Oregon Dmv Accident Report Template Access Oregon Dmv Accident Report Editor Now

Oregon Dmv Accident Report Template

The Oregon DMV Accident Report form is a crucial document for drivers involved in traffic incidents in Oregon, particularly when the accident involves substantial damage, injury, or death. It serves as a formal notification to the Department of Motor Vehicles, documenting the essential details of the incident and fulfilling legal reporting requirements. Failure to submit this report within the stipulated 72-hour window may result in significant consequences, including the suspension of driving privileges. For detailed guidance on completing and submitting this form correctly, click the button below.

Access Oregon Dmv Accident Report Editor Now
Table of Contents

In the event of a traffic accident in Oregon, drivers may find themselves needing to navigate the complexities of the Oregon Traffic Crash and Insurance Report. This document serves a crucial function in the aftermath of an accident, especially when certain conditions are met, such as damage exceeding $2,500 to any vehicle or property, any form of injury regardless of its severity, a vehicle being towed due to damage, or, most tragically, a fatality. Oregon law mandates the submission of this report within a 72-hour window following the incident, stressing the importance of timely and accurate filing to avoid possible suspension of driving privileges. It's vital to recognize the dual necessity of filing this report alongside any police report generated, highlighting the individual's responsibility in documenting the incident with the Oregon DMV. The form itself demands a comprehensive account of the crash details, including insurance information, to prevent the suspension of driving privileges. Additionally, it outlines specific instructions for instances involving commercial vehicles or if a vehicle is considered "totaled." This underscores the form's role not only as a mere procedural requirement but as a critical tool for legal and insurance purposes, ensuring all parties involved have a clear, official record of the event and its consequences.

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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

 

Form Breakdown

Fact Detail
Reporting Requirement Drivers must file a report if the damage to any vehicle or property exceeds $2500, there is any injury regardless of severity, a death occurs, or a vehicle is towed due to damage.
Filing Deadline Reports must be filed within 72 hours of the crash. A delay beyond this period requires submission as soon as possible to avoid potential suspension of driving privileges.
Submission Methods The form can be submitted via email, fax, mail, or delivery to a DMV office. Particular attention should be paid to retaining proof of the submission date.
Governing Laws Oregon laws ORS 802.220(5) regulates report confidentiality and ORS 801.527 covers the definition and procedures concerning "totaled" vehicles.

Guidelines on Filling in Oregon Dmv Accident Report

When involved in a traffic accident in Oregon, certain criteria require you to complete an Oregon DMV Accident Report. If your vehicle sustains damage exceeding $2500, if any one person's property has over $2500 in damage, if there's any injury regardless of how minor, if any vehicle is towed due to damage, or in the unfortunate event of a death, it's mandatory to file this report. The report must be filed within 72 hours of the accident. Neglecting to submit this report can lead to the suspension of driving privileges. Additionally, even if a police report is filed, a personal DMV report is still necessary. Remember, the Oregon DMV doesn't assign fault in the accident but records the event on the driving records of the involved drivers, with exemptions for parked vehicles. If you need help, contact the DMV Crash Reporting Unit at (503) 945-5098.

Here is how to fill out the Oregon DMV Accident Report form:

  1. Section 1: Date, Location, and Time - Provide the exact date, time, and location of the accident. Make sure to document the nearest intersecting roads, city or town, and if possible, the county. Precise information is critical for processing your report.
  2. Section 2: Your Information - Fill in all requested details about yourself, the driver, including your full name, driver's license number, state, date of birth, and gender. Also, include your complete address, vehicle information like the insurance company's name, policy number, and your vehicle's identification number (VIN).
  3. Section 3: Failures to Complete This Section - This part is crucial in preventing the DMV from issuing a Notice of Suspension. Tick the appropriate boxes that describe the crash context, such as vehicle damage exceeding $2500, injury, vehicle towed, etc.
  4. Section 4: Other Vehicle(s) Information - If there were more vehicles involved, provide their information here. Include the driver's name, license number, vehicle owner's information, insurance details, and vehicle identification number.
  5. Section 5: Description and Signature - Describe the accident in your own words. Sign and date the form, ensuring accuracy of the information provided. If you’re physically unable to sign, a family member may do so on your behalf.
  6. Completing and Filing the Report: Once all sections are completed, you may submit the form via email, fax, mail, or in person at a DMV office. It’s important to keep a copy for your records, along with any submission confirmations or receipts.

Remember, in cases where the vehicle is considered "totaled", additional steps outlined in the Totaled Vehicle Notice section must be followed. This may involve surrendering the title to the DMV or insurer and applying for a salvage title where necessary. Ensure compliance to avoid potential legal consequences.

Learn More on Oregon Dmv Accident Report

Oregon DMV Accident Report Form FAQ

What is the purpose of the Oregon Traffic Crash and Insurance Report?

The Oregon Traffic Crash and Insurance Report is a mandatory document that drivers involved in a crash in Oregon must complete if the incident resulted in property damage exceeding $2500, any injury, death, or if any vehicle involved is towed due to damage. It serves to inform the DMV about the crash and helps in processing insurance claims and updating driving records appropriately.

When must the Oregon Traffic Crash and Insurance Report be filed?

This report must be filed within 72 hours of the crash. If it's not possible to file within this timeframe, it should be submitted as soon as possible thereafter. Delaying beyond this period could lead to a suspension of driving privileges.

Am I required to file the report if the police make a report at the crash scene?

Yes, even if the police file a report at the scene of the crash, you are still required to submit your own Crash and Insurance Report to the Oregon DMV. This is necessary for the DMV to have a direct account from the involved drivers and to ensure all necessary information is captured accurately.

Does the Oregon DMV determine fault when I file a report?

No, the Oregon DMV does not determine fault in a crash when you file your report. The DMV's role is to record the crash information on the driving records of the drivers required to report. Determinations of fault are generally made by insurance companies as they process claims.

What information is needed to complete the Oregon Traffic Crash and Insurance Report?

To complete the report, you need to provide detailed information about the crash, including:

  • Date, location, and time of the crash
  • Personal, insurance, and vehicle information for vehicle #1 (your vehicle)
  • Similar information for the other vehicle(s) involved if applicable
  • A description of how the crash occurred
  • Signature and contact information

How can I submit the completed Oregon Traffic Crash and Insurance Report?

The completed report can be submitted to the DMV via:

  • Email to OregonDMVAccidents@odot.oregon.gov
  • Fax to 503-945-5267
  • Mail to DMV Crash Reporting Unit, 1905 Lana Ave NE, Salem, Oregon 97314
  • In person at a DMV office
It's important to keep a copy of the report and documentation that shows when you submitted your report.

What if I can't file the report within the specified 72 hours?

While the law requires the report to be filed within 72 hours, if you are unable to meet this deadline, submit the report as soon as you can afterward. Delaying the filing of the report can lead to the suspension of your driving privileges, so it's important to act quickly.

What happens if I fail to report a crash to the DMV?

Failing to report a crash that meets the reporting criteria can lead to the suspension of your driving privileges. It's crucial to ensure that the report is filed within the required timeframe to avoid potential penalties.

Are there any exceptions to who must file a report?

All drivers involved in a crash that results in property damage over $2500, injury, death, or if any vehicle is towed due to damage are required to file a report, regardless of whether they are Oregon residents or licensed in another state. The only exception is if the vehicle involved was parked at the time of the crash.

What should I do if my vehicle is "totaled" in the crash?

If your vehicle is considered "totaled" (a total loss), in addition to completing the Crash and Insurance Report, you may need to follow specific steps based on your situation, such as surrendering the title to your insurer or DMV, applying for a salvage title, or notifying DMV if you can't obtain the title. Be sure to review the instructions for totaled vehicles carefully to comply with state laws.

Common mistakes

Filling out the Oregon DMV Accident Report form is a crucial step after being involved in a traffic crash, and it's important to do it accurately to avoid any potential problems. Here are seven common mistakes people make when completing this form:

  1. Not filing within the required 72-hour window: Oregon law mandates that the Crash and Insurance Report be filed within 72 hours of the crash. Delaying beyond this timeframe can result in the suspension of driving privileges.
  2. Incomplete insurance information: It's crucial to provide complete insurance details, including the insurance company name (not the agent's name), policy number, and VIN (Vehicle Identification Number). Incomplete information may lead to a Notice of Suspension from the DMV.
  3. Omitting details about the crash: Failing to clearly identify the date, location, and time of the crash can cause issues in processing your report. These details are critical for an accurate record of the event.
  4. Incorrect vehicle information: Your vehicle is always listed as Vehicle #1 in the report. All fields must be completed accurately, including the vehicle owner's name, vehicle plate number, year, make, and model.
  5. Not using black or dark blue ink: The instructions specify to print or type all information using black or dark blue ink and to press firmly. This ensures the readability and processing of your report.
  6. Failure to complete both sides of the form: Both sides of the form contain important information that must be filled out. Overlooking the back side can lead to incomplete filing.
  7. Leaving the description and signature section blank: Describing what happened and signing the form is imperative. In cases where the driver is incapacitated, only a family member is permitted to sign on their behalf. No other signatures will be accepted.

Avoiding these common mistakes can help ensure that your report is processed smoothly and without delay. Remembering to complete the form thoroughly and accurately is essential for fulfilling your legal obligations and protecting your rights after a crash.

Documents used along the form

When dealing with the aftermath of a traffic crash in Oregon, completing and submitting the Oregon Traffic Crash and Insurance Report form is a crucial step for individuals involved in incidents that meet certain criteria, such as injuries, fatalities, or significant property damage. However, to comprehensively address the situation and ensure all legal and insurance-related matters are appropriately handled, several other documents might also need to be completed or collected. Understanding these documents can provide clarity on the process and ensure that all necessary information is accurately recorded and reported.

  • Supplemental Report (Form 735-32B): Used when more than two vehicles are involved in the crash. It ensures that comprehensive information is available for each vehicle and driver involved.
  • Motor Carrier Crash Report (Form 735-9229): Required for commercial motor vehicle crashes that result in fatality, injury, or disabling damage that necessitates towing. This form addresses specifics related to commercial vehicle incidents.
  • Application for Salvage Title (Form 735-229): This is necessary when a vehicle is declared a total loss. The form is used to apply for a salvage title through the DMV, indicating the vehicle has been damaged to the extent that repair costs would exceed its value.
  • Exchange of Information Form: Although not a DMV form, it's crucial for drivers to exchange contact and insurance information at the crash scene. This form typically includes names, addresses, phone numbers, insurance companies, and policy numbers.
  • Medical Release Form: Used to authorize the release of medical records to insurance companies for the purpose of evaluating injury claims. This document is particularly important in crashes involving injuries.
  • Proof of Loss Form: Required by insurance companies when filing a claim. It details the extent of the vehicle damage or personal injury and the associated financial impact.
  • Property Damage Release Form: A document used to settle claims related to property damage. It typically signifies that the party receiving the settlement agrees not to pursue further claims related to the incident.

Navigating through the aftermath of a vehicle crash involves more than just dealing with immediate physical and emotional impacts. The documentation process, including the Oregon Traffic Crash and Insurance Report form and related documents, plays a pivotal role in ensuring that all aspects of the crash are legally documented and that financial matters are settled accordingly. Drivers, hence, find it essential to familiarize themselves with these forms and the procedures for their submission, making the recovery and claims process as smooth as possible.

Similar forms

The Oregon DMV Accident Report form shares similarities with several other documents used in various contexts across the United States. These include:

  • Police Accident Reports: Like the Oregon DMV Accident Report, these are filled out following traffic incidents. Both capture detailed information about the crash, the parties involved, and the circumstances, including location, time, and conditions.
  • Insurance Claim Forms: These forms are also filled out after accidents. They collect similar details about the incident to process insurance claims, including vehicle damage, injuries, and witness information.
  • Vehicle Damage Inspection Reports: Used by insurance companies or repair shops, these focus on assessing the extent of vehicle damage, mirroring the damage assessment section of the DMV form.
  • Motor Carrier Crash Report: Required for commercial vehicle accidents in some states, this report collects information on crashes involving commercial vehicles, similar to specific sections in the Oregon report.
  • Driver's Exchange of Information Form: Typically exchanged at the scene of an accident, these contain driver and insurance information, paralleling the basic info captured by the DMV form.
  • Incident Report Forms at Workplaces: These are used to report any incidents or near-misses in the workplace. While the focus differs, the structure of recording event specifics aligns with the way traffic incidents are documented.
  • Personal Injury Claim Forms: Used by individuals to claim compensation for injuries. Like the DMV form, they detail the incident, injuries sustained, and the impact on the individual’s life.
  • Totaled Vehicle Report Forms: In the event of a vehicle being declared a total loss, specific forms are required, similar to the totaled vehicle instructions on the DMV form.
  • Property Damage Report Forms: Used when property other than vehicles is damaged. These forms align with the section of the DMV report that deals with damage to property beyond the vehicles involved.
  • Witness Statement Forms: These are used to collect witnesses' accounts of various incidents, including traffic accidents. The DMV form also has a section for witness information, emphasizing its importance in reconstructing the event.

Each of these documents serves a unique purpose but shares the common goal of meticulously documenting an event to ascertain details, assign responsibility, and facilitate any necessary follow-up, such as insurance claims or legal action.

Dos and Don'ts

When filling out the Oregon DMV Accident Report form, there are several do's and don'ts that you should be aware of. This guidance aims to ensure that your report is accurate, complete, and filed within the required timeline, helping to avoid any potential issues with your driving privileges.

  • Do ensure you report the accident to the DMV within 72 hours if the damage to your vehicle is over $2500, there's damage to any one person’s property over $2500, if there’s any injury (no matter how minor), death, or if any vehicle is towed from the scene as a result of damages.
  • Do not delay filing your report if you are unable to submit it within the 72-hour window; submit it as soon as possible to avoid penalties.
  • Do complete both sides of the form thoroughly, using black or dark blue ink and pressing firmly.
  • Do not overlook the need to fill out a Supplemental Report (Form 735-32B) if additional vehicles were involved in the crash beyond what the main form can accommodate.
  • Do accurately provide all requested insurance information, including the insurance company name (not just the agent), policy number, and Vehicle Identification Number (VIN); incomplete information can lead to the suspension of your driving privileges.
  • Do not ignore the instructions regarding totaled vehicles if applicable to your situation, make sure to follow the guidelines for reporting and, if necessary, applying for a salvage title.
  • Do ensure the date, location, and time of the crash are recorded accurately. This information is critical for the processing of your report.
  • Do not forget to sign and date the form. If you are unable to sign the form due to incapacity or physical inability, a family member may sign on your behalf.
  • Do keep a copy of the report and documentation that shows when you submitted your report to the Oregon DMV, for your records.

Adhering to these guidelines when completing the Oregon DMV Accident Report form will facilitate a smoother process for recording your accident with the DMV, and help in maintaining your driving privileges without unnecessary interruption.

Misconceptions

  • It's not necessary to file a Crash & Insurance Report if the police already filed one: This is a misconception. Even if the police file a report, drivers involved in a crash must file their own Crash and Insurance Report with the Oregon DMV if it meets the reporting criteria.

  • Only Oregon residents need to file a report: This is incorrect. Regardless of whether you are an Oregon resident or licensed in another state, if you are involved in a crash in Oregon that meets the filing criteria, you must file a report with the Oregon DMV.

  • The DMV will determine who was at fault in the crash based on this report: This is not true. The Oregon DMV does not determine fault in a crash. Their role is to collect crash data and post the crash to the driving records of those drivers required to report.

  • If your vehicle is totaled, you must submit the title with the Crash Report: Actually, you should not submit the title with the crash report. Specific instructions are provided for cases where a vehicle is deemed totaled, including possibly surrendering the title to your insurer or the DMV, but this is separate from the crash report submission.

  • You can get a copy of the report you filed from the DMV: This is incorrect. Under ORS 802.220(5), the DMV is not authorized to provide copies of the crash report that you file to you.

  • Any damage to property or vehicle over $2500 requires a report, regardless of injury or vehicle towing: This is slightly misleading. While it's true that damage exceeding $2500 necessitates filing a report, the need to file is not solely based on the cost of damages. Scenarios including injury, death, or a vehicle being towed from the scene also mandate a report, regardless of the financial estimate of the damage.

Key takeaways

When dealing with the aftermath of a traffic incident in Oregon, the Oregon DMV Accident Report form serves as a crucial document for drivers. It's essential to understand the conditions under which this form must be filled out and submitted:

  • If the damage to any vehicle surpasses $2500, or if any individual's property sustains damage over $2500.
  • In cases where an injury occurs, irrespective of its severity, or in the tragic event of a death.
  • When a vehicle involved is towed away from the scene due to the damage it has sustained.

The requirement to file this report is stringent, with a 72-hour window post-incident for submission. Delayed filing is allowed under certain circumstances, but immediate compliance is advised to avoid potential suspension of driving privileges. Information about the accident, including insurance details, must be filled out comprehensively.

Oregon law emphasizes the need for accuracy in completing both sides of the form. In particular, insurance information is verified by DMV Headquarters, and failing to provide full details can lead to suspension notices.

Submission of the report can be done via email, fax, mail, or in person at a DMV office. Keeping proof of submission, such as email auto-replies, fax confirmation reports, or receipts from DMV offices, is critical. This is especially important since, according to ORS 802.220(5), the DMV cannot provide a copy of the submitted report to the filer.

Additionally, for vehicles declared as "totaled" – meaning the damage renders the vehicle a total loss, or repair costs exceed 80% of its market value – specific steps outlined in the form must be followed. This includes notifying the DMV and potentially surrendering the vehicle’s title.

Lastly, while the Oregon DMV Accident Report form is a necessary step for drivers involving in traffic incidents, it's just as crucial to recognize that the DMV's role does not extend to determining fault in an accident. Instead, the form's primary function is to document the incident officially and ensure all impacted parties have complied with Oregon's traffic law requirements.

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