Free Iowa Accident Report Template
Things You Should Know About This Form
What is the purpose of the Iowa Accident Report form?
The Iowa Accident Report form is designed to document motor vehicle accidents that occur within the state. If an accident results in death, personal injury, or property damage totaling $1,500 or more, it must be reported using this form. Timely submission is crucial; failure to return the form within 72 hours may lead to suspension of driving privileges. This form serves as an official record that can be used by law enforcement, insurance companies, and legal entities for various purposes.
How do I complete the Iowa Accident Report form?
Completing the Iowa Accident Report form involves several steps. First, you need to accurately fill out the basic details of the accident, such as the date, time, and location. You must also provide information about all vehicles and drivers involved, including names, license numbers, and vehicle details. If there are more than two vehicles, additional sheets can be used. It’s important to use the correct vehicle type codes and to describe the accident's circumstances as thoroughly as possible. Finally, ensure that the form is signed and sent to the Iowa Department of Transportation.
What information is required about the drivers and vehicles involved?
When filling out the report, it is essential to include comprehensive details for each driver and vehicle. This includes:
- Driver's name, date of birth, and driver license number along with the state of issuance.
- Vehicle owner's name and address.
- License plate number and state of registration for each vehicle.
- Vehicle make, model, and year.
If the accident involved a pedestrian or a cyclist, specific notations should be made in the designated sections. All drivers involved, regardless of injury status, should be listed.
What happens if I do not submit the form on time?
Submitting the Iowa Accident Report form within 72 hours is not merely a formality; it is a legal requirement. If you fail to do so, you may face suspension of your driving privileges. This suspension can impact your ability to operate a vehicle legally in Iowa, potentially affecting your daily life and responsibilities. Therefore, it is crucial to prioritize the completion and submission of the form to avoid these consequences.
How should I handle insurance information on the form?
Insurance information is a vital part of the Iowa Accident Report form. You must provide details about your insurance coverage, including the name of the insurance company, policy number, and the policy period. This information helps ensure that all parties involved in the accident can address liability and damages appropriately. Failure to complete this section may result in suspension of your driving and registration privileges, so it is important to fill it out accurately and completely.
Form Features
| Fact Name | Details |
|---|---|
| Reporting Requirement | Accidents causing death, personal injury, or property damage of $1,500 or more must be reported using the Iowa Accident Report Form. |
| Submission Deadline | The completed form must be returned within 72 hours to avoid suspension of driving privileges. |
| Filing Instructions | All information must be printed or typed in black or dark blue ink. Ensure accuracy in details such as driver and vehicle information. |
| Governing Law | Iowa Code Section 321.271 outlines the requirement for reporting motor vehicle accidents. |
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Key takeaways
When filling out and using the Iowa Accident Report form, it is essential to follow specific guidelines to ensure that all necessary information is accurately captured. Here are some key takeaways:
- Mandatory Reporting: Any accident resulting in death, personal injury, or property damage exceeding $1,500 must be reported using this form.
- Timeliness: Submit the completed report within 72 hours to avoid potential suspension of your driving privileges.
- Clear Information: Use black or dark blue ink and print or type all information clearly to ensure legibility.
- Accident Details: Start by entering the date, time, and location of the accident, along with the number of vehicles involved and the total damage incurred.
- Driver and Vehicle Information: Include complete details for all drivers and vehicles involved, such as names, license numbers, and vehicle registration information.
- Vehicle Type Codes: Familiarize yourself with the vehicle type codes provided in the form to accurately classify the vehicles involved in the accident.
- Injury Reporting: Document injuries for all individuals involved, specifying the severity and nature of each injury.
- Accident Diagram: Create a simple diagram of the accident scene, noting the direction of travel and any relevant road features.
- Insurance Information: Complete the insurance section on the back of the report. Failing to do so may lead to suspension of driving privileges.
- Signature Requirement: Ensure that the report is signed by the driver of Vehicle No. 1, as this validates the information provided.
By following these key points, you can ensure that the Iowa Accident Report form is filled out correctly and submitted in a timely manner. This helps facilitate the processing of your report and any necessary follow-up actions.
Sample - Iowa Accident Report Form
Form 433002
IOWA ACCIDENT REPORT FORM
An accident occurring anywhere within the State of Iowa causing death, personal injury, or total property damage of $1,500.00 or more must be reported on this accident report form. Failure to return this accident report form within 72 hours may result in suspension of your driving privilege. Caution: You must attempt to completely fill out this report.
Instructions
Please print or type all information. Use black or dark blue ink.
Step 1. Begin completing the "Report of Motor Vehicle Accident" form by entering accident date, day of week, time, number of vehicles, total number killed, number injured, and the total amount of damage to all vehicles and any property other than vehicles.
Step 2. Enter the information pertaining to all drivers and vehicles involved in the accident. Important: Be sure to include the driver's name, driver license number, and driver license state. Also include the vehicle owner's name, license plate number, and license plate state. If more than two drivers or two vehicles were involved, use an extra report form or sheet of paper making sure that the extra vehicles and drivers are numbered 3, 4, 5, etc.
If you were involved in an accident with a pedestrian, print PEDESTRIAN in the driver space provided for vehicle No. 2 and complete pedestrian information in Step 7. If you were involved in an accident with a pedalcyclist (bicycle, etc.) print 'Bike' in the driver space provided for Vehicle 2 and complete information for
If one of the vehicles involved was parked at the time of the accident, print PARKED in the driver space and complete the vehicle owner information.
Step 3. Please use the following codes when completing the box marked "vehicle type code":
01 |
= Passenger Car |
09 |
= |
17 |
= Small school bus (seats |
02 |
= |
10 |
= Tractor/doubles |
18 |
= Other bus (seats > 15) |
03 |
= Van or |
11 |
= Tractor/triples |
19 |
= Other small bus (seats |
04 |
= Sport utility vehicle |
12 |
= Other heavy truck (cannot classify) |
20 |
= Farm vehicle/equipment |
05 |
= |
13 |
= Motor home/recreational vehicle |
21 |
= Maintenance/construction vehicle |
06 |
= |
14 |
= Motorcycle |
22 |
= Train |
07 |
= Truck/trailer |
15 |
= |
88 |
= Other (explain in narrative) |
08 |
= Truck tractor (bobtail) |
16 |
= School bus (seats > 15) |
99 |
= Unknown |
Step 4. The location of the accident is very important. Please be as specific as possible.
Step 5. To the best of your ability, complete the Accident Codes section for your own vehicle using codes provided on page 2 of this form.
Step 6. If there is damage to property other than the vehicles involved complete the property damage information.
Step 7. Injury information should be entered in the space provided. Make sure that the vehicle number in which the injured party was riding is complete, describe the nature of the injury, and check the box under the column most appropriate for the injury severity. NOTE: Include all drivers whether injured or not. The codes are:
Injury Status:
1 = Fatal
2 = Incapacitating
3 =
4 = Possible
5 = Uninjured
9 = Unknown
Occupant Protection: |
Airbag Deployment: |
Ejection: |
Type |
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1 |
= None used |
1 |
= Deployed front of person |
1 |
= Not ejected |
1 |
= Pedestrian |
2 |
= Shoulder and lap belt used |
2 |
= Deployed side of person |
2 |
= Partially ejected |
2 |
= Pedalcyclist (bicycle, tricycle, |
3 |
= Lap belt only used |
3 |
= Deployed both front/side |
3 |
= Totally ejected |
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unicycle, pedal car) |
4 |
= Shoulder belt only used |
4 |
= Other deployment (explain |
4 |
= Not applicable |
3 |
= Skater |
5 |
= Child safety seat used |
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in narrative |
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(motorcycle, |
8 |
= Other (explain in narrative) |
6 |
= Helmet used |
5 |
= Not deployed |
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bicycle, etc.) |
9 |
= Unknown |
8 |
= Other (explain in narrative) |
6 |
= Not applicable |
9 |
= Unknown |
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9 |
= Unknown |
9 |
= Unknown |
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Motorcycle Seating Position |
Seating |
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01 |
- Motorcycle Driver |
Position |
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04 |
- Motorcycle Passenger |
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88 |
- Other (explain in |
01 |
02 |
03 |
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narrative) |
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04 |
05 |
06 |
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07 |
08 |
09 |
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10 - Sleeper Section
11 - Enclosed Cargo Area
12 - Unenclosed Cargo Area
13 - Training Unit
14 - Exterior
15 - Pedestrian
16 - Pedalcyclist
17 - Pedalcyclist, passenger
88 - Other (explain in narrative)
99 - Unknown
(Instructions continued on page 2) Æ
(Instructions continued from page 1)
Step 8. To the best of your ability, complete the accident diagram and description as briefly as possible. Important: If you are vehicle No. 1 in Step 2, make sure that your vehicle is vehicle No. 1 in the description and diagram. Indicate if there has been a Peace Officer investigation.
Step 9. Complete the insurance information on the back of the report. Failure to complete insurance coverage information may result in a suspension of your driving and registration privileges.
Step 10. Sign the accident report and tear at the perforated line and return accident report to:
Iowa Department of Transportation
Office of Driver Services
P.O. Box 9235
Des Moines, IA
ACCIDENT CODES (See Step 5)
LOCATION OF ACCIDENT (Where did first damage or injury event occur)
1 |
= On Roadway |
4 |
= Roadside (ditch) |
6 = Outside Trafficway |
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2 |
= Shoulder |
5 |
= Grassy Area between |
9 = Unknown |
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3 |
= Median |
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exit ramp and roadway |
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MANNER OF CRASH/COLLISION |
7 = Sideswipe, |
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1 |
= |
5 |
= Broadside |
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2 |
= |
6 |
= Sideswipe, |
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opposite direction |
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3 |
= |
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same direction |
9 = Unknown |
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4 |
= Angle, oncoming |
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left turn |
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VEHICLE ACTION |
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01 |
= Movement essentially |
06 |
= Changing lanes |
11 |
= Stopped for |
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straight |
07 |
= Entering traffic lane |
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stop sign/signal |
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02 |
= Turning left |
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(merging) |
12 |
= Legally Parked |
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03 |
= Turning right |
08 |
= Leaving traffic lane |
13 |
= Illegally Parked / |
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WEATHER CONDITIONS (up to two)
01 |
= Clear |
06 |
= Rain |
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02 |
= Partly cloudy |
07 |
= Sleet, hail, freezing |
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03 |
= Cloudy |
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rain |
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04 |
= Fog, smoke |
08 |
= Snow |
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05 |
= Mist |
09 |
= Severe winds |
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SURFACE CONDITIONS |
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1 |
= Dry |
5 |
= Slush |
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2 |
= Wet |
6 |
= Sand, mud, dirt, oil, |
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3 |
= Ice |
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gravel |
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4 |
= Snow |
7 |
= Water (standing, |
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moving) |
VISION OBSCURED
10 = Blowing sand, soil, dirt, snow
88 = Other (explain in narrative)
99 = Unknown
8 = Other (explain in
narrative)
9 = Unknown
04 |
= Making |
09 |
= Backing |
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Unattended |
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05 |
= Overtaking/passing |
10 |
= Slowing/stopping |
88 |
= Other (explain in |
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narrative |
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99 |
= Unknown |
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FIRST HARMFUL EVENT |
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24 |
= Railway vehicle/train |
35 |
= Guardrail |
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11 |
= Overturn/rollover |
25 |
= Animal |
36 |
= Concrete barrier |
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12 |
= Jackknife |
26 |
= Other |
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(median or right side) |
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13 |
= Other |
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(explain in narrative) |
37 |
= Tree |
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(explain in narrative) |
Collision with fixed object: |
38 |
= Poles (utility, light, |
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Collision with: |
30 |
= Bridge/bridge rail/ |
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etc.) |
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20 |
= |
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overpass |
39 |
= Sign post |
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31 |
= Underpass/structure |
40 |
= Mailbox |
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21 |
= Vehicle in traffic |
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support |
41 |
= Impact attenuator |
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22 |
= Vehicle in/from other |
32 |
= Culvert |
42 |
= Other fixed object |
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roadway |
33 |
= Ditch/Embankment |
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(explain in narrative) |
23 |
= Parked motor vehicle |
34 |
= Curb/island/raised median |
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01 |
= Not obscured |
08 |
= Moving vehicles |
12 |
= Blowing snow |
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02 |
= Trees/crops |
09 |
= Person/object in or |
13 |
= Fog/smoke/dust |
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03 |
= Buildings |
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on vehicle |
88 |
= Other (explain in |
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04 |
= Embankment |
10 |
= Blinded by sun or |
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narrative) |
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05 |
= Sign/billboard |
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headlights |
99 |
= Unknown |
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06 |
= Hillcrest |
11 |
= Frosted windows/ |
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07 |
= Parked vehicles |
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windshield |
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DRIVER CONDITION |
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1 |
= Apparently normal |
4 |
= Illness |
8 = Other (explain in |
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2 |
= Physical impairment |
5 |
= Asleep, fainted, |
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narrative) |
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3 |
= Emotional (e.g., |
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fatigued, etc. |
9 = Unknown |
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depressed, angry, |
6 |
= Under the influence of |
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disturbed) |
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alcohol/drugs/ |
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medications |
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CONTRIBUTING CIRCUMSTANCES Driver (up to two)
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TYPE OF ROADWAY JUNCTION/FEATURE |
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08 |
= Other |
16 |
= Intersection with ramp |
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01 |
= No special feature |
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(explain in narrative) |
17 |
= |
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02 |
= Bridge/overpass/ |
Intersection: |
18 |
= |
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underpass |
11 |
= |
19 |
= |
03 |
= Railroad crossing |
12 |
= |
20 |
= |
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04 |
= Business drive |
13 |
= |
21 |
= With bike/pedestrian |
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05 |
= Farm/residential drive |
14 |
- |
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path |
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06 |
= Alley intersection |
15 |
- Offset |
22 |
= Other intersection |
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07 |
= Crossover in median |
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intersection |
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(explain in narrative) |
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99 |
= Unknown |
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TRAFFIC CONTROLS |
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01 |
= No controls present |
06 |
= No Passing Zone |
10 |
= Traffic director |
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02 |
= Traffic signals |
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(marked) |
11 |
= Workzone signs |
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03 |
= Flashing traffic control |
07 |
= Warning sign |
88 |
= Other control (explain |
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signal |
08 |
= School zone signs |
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in narrative) |
04 |
= Stop signs |
09 |
= Railway crossing |
99 |
= Unknown |
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05 |
= Yield signs |
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device |
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LIGHT CONDITIONS |
4 = Dark, roadway lighted |
6 = Dark, unknown |
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1 = Daylight |
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2 = Dusk |
5 = Dark, roadway not |
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roadway lighting |
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3 = Dawn |
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lighted |
9 = Unknown |
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01 = Ran traffic signal
02 = Ran stop sign
03 = Exceeded authorized speed
04 = Driving too fast for conditions
05 = Made improper turn
06 = Traveling wrong way or on wrong side of road
07 = Crossed centerline
08 = Lost Control
09 = Followed too close
10 = Swerved to avoid; vehicle, object, non- motorist, or animal in roadway
11 = Over correcting/over steering
12 = Operating vehicle in erratic, reckless, careless, negligent, or aggressive manner
Failed to yield
14 = From yield sign
15 = Making left turn
16 = Making right turn on red signal
17 = From driveway
18 = From parked position
19 = To pedestrian
20 = At uncontrolled intersection
21 = Other (explain in narrative)
Inattentive/distracted by: 22 = Passenger
23 = Use of phone or other device
24 = Fallen object
25 = Fatigued/asleep
Other
26 = Vision obstructed
27 = Other improper action
28 = No improper action
99 = Unknown
Form 433002 |
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REPORT OF MOTOR VEHICLE ACCIDENT |
Step 1. |
See Instructions on completing (please print or type) |
Did accident occur on |
Yes |
private property? |
No |
Accident Date (Mo/Day/Year) |
Day of Week |
Time |
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AM |
Number of Vehicles |
Total Killed |
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Total Injured |
Total Estimated Damage |
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Step 2. |
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NO. 1 (YOUR VEHICLE) |
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NO. 2 (OTHER VEHICLE) |
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Date of Birth |
Sex |
Dr.Lic. State |
Driver License No. as Printed on License |
D |
Date of Birth |
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Sex |
Dr.Lic. State |
Driver License No. as Printed on License |
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Last Name of Driver 1 |
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First Name |
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Middle Initial |
I |
Last Name of Driver 2 |
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First Name |
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Middle Initial |
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Number and Street |
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State |
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E |
Number and Street |
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Last Name of Owner 1 |
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First Name |
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Last Name of Owner 2 |
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Number and Street |
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Plate Number |
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Est. Cost of Repairs |
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Vehicle Year & Make |
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Step 3. |
Vehicle Type Code |
L |
Vehicle Year & Make |
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Step 3. |
Vehicle Type Code |
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Step 4. |
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LOCATION OF ACCIDENT |
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County
Accident occurred within corporate limits of (city)
If accident occurred outside of |
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N NE E SE S SW W NW |
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city limits, describe distance to city |
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miles |
of nearest city |
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Name of Road, Street or Highway |
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At Intersection with |
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Note: Unless accident occurred at an intersection which is completely described above, use the space below to give the exact location from a milepost or definable intersection, bridge or railroad crossing, using two distances and directions if necessary.
Feet Miles
or
N NE E SE S SW W NW |
Feet |
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Miles |
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N NE E SE S SW W NW
of
Milepost Number |
Definable Intersection, bridge, or railroad crossing |
Or
Step 5. Accident Codes (on page 2) For your own vehicle
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Location of Accident |
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Manner of Crash |
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Vehicle Action |
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Type of Roadway |
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Traffic Controls |
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Light Conditions |
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Junction/Feature |
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Surface Conditions |
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Driver Condition |
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Identify Damaged Property Other Than Vehicles |
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Owner |
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Step 6. |
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Step 7. Injury Section: Fill Out Space Below For Every Person Injured Or Killed In The Accident (Attach additional sheets if necessary)
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Vehiclen |
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Gender |
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Name & Address |
I Number |
Date of Birth |
Describe Injuries |
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First Harmful Event
Weather Conditions
Contributing Circumstances 


Amount of Damage
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Insert Correct Code |
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(See Step 7 of Instructions) |
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InjuryStatus |
Occupant Protection |
Airbag Deployment |
Ejection |
Type |
Seating Position |
Date of |
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Death |
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(Complete reverse side)´
Step 8.
Indicate On This Diagram What Happened
Use one of these outlines to sketch the scene of your accident, writing in street or highway names or numbers.
Initial Travel Direction |
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(prior to coded Vehicle Action) |
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N |
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- North |
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2 |
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W |
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- South |
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S |
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INDICATE
NORTH
BY ARROW
Street or Highway
Original Direction of Travel: (Example: Vehicle going north then turning left, code 'N' for Original Direction of Travel)
Vehicle 1 |
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Vehicle 2 |
Street or Highway
Street or Highway
Description
Did Peace Officer investigate? |
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Yes |
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No |
Department |
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If you did not have automobile liability insurance coverage for this accident, please check this box |
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. |
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If you had automobile liability insurance coverage for this accident, please complete insurance information below:
Failure To Complete Insurance Coverage Information Requested Below May Result In A Suspension Of Your Driving And/Or Registration Privileges.
Step 9.
Name of Insurance Company (Not Agent) Providing Insurance To Cover Your Liability For Damage Or Injury To Others:
Name of Agent Who Sold Policy
Agent Address
Policy No. |
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Policy Period: From |
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Name of Driver |
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Name of Owner |
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Name of Policyholder |
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Step 10. |
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Date
Signature of Driver of Vehicle No. 1
If Signed By Person Other Than Driver, Give Reason
IMPORTANT: This accident should also be reported directly to your insurance company. Failure to report may jeopardize your automobile liability insurance.
Similar forms
The Iowa Accident Report form shares similarities with the police accident report, which is typically completed by law enforcement officers at the scene of an accident. Both documents aim to provide a detailed account of the incident, including information about the vehicles involved, injuries sustained, and property damage. The police report may also include witness statements and officer observations, which can enhance the accuracy and reliability of the information presented. Timeliness is crucial, as both reports must be filed promptly to ensure that all pertinent details are captured before memories fade.
Another document that resembles the Iowa Accident Report is the insurance claim form. When individuals file claims with their insurance companies after an accident, they often need to provide information similar to what is required on the Iowa form. This includes details about the accident, the parties involved, and any injuries or damages incurred. The accuracy of the information provided can significantly impact the outcome of the claim, making it essential for individuals to complete this document thoroughly and promptly.
The motor vehicle accident report from other states also bears a resemblance to the Iowa form. Most states have their own version of an accident report that collects similar information about the incident. These reports typically include the date, time, and location of the accident, as well as the parties involved and any injuries or damages. The consistency across states helps maintain a standard for reporting accidents, which can be beneficial for insurance and legal purposes.
The DMV accident report is another document that shares characteristics with the Iowa Accident Report. This report is often required by the Department of Motor Vehicles when an accident occurs. It serves to inform the DMV of any incidents that could affect a driver’s record or insurance status. Like the Iowa form, it collects essential information about the accident and the individuals involved, emphasizing the importance of timely and accurate reporting.
In addition, the liability waiver form can be compared to the Iowa Accident Report. While not directly related to reporting accidents, liability waivers often require individuals to acknowledge risks associated with activities that could lead to accidents. Both documents emphasize the importance of understanding responsibilities and potential consequences, especially in situations involving injuries or property damage.
The incident report used by employers in the workplace is another document that mirrors the Iowa Accident Report. In the event of an accident occurring on company premises, employers must document the incident to ensure compliance with safety regulations and to protect against potential liability. This report usually includes details about the accident, the individuals involved, and any injuries sustained, similar to the information required on the Iowa form.
In addition to the Iowa Accident Report and DMV Accident Report, individuals seeking information on vehicle registration and titling may find the Missouri 4803 form particularly useful, as it serves as a resource for obtaining crucial vehicle history details that can aid in insurance claims and legal matters.
The medical report generated after an accident also shares similarities with the Iowa Accident Report. Medical professionals document injuries sustained during an accident, providing crucial information for insurance claims and legal proceedings. Both reports focus on the details surrounding the incident, including the nature of injuries and treatment received, highlighting the importance of accurate documentation in both medical and legal contexts.
Furthermore, the vehicle damage assessment report is akin to the Iowa Accident Report in that it outlines the extent of damages sustained by vehicles involved in an accident. This report is often used by insurance companies to determine repair costs and liability. Like the Iowa form, it requires detailed descriptions and assessments, which are essential for processing claims efficiently.
Lastly, the witness statement form can be compared to the Iowa Accident Report. Witnesses to an accident often provide statements that detail their observations, which can be critical in understanding the circumstances surrounding the incident. Both documents aim to capture factual information that can be used to establish liability and clarify the events leading up to the accident.