver information, including name, address, and insurance details.

  • The Florida Traffic Crash Report is similar because it also mandates that drivers involved in accidents resulting in a certain amount of property damage, injury, or death must file a report. This form, like Minnesota’s, requests comprehensive details about the accident conditions, including weather, road conditions, and the sequence of events leading to the collision.

  • New York Motor Vehicle Accident Report requires the completion by individuals involved in accidents with significant damage or injuries, akin to the Minnesota form. Both documents make it necessary to outline specifics about the accident scene and demand insurance information, driver and vehicle details, and an account of damages and injuries.

  • The Texas Peace Officer’s Crash Report is paralleled with the Minnesota report in that it is designed to collect extensive data on motor vehicle accidents for safety and statistical analysis. Each form includes sections on the timing and environment of the crash, participant information, and a narrative description of the accident.

  • Illinois Motorist Report is reconcilable with Minnesota's requirement that drivers report accidents exceeding a certain damage threshold. Both seek information on the accident location, involved parties, insurance status, and vehicle damage, along with a schematic diagram or narrative of the accident.

  • The Ohio Traffic Crash Report demands thorough documentation similar to Minnesota's, including data about the crash circumstances, participants, vehicle information, and detailed reporting of any injuries or fatalities. It too serves a dual purpose of legal record and data collection for traffic safety.

  • Washington State Motor Vehicle Collision Report aligns with Minnesota’s form as it compels drivers involved in significant accidents to provide detailed accounts of the incident. These include descriptions of the collision, information on the drivers and vehicles involved, and details on the accident’s context like weather and road conditions.

Dos and Don'ts

When you're filling out the Minnesota Accident Report form, there are important steps to follow to ensure your report is complete and accurately reflects the incident. Here are four things you should do and four things you shouldn't do:

What you should do:
  • Provide detailed information: Be as specific as possible when describing the accident. Include all relevant details such as how the accident occurred, the speed you were traveling, weather conditions, and any other contributing factors.
  • Check for accuracy: Before submitting the report, review all the information you've entered to make sure it's correct. A small mistake could have significant implications.
  • Include insurance information: It's critical to provide full liability insurance information. If you don't, it may be assumed that you were not insured at the time of the accident.
  • Sign the report: Your signature is required at the bottom of the form. By signing, you confirm that the information provided is accurate to the best of your knowledge.
What you shouldn't do:
  • Leave sections blank: If a section of the report doesn't apply to your specific accident, rather than leaving it blank, it's better to indicate that it's not applicable. This shows that you didn't simply overlook a part of the form.
  • Guess or estimate: When providing details about the accident, avoid making guesses or estimates. If you're unsure about specific information, such as the exact speed you were traveling, note that it's an approximation or find out the accurate information before submitting.
  • Ignore diagrams and additional information sections: The space provided to diagram the accident and the section for additional information can be incredibly useful for explaining what happened. Don't ignore these sections; use them to your advantage to provide a clear picture of the incident.
  • Forget to report within 10 days: According to Minnesota law, you must submit this report within 10 days of the accident if there was $1,000 or more in property damage, or if the accident resulted in injury or death. Failing to do so is a misdemeanor.

Misconceptions

There are several misconceptions about the Minnesota Accident Report form that individuals involved in vehicle accidents often encounter. Understanding these can help in accurately completing the form and ensuring compliance with Minnesota law.

  • Misconception 1: The report is optional for minor accidents. In reality, any crash involving $1,000 or more in property damage, or any injury or death, requires the completion and submission of this form within 10 days.

  • Misconception 2: Only the driver at fault needs to complete the form. However, every driver involved in such an accident must complete and submit a report, regardless of fault.

  • Misconception 3: Insurance information is not mandatory. Failing to provide full liability insurance information may lead to the presumption of not having insurance, which can carry legal consequences.

  • Misconception 4: Personal injury lawyers can use this report in court. The report is protected under the data privacy act, meaning the information cannot be used as evidence in civil or criminal matters, and all narratives or depictions of the accident are confidential.

  • Misconception 5: Police must be at the scene to complete the report. Whether or not police were present or a police report was made, drivers must still fill out and submit the Minnesota Accident Report form if the damage or injuries meet the criteria.

  • Misconception 6: All sections must be filled out by both involved parties. Each driver only fills out information pertaining to themselves, their vehicle, and their insurance, not the information of the other involved parties.

  • Misconception 7: The form is only for automobile accidents. The form is required for all motor vehicle accidents, including cars, pickups, vans, SUVs, motorcycles, trucks, etc.

  • Misconception 8: Submission is only by mail. While mailing is a primary method, electronic submission options are available, enhancing convenience.

  • Misconception 9: Estimation of damages is unnecessary or can be guessed. An accurate estimate of the cost to repair damages to the vehicle is required; guesswork can lead to under or overestimation, affecting claims and records.

Clearing up these misconceptions can facilitate a more straightforward and accurate reporting process for individuals involved in vehicle accidents in Minnesota. Ensuring the correct completion of the Minnesota Accident Report form is crucial for compliance with state laws and for the proper handling of traffic accidents from a legal standpoint.

Key takeaways

  • Every driver involved in a crash resulting in either $1,000 or more in property damage, or in any injury or death, must fill out the Minnesota Accident Report form and send it to the Driver and Vehicle Services within 10 days. Not doing so is considered a misdemeanor under Minnesota law.
  • Accurate and thorough completion of the form is crucial as it provides essential information used to enhance road safety. This includes the location and time of the accident, the vehicles involved, descriptions of the accident itself, and any injuries or damages incurred.
  • It's imperative to provide full liability insurance information on the form. Failure to do so may lead to the assumption that the involved driver did not have proper insurance coverage at the time of the accident.
  • Information supplied on the Minnesota Accident Report form is collected under authority of the Minnesota Data Privacy Act and is used to compile statistical data on traffic accidents. While the details like the time and place of the accident, names of parties involved, and insurance information may be disclosed as per law, the written report itself cannot be used as evidence in a court of law against the person submitting it.
Please rate Minnesota Accident Report Template Form
4
(Impressive)
2 Votes

Create More Documents