Free Minnesota Accident Report Form in PDF

Free Minnesota Accident Report Form in PDF

The Minnesota Accident Report form, officially known as form PS 32001 - 08, is a crucial document designed to gather information following motor vehicle accidents. This form assists in building safer roads by requiring drivers involved in accidents with $1,000 or more in property damage, injury, or death to report the incident to the Driver and Vehicle Services within ten days. Failure to submit this form is considered a misdemeanor, emphasising the importance of accurate and timely reporting to aid statistical data collection and road safety improvements. Ensure you fill out this form accurately by clicking the button below.

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In Minnesota, ensuring the safety of all road users and providing a mechanism for accountability in the event of motor vehicle accidents is critical. To that end, the Minnesota Motor Vehicle Accident Report, form PS 32001-08, serves as a vital tool for drivers involved in accidents that result in property damage of $1,000 or more, or in cases where there is injury or death. The form, which must be submitted to the Driver and Vehicle Services within 10 days of the accident, collects essential information that aids in the construction of safer roads and the enforcement of traffic laws. Information required includes the date, location, and time of the accident, details about the vehicles involved (including make, model, and year), driver and owner information, insurance details, and a description of the accident. It's noteworthy that failing to complete this report is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7. Further, the report plays a significant role in statistical analyses aimed at road safety improvements, yet it protects the privacy of the individuals involved; it cannot be used against the reporter in any civil or criminal case, underscoring the state's commitment to both accountability and privacy.

Preview - Minnesota Accident Report Form

MINNESOTA MOTOR VEHICLE ACCIDENT REPORT

PS 32001 - 08

The information on this report is used to help build safer roads.

Every driver in a crash involving $1,000 or more in property damage, or injury or death, MUST COMPLETE this form and send it to Driver and Vehicle Services within 10 days.

Failure to provide this information is a misdemeanor under Minnesota Statute 169.09, subdivision 7. See reverse side for address and for data privacy information.

A

B

C

DRIVER’S TRAFFIC ACCIDENT REPORT

E-form available at www.mndriveinfo.org

 

 

 

DO NOT DETACH

 

 

DATE OF

MONTH

DAY

YEAR

DAY OF WEEK

TIME

 

 

TOTAL # OF

 

COUNTY

 

 

NAME OF CITY OR TOWNSHIP

 

 

 

 

T

 

ACCIDENT

 

 

 

 

 

 

 

 

 

 

AM

VEHICLES

 

 

 

 

 

CITY

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

PM

INVOLVED

 

 

 

 

 

TWP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

ACCIDENT OCCURRED

LOCATION OF ACCIDENT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

(Choose only one box below

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and proceed to the right)

ON:

 

 

 

 

 

 

 

 

 

 

 

 

 

AT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AT INTERSECTION

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P

 

 

 

 

 

LOCATION OF ACCIDENT:

 

 

 

 

DISTANCE

 

 

DIRECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MILES

N

E

 

 

 

 

 

 

 

A

 

 

NOT AT INTERSECTION

ON:

 

 

 

 

 

 

 

 

 

 

FEET

S

W FROM:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

(Number)

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

IN PARKING LOT

DESCRIBE LOCATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D DRIVER’S FULL NAME

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

INJURY

M

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CODE*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LICENSE NUMBER

 

 

 

 

 

 

 

 

CLASS

 

 

STATE OF ISSUE

 

DATE OF BIRTH

 

SEX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VE

E R

H

V

 

OWNER’S FULL NAME

 

 

ADDRESS

 

CITY

 

STATE

ZIP CODE

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

E

 

 

 

 

 

 

 

 

 

 

 

 

H

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE PLATE NUMBER

YEAR

STATE OF ISSUE

PARTS OF VEHICLE DAMAGED

 

 

 

ESTIMATE COST TO REPAIR

E

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

$

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE (CAR, PICKUP, VAN, SUV, MOTORCYCLE, TRUCK, ETC.)

MAKE

 

MODEL

YEAR

 

COLOR

 

# OF OCCUPANTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IGIVE FULL LIABILITY INSURANCE INFORMATION OR IT WILL BE ASSUMED YOU DID NOT HAVE INSURANCE

N

SPLEASE NAME OF INSURANCE COMPANY (NOT AGENCY)

 

 

U

COPY

Automobile Insurance

 

 

 

 

 

 

 

 

 

 

 

 

MONTH

 

DAY

 

YEAR

 

 

 

MONTH

 

DAY

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

Policy Period: from

 

 

 

 

 

 

 

 

to

 

 

 

 

 

 

 

 

 

 

A

POLICY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

Name of Policy Holder

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Signature X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

OTHER

FULL NAME

 

 

 

ADDRESS

 

 

 

 

 

CITY

 

 

 

 

STATE

ZIP CODE

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CODE*

O

 

R

DRIVER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

DRIVER’S LICENSE NUMBER

 

 

 

 

 

 

CLASS

 

STATE OF ISSUE

 

 

 

DATE OF BIRTH

 

 

 

 

SEX

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

V

OTHER FULL NAME

 

 

 

ADDRESS

 

 

 

 

 

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

HE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

OWNER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE PLATE NUMBER

 

YEAR

STATE OF ISSUE

 

PARTS OF VEHICLE DAMAGED

 

 

 

 

 

 

 

 

ESTIMATE COST TO REPAIR

I

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

C

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE (CAR, PICKUP, VAN, SUV, MOTORCYCLE, TRUCK, ETC.)

MAKE

 

 

MODEL

 

 

 

 

YEAR

 

 

COLOR

 

 

# OF OCCUPANTS

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF MORE THAN TWO VEHICLES - FILL IN SECTION “C” ON SEPARATE FORM AND ATTACH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*SEE CODES ON REVERSE SIDE*

ENTER NUMBER FOR CORRECT RESPONSE IN EACH BOX BELOW

 

 

 

 

TYPE ACCIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLLISION WITH A(N)

 

 

 

 

COLLISION WITH FIXED OBJECT

 

 

 

NON-COLLISION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- MOTOR VEHICLE

 

 

8- DEER

 

21- CONSTRUCTION EQUIPMENT

29- HYDRANT

 

37- EMBANKMENT/DITCH/CURB

51- OVERTURN/ROLLOVER

 

 

 

 

2- PARKED MOTOR VEHICLE

 

9- OTHER ANIMAL

 

22- TRAFFIC SIGNAL

30- TREE/SHRUBBERY

 

38- BUILDING/WALL

52- SUBMERSION

 

 

 

 

3- ROADWAY EQUIPMENT - SNOWPLOW

 

 

 

23- RR CROSSING DEVICE

31- BRIDGE PIERS

 

39- ROCK OUTCROPS

53- FIRE/EXPLOSION

 

 

 

 

4- ROADWAY EQUIPMENT - OTHER

 

12- COLLISION WITH OTHER

 

24- LIGHT POLE

 

32- MEDIAN SAFETY BARRIER

40- PARKING METER

54- JACKKNIFE

 

 

 

 

5- TRAIN

 

 

TYPE OF NON-FIXED OBJECT

 

25- UTILITY POLE

33- CRASH CUSHION

 

41- OTHER FIXED OBJECT

55- LOSS/SPILLAGE NON-HAZ MAT

 

 

 

 

6- PEDALCYCLE, BIKE, ETC.

 

13- OTHER COLLISION TYPE

 

26- SIGN STRUCTURE

34- GUARDRAIL

 

42- UNKNOWN FIXED OBJECT

56- LOSS/SPILLAGE HAZ MAT

 

 

 

 

7- PEDESTRIAN

 

 

 

 

27- MAILBOXES

 

35- FENCE (NON-MEDIAN BARRIER)

 

64- NON-COLLISION OF OTHER TYPE

 

 

 

 

 

 

 

 

 

28- OTHER POLES

36- CULVERT/HEADWALL

 

65- NON-COLLISION OF UNKNOWN TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WORK ZONE (CIRCLE CORRECT RESPONSE)

 

 

 

 

SPEED LIMIT ENTER POSTED SPEED LIMIT ( NOT YOUR TRAVEL SPEED)

 

YES

NO

 

 

 

 

 

 

 

 

DID THE CRASH OCCUR IN A WORK ZONE?

 

 

 

 

 

 

 

 

 

YES

NO

IF YES, WERE WORKERS PRESENT?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEATHER / ATMOSPHERE

5- SLEET/HAIL/FREEZING RAIN

8- SEVERE CROSSWINDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- CLEAR

3- RAIN

6- FOG/SMOG/SMOKE

90- OTHER

 

 

 

 

ROAD SURFACE

 

 

 

 

 

 

2- CLOUDY

4- SNOW

7- BLOWING SAND/DUST/SNOW

 

 

 

 

 

1- DRY

3- SNOW

5- ICE PACKED SNOW

7- MUDDY

9- OILY

 

 

 

 

 

 

 

 

2- WET

4-SLUSH

6- WATER (STANDING/MOVING)

8- DEBRIS

90- OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIGHT CONDITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- DAY LIGHT

 

4- DARK (STREET LIGHTS ON)

7- DARK (UNKNOWN LIGHTING)

 

 

 

 

TRAFFIC CONTROL DEVICE

 

 

 

 

 

2- BEFORE SUNRISE (DAWN)

5- DARK (STREET LIGHTS OFF)

90- OTHER

 

 

 

 

1- TRAFFIC SIGNAL

 

 

7- SCHOOL BUS STOP ARM

 

13- RR OVERHEAD FLASHERS

3- AFTER SUNSET (DUSK)

6- DARK (NO STREET LIGHTS)

 

 

 

 

 

2- OVERHEAD FLASHERS

 

8- SCHOOL ZONE SIGN

 

14- RR OVERHEAD FLASHERS/GATE

 

 

 

 

 

 

 

 

3- STOP SIGN - ALL APPROACHES

 

9- NO PASSING ZONE

 

15- RR SIGN ONLY

 

 

 

 

 

 

 

 

 

4- STOP SIGN - NOT ALL APPROACHES

 

10- RR CROSSING GATE

 

(NO LIGHTS, GATES OR STOP SIGN)

MANNER OF COLLISION

4- RAN OFF ROAD - LEFT SIDE

8- HEAD ON

 

 

 

 

5- YIELD SIGN

 

 

11- RR CROSSING -FLASHING LIGHTS

 

1- REAR END

 

5- RIGHT ANGLE (”T-BONE”)

9- SIDE SWIPE - OPPOSING DIRECTION

 

 

 

 

 

 

 

 

 

 

 

 

6- OFFICER/FLAG PERSON/SCHOOL PATROL

12- RR CROSSING - STOP SIGN

 

90- OTHER

 

2- SIDESWIPE - SAME DIRECTION

6- RIGHT TURN

90- OTHER

 

 

 

 

 

 

 

 

 

98- NOT APPLICABLE

3- LEFT TURN

 

7- RAN OFF ROAD - RIGHT SIDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MY

VEHICLE

OTHER

VEHICLE

ACTIONS / MANEUVERS PRIOR TO ACCIDENT

BY VEHICLE

PARKED VEHICLES

1- GOING STRAIGHT AHEAD

21- PARKED LEGALLY

FOLLOWING ROADWAY

22- PARKED ILLEGALLY

2- WRONG WAY INTO

23- VEHICLE STOPPED

OPPOSING TRAFFIC

OFF ROADWAY

3- RIGHT TURN ON RED

 

4- LEFT TURN ON RED

 

5- MAKING RIGHT TURN

 

6- MAKING LEFT TURN

 

7- MAKING U-TURN

 

8- STARTING FROM PARKED POSITION

 

9- STARTING IN TRAFFIC

 

10- SLOWING IN TRAFFIC

 

11- STOPPED IN TRAFFIC

 

12- ENTERING PARKED POSITION

 

13- AVOID UNIT/OBJECT IN ROAD

 

14- CHANGING LANES

 

15- OVERTAKING/PASSING

 

16- MERGING

 

17- BACKING

 

18- STALLED ON ROADWAY

 

 

 

 

 

 

 

 

 

 

DIRECTION OF TRAVEL PRIOR TO ACCIDENT

BY PEDESTRIAN

 

 

 

 

BY BICYCLIST

1- NORTHBOUND

 

 

 

 

 

 

 

31- CROSSING WITH SIGNAL

 

40- WALKING/RUNNING IN ROAD

51- RIDING WITH TRAFFIC

2- NORTH EASTBOUND

 

 

 

 

 

 

 

32- CROSSING AGAINST SIGNAL

 

AGAINST TRAFFIC

 

52- RIDING AGAINST TRAFFIC

3- EASTBOUND

 

 

 

 

 

 

 

33- DARTING INTO TRAFFIC

 

41- STANDING/LYING IN ROAD

53- MAKING RIGHT TURN

4- SOUTH EASTBOUND

 

 

 

 

 

 

 

34- OTHER IMPROPER CROSSING

 

42- EMERGING FROM BEHIND

54- MAKING LEFT TURN

5- SOUTHBOUND

 

 

 

 

 

 

 

35- CROSSING IN A MARKED CROSSWALK

PARKED VEHICLE

 

55- MAKING U-TURN

6- SOUTH WESTBOUND

 

 

 

 

 

 

 

36- CROSSING (NO SIGNAL OR CROSSWALK)

43- CHILD GETTING ON/OFF SCHOOL BUS

56- RIDING ACROSS ROAD

7- WESTBOUND

 

 

N

 

 

 

37- FAIL TO YIELD RIGHT OF WAY TO TRAFFIC

44- PERSON GETTING ON/OFF VEHICLE

57- SLOWING/STOPPING/STARTING

8- NORTH WESTBOUND

 

 

 

 

 

38- INATTENTION/DISTRACTION

 

45- PUSHING/WORKING ON VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

8

1

2

 

 

39- WALKING/RUNNING IN ROAD WITH TRAFFIC

46- WORKING IN ROADWAY

90- OTHER

 

 

 

 

 

 

 

 

W

 

7

 

 

3

 

E

 

 

 

47- PLAYING IN ROADWAY

 

 

 

 

 

 

 

 

 

6

 

 

4

 

 

 

 

48- NOT IN ROADWAY

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

 

 

 

 

 

CONTINUE

 

WAS THERE A POLICE

 

IF YES, WHAT DEPARTMENT (NAME OF CITY, COUNTY OR STATE PATROL)

 

 

 

 

 

 

 

OFFICER AT THE

 

 

 

 

 

 

 

 

 

 

 

REPORT ON

 

 

 

 

 

 

 

 

 

 

 

 

 

SCENE?

 

 

 

 

 

 

 

 

 

 

 

 

OTHER SIDE

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

MY

VEHICLE

OTHER

As required by Minnesota Data Privacy Act you are hereby informed that the information requested on this form is collected pursuant to statute to provide statistical data on traffic accidents. The time and place of the accident, names of parties involved and insurance information may be disclosed to any person involved in the accident or to others persons as specified by law. This written report cannot be used against you as evidence in any civil or criminal matter and your version of how the accident happened is confidential.

SEAT

TYPE

USE

AIR BAG

EJECT

INJURY

OCCUPANT SEAT POSITION CODES

SAFETY EQUIPMENT TYPE

RESTRAINT DEVICE USED

SAFETY EQUIPMENT USED

EJECTION CODES

INJURY CODES

 

CODES

CODES

CODES

 

 

1- DRIVER

 

 

 

1- TRAPPED, EXTRICATED

K- KILLED

(INCLUDE MOTORCYCLE DRIVER)

1- NO SAFETY EQUIP IN PLACE

1- BELTS NOT USED

1- DEPLOYED-FRONT

(BY MECHANICAL MEANS)

A- INCAPACITATING INJURY

2- FRONT CENTER

 

2- LAP BELT ONLY USED

2- DEPLOYED-SIDE

2- TRAPPED, FREED BY

B- NON-INCAPACITATING INJURY

3- FRONT RIGHT

2- LAP BELT

3- SHOULDER BELT ONLY USED

3- DEPLOYED-FRONT AND SIDE

NON-MECHANICAL MEANS

C- POSSIBLE INJURY

4- SECOND ROW SEAT LEFT

3- SHOULDER BELT

4- LAP AND SHOULDER BELT USED

4- NOT DEPLOYED-SWITCH ON

3- PARTIALLY EJECTED

N- NO APPARENT INJURY

5- SECOND ROW SEAT CENTER

4- LAP & SHOULDER BELT

 

5- NOT DEPLOYED-SWITCH OFF

4- EJECTED

 

6- SECOND ROW SEAT RIGHT

5- CHILD SAFETY SEAT

5- CHILD SEAT NOT USED

6- NOT DEPLOYED- UNKNOWN

 

 

7- THIRD ROW SEAT LEFT

6- CHILD BOOSTER SEAT

6- CHILD SEAT USED IMPROPERLY

IF SWITCH ON OR OFF

5- NOT EJECTED OR TRAPPED

 

8- THIRD ROW SEAT CENTER

 

7- CHILD SEAT USED PROPERLY

 

 

 

9- THIRD ROW SEAT RIGHT

98- NOT APPLICABLE

8- BOOSTER SEAT NOT USED

90- OTHER DEPLOYMENTS

 

 

10- OUTSIDE OF VEHICLE

(MOTORCYCLE,

9- BOOSTER SEAT USED IMPROPERLY

98- NOT APPLICABLE

 

 

11- TRAILING UNIT

SNOWMOBILE, ECT.)

10- BOOSTER SEAT USED PROPERLY

(MOTORCYCLE,

 

 

12- PICKUP TRUCK BED

 

 

SNOWMOBILE, ECT.)

 

 

13- TRUCK CAB SLEEPER SECTION

 

11- HELMET NOT USED

 

 

 

14- PASSENGER IN OTHER POSITION

 

12- HELMET USED

 

 

 

(INCLUDE MOTORCYCLE PASSENGER)

 

 

 

 

 

15- PASSENGER IN UNKNOWN POSITION

 

 

 

 

 

16- FRONT LEFT (NON-DRIVER)

 

 

 

 

 

MY VEHICLE: DRIVER AND PASSENGERS INFORMATION:

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER >>>>>>>>>>>>>>>>>>

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE ACCIDENT IN SUFFICIENT DETAIL BELOW TO DISCLOSE CAUSES.

 

 

 

 

 

 

INDICATE

 

 

 

 

 

 

 

NORTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE WHAT HAPPENED:

 

 

DIAGRAM WHAT HAPPENED:

 

 

 

 

 

BY ARROW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAMAGE TO PROPERTY OTHER THAN VEHICLES: (MAILBOX, FENCE, SIGNPOST, GUARDRAIL, ETC.)

DESCRIBE

NAME OF

PROPERTY

PROPERTY

DAMAGED:

OWNER:

 

 

ESTIMATE COST OF REPAIR

$

SIGN HERE X

SIGNATURE OF PERSON SUBMITTING REPORT IS REQUIRED

ADDRESS

DATE OF REPORT

MAIL THIS REPORT TO:

DVS / ACCIDENT RECORDS

445 MINNESOTA STREET, SUITE 181

ST. PAUL, MN 55101-5181

Document Specs

Fact Number Fact Description
1 The Minnesota Motor Vehicle Accident Report Form is officially designated as PS 32001 - 08.
2 This form is required for any crash in Minnesota involving $1,000 or more in property damage, or any injury or death.
3 Drivers involved in such crashes must complete and send this form to Driver and Vehicle Services within 10 days of the incident.
4 Failure to submit the form is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7.
5 The form is also available in an electronic format (E-form) at www.mndriveinfo.org.
6 The information collected on the form is used for building safer roads by providing statistical data on traffic accidents.
7 According to the Minnesota Data Privacy Act, the information requested is collected under statute and while it may be disclosed for specific purposes, the written report itself cannot be used against the individual as evidence in any civil or criminal matter.

Instructions on Writing Minnesota Accident Report

After being involved in a vehicle accident in Minnesota that results in injury, death, or property damage of $1,000 or more, it is mandatory to fill out the Minnesota Motor Vehicle Accident Report Form PS 32001-08. Timely submission of this form helps in building safer roads and is a legal requirement that must be complied with within 10 days of the incident. Neglecting to submit this form is considered a misdemeanor under Minnesota law. The following step-by-step instructions are meant to guide you through the process of accurately completing the form.

  1. Visit www.mndriveinfo.org to access an electronic version of the form or use a hard copy.
  2. Fill in the date of the accident (month, day, year), followed by the day of the week and the time the accident occurred, specifying AM or PM.
  3. Indicate the total number of vehicles involved and the county name as well as whether the accident occurred in a city or township.
  4. Specify the location of the accident, choosing whether it was at an intersection or not. Provide street names or road numbers as applicable.
  5. Enter your full name, address, city, state, zip code, driver’s license number, and other personal information. Include the date of birth and sex.
  6. Provide details about your vehicle, including the owner’s full name (if different from the driver), license plate number, year and state of issue, specific parts damaged, estimated cost of repair, and vehicle type (make, model, year, color).
  7. Fill in your liability insurance information, including the name of the insurance company (not agency), policy number, and the policy period.
  8. If another vehicle is involved, repeat steps 5 and 6 for the other driver/vehicle, providing their information in the corresponding section of the form.
  9. For accidents involving more than two vehicles, use section “C” on a separate form and attach it.
  10. Select the right type of accident from the coded list, marking the appropriate number in the box.
  11. Circle the correct response for whether the crash occurred in a work zone and if workers were present.
  12. Indicate the weather/atmosphere conditions, road surface condition, and light condition at the time of the accident from the available options.
  13. Detail any traffic control devices present and the manner of collision, choosing from the provided codes.
  14. Describe the actions/maneuvers prior to the accident for each vehicle involved, including direction of travel and any relevant details about parked vehicles, pedestrians, or bicyclists.
  15. If a police officer was at the scene, indicate 'yes' and provide the department name.
  16. Include information about seat position, use of safety equipment, and injury codes for all occupants in your vehicle.
  17. Provide a narrative description of the accident and a diagram if possible. Include details about property damage outside of the vehicles.
  18. Sign and date the report at the bottom, ensuring all provided information is truthful and accurate.
  19. Mail the completed report to: DVS / Accident Records, 445 Minnesota Street, Suite 181, St. Paul, MN 55101-5181.

This comprehensive documentation is crucial for legal purposes, insurance claims, and contributes to road safety analyses. Ensuring accuracy and thoroughness in completing the form helps in resolving any resulting issues from the accident more efficiently.

Understanding Minnesota Accident Report

What is the Minnesota Motor Vehicle Accident Report and when must it be completed?

The Minnesota Motor Vehicle Accident Report is a form that must be filled out by every driver involved in a crash resulting in either $1,000 or more in property damage, or any injury or death. This form must be completed and sent to the Driver and Vehicle Services (DVS) within 10 days of the accident. It's utilized to help improve road safety by analyzing accident data.

What information is required on the Minnesota Accident Report form?

The form requires a comprehensive set of information including the date, time, and location of the accident, details about the driver, vehicle, and the accident itself, descriptions of any injuries or property damage, insurance details, and a narrative and diagram of how the accident occurred. Each involved driver’s full name, address, driver’s license number, vehicle details, and insurance information are mandatory fields.

What happens if I do not complete the Minnesota Accident Report form?

Failing to complete and submit the Minnesota Accident Report form within the required 10-day timeframe when required is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7. This could potentially result in legal penalties, including fines or other legal actions.

Can the Minnesota Accident Report form be used against me in court?

No, the information you provide in the Minnesota Accident Report is protected under the Minnesota Data Privacy Act. Although it collects data for statistical purposes and may disclose certain information to parties involved in the accident or as specified by law, your personal account of the accident (your version of how the accident happened) is classified as confidential and cannot be used against you as evidence in any civil or criminal matter.

How can I obtain a Minnesota Accident Report form?

You can obtain the Minnesota Accident Report form electronically by visiting the website www.mndriveinfo.org. This form can be filled out and submitted directly through the online platform.

Where do I send the completed Minnesota Accident Report form?

Once you have completed the Minnesota Accident Report form, it should be mailed to the address provided on the form: DVS / ACCIDENT RECORDS, 445 MINNESOTA STREET, SUITE 181, ST. PAUL, MN 55101-5181.

Is it required to complete the Minnesota Accident Report form if a police report is filed?

Yes, even if a police officer completes an accident report at the scene, you are still required to fill out and submit the Minnesota Accident Report form if the incident results in injury, death, or property damage of $1,000 or more. The form serves distinct purposes and contributes to road safety analyses and improvements.

What should I do if I am unsure whether the damage exceeds $1,000 or if there has been an injury?

If you are unsure whether the property damage exceeds $1,000 or if anyone was injured in the accident, it is advisable to complete and submit the Minnesota Accident Report form regardless. Overestimating the severity of the accident and submitting the form can help ensure you are adhering to Minnesota law and protecting yourself from potential legal consequences for not reporting an accident.

Common mistakes

One common mistake individuals make when filling out the Minnesota Accident Report form is not providing complete insurance information. It's crucial to understand that failure to include full details of your liability insurance implies that you were not insured at the time of the accident. This misunderstanding can lead to unnecessary complications or assumptions about a driver's insurance coverage status.

Another error is inaccurately reporting the location of the accident. The form requires specificity, including whether the accident happened at an intersection or not, the street names, or the precise location in case of a parking lot accident. Misreporting this can not only cause confusion but also potentially impact the accuracy of statistical data used for improving road safety.

A significant number of individuals overlook the need to indicate the number of occupants in the vehicle at the time of the accident. This information is not only crucial for the immediate understanding of the accident’s impact but also for statistical purposes. Ignoring this section can lead to a lack of important contextual information about the accident.

Omitting the estimated cost to repair the vehicle damage is another frequent mistake. This estimate helps in providing a clearer picture of the accident’s severity. Leaving this blank might lead to underestimating the incident's overall impact.

Many people fail to describe the accident in sufficient detail in the designated section. A thorough and clear description helps in understanding the causality and dynamics of the accident, which can be critical for insurance claims and legal matters. A vague or incomplete description can hinder the process significantly.

Not using the diagram provided to illustrate what happened is also a common error. Visual representation can greatly enhance the clarity of the situation, offering insights that words alone may not fully convey. Escaping this step can result in a missed opportunity to communicate critical details of the accident.

Last but not least, often, drivers do not check the weather/atmosphere conditions and road surface sections accurately. These details can significantly influence the understanding of how external factors contributed to the accident. Incorrect or incomplete information in these sections can distort the assessment of the accident’s circumstances.

Documents used along the form

When an individual is involved in a motor vehicle accident in Minnesota, filling out the Minnesota Motor Vehicle Accident Report Form (PS 32001 - 08) is a critical first step. However, this form is just one of several documents that may be necessary to properly address the aftermath of an accident. Understanding these associated documents can provide clarity and ensure that all necessary steps are taken during what can be a confusing and stressful time.

  • Proof of Insurance: This document serves as verification that the vehicle involved in the accident is insured. It is essential for drivers to exchange insurance information at the accident scene.
  • Medical Records: If injuries were sustained during the accident, detailed records from hospitals or doctors who provided treatment are crucial for insurance claims and potential legal actions.
  • Vehicle Repair Estimates: Written estimates from auto repair shops detailing the cost of repairing the damage to the vehicle(s) involved are needed for insurance claims and may also be used in court.
  • Photographs of the Accident Scene: Photos can provide visual evidence of the accident scene, vehicle damage, and any relevant road signs or conditions, which can be useful for insurance claims and legal proceedings.
  • Police Report: A formal report by the law enforcement agency that investigated the accident provides an official account of the incident, which is necessary for insurance and legal matters.
  • Witness Statements: Written or recorded accounts from people who witnessed the accident can support claims about how the accident occurred and who was at fault.
  • Driver’s Statement: A personal account from the driver(s) involved in the accident giving their version of events can be an important part of the documentation for insurance, legal, or medical purposes.

Each of these documents plays a role in the broader context of responding to and resolving issues stemming from a motor vehicle accident. Whether for insurance claims, legal disputes, or medical treatment, gathering and maintaining these documents can help ensure that the process moves as smoothly as possible. Remember, the importance of accurate and thorough documentation cannot be overstated in these situations.

Similar forms

The National Highway Traffic Safety Administration (NHTSA) Accident Report Form bears many similarities to the Minnesota Motor Vehicle Accident Report form. Both documents are designed to compile data from vehicular accidents for statistical analysis and road safety improvements. They require detailed information about the crash, including the date, location, vehicle types involved, and descriptions of how the accident occurred. These forms also emphasize the importance of reporting within a specific timeframe to ensure the data collected is timely and relevant for developing safety measures.

Workers' Compensation First Report of Injury Form parallels the Minnesota Accident Report Form in its function of documenting an incident soon after it occurs, although it focuses on workplace injuries. Both forms are critical for initiating a formal record of the event, detailing pertinent information such as personal details of those involved, the precise location of the incident, and a comprehensive description of the incident and any injuries sustained. This documentation is crucial for both analysis and potential claims processing.

Aviation Accident/Incident Report mirrors the Minnesota form in its objective to scrutinize and mitigate risks within a specific transportation sector. It gathers exhaustive details about the incident, including environmental conditions, aircraft involved, and pilot information, akin to how the vehicle accident report collects data on road conditions, vehicles, and drivers. The thorough collection of such data aids in identifying patterns that could lead to safety enhancements.

The Occupational Safety and Health Administration (OSHA) Form 301, Injury and Illness Incident Report, shares the goal of the Minnesota form to document incidents meticulously to prevent future occurrences. Both require detailed accounts of how the incident unfolded, the resultant injuries or damages, and personal information of those involved. This process helps in pinpointing risk factors and developing strategies to enhance safety and prevent further incidents.

The Coast Guard Boating Accident Report Form also prioritizes the collection of detailed information following a specific type of incident, focusing on marine environments. This form, much like its Minnesotan road counterpart, gathers data on the incidents’ circumstances, including weather conditions, types of vessels involved, and details regarding the participants. These insights are crucial for improving boating safety standards and regulations.

Insurance Claim Forms for auto accidents are directly related to the Minnesota Motor Vehicle Accident Report Form in their shared aim of capturing a detailed record of the incident for financial assessment. Both require information on the vehicles involved, the extent of the damages, and a narrative of how the incident occurred. This information is vital for processing claims and determining liability and compensation.

The Department of Motor Vehicles (DMV) Accident Report Form in various states serves a similar purpose to Minnesota's report, aiming to gather a comprehensive account of vehicle accidents within the jurisdiction. These forms typically require detailed information about the crash participants, location, damages, and a narrative description of the crash, facilitating a systematic approach to road safety analysis and legal documentation.

The Federal Railroad Administration (FRA) Accident/Incident Report provides an analogous function for the railroad sector, offering a systematic method for reporting and analyzing train-related incidents. Like the Minnesota form, it requires detailed incident descriptions, environmental and operational conditions at the time, and participant information, contributing to safety and prevention strategies in the railroad industry.

Property Damage Report Forms, while not specific to vehicular accidents, share the objective of documenting the occurrence and extent of damage, similar to the property damage section in Minnesota’s vehicular accident report. Both forms are essential for assessing the impact, facilitating repairs, and processing claims, thereby ensuring that the affected parties receive appropriate compensation and support.

The Incident Report Forms used by law enforcement agencies for various types of incidents, including but not limited to traffic accidents, resemble the Minnesota form in their comprehensive approach to documentation. They collect detailed information about the incident, those involved, and the circumstances, playing a vital role in legal and safety analysis processes.

Dos and Don'ts

When completing the Minnesota Accident Report form, certain practices can significantly affect the accuracy and acceptability of your report. It is paramount to follow the outlined instructions meticulously to ensure your report is not only compliant but also useful for the purposes intended. Below are essential dos and don'ts to guide you through this critical process.

Things You Should Do

  1. Provide accurate and detailed information: Ensure that every piece of information you supply, from the date of the accident to the description of the event, is correct and as detailed as possible. This includes accurately estimating the cost of repairs and correctly indicating the location of the accident.

  2. Describe the accident clearly: Use the section designated for the description of the accident to give a clear and concise explanation of what happened. This should include directions of the involved vehicles, actions taken by drivers, and any contributing factors to the accident.

  3. Report in a timely manner: Submit the completed form to the Driver and Vehicle Services (DVS) within 10 days of the accident. Timely submission is not only a legal requirement but also beneficial for a prompt response from relevant authorities.

  4. Check for completeness and accuracy: Before mailing the report, review all sections carefully to ensure no required information is missing and that all details are accurate. A complete and accurate report facilitates a smoother processing.

Things You Shouldn't Do

  1. Avoid guessing or approximating details: If certain information is unknown, it's better to indicate so rather than provide inaccurate or guessed information. This is particularly important for details like the exact cost of damage or the specific make and model of involved vehicles.

  2. Do not leave insurance information blank: Failing to provide full liability insurance information can lead to an assumption of lack of insurance coverage, which has its own legal consequences. Ensure this section is filled out in full.

  3. Refrain from attaching unnecessary documentation: Only attach additional forms if more than two vehicles were involved as instructed. Overloading the report with unnecessary documents can complicate the processing of your report.

  4. Do not use the report to admit fault or liability: The accident report is designed to document the events as they happened. It's not the appropriate platform to admit fault or liability. Statements within can be used in legal or insurance proceedings in various ways.

Misconceptions

Understanding the Minnesota Accident Report Form is crucial, but there are common misconceptions that can lead to mistakes when filling it out. Let's clear up four of these misconceptions to help ensure the process is as smooth as possible.

  • Misconception #1: The form is only for accidents involving severe injuries or fatalities.

    Actually, the report must be completed for any accident if there's either $1,000 or more in property damage, or if anyone is injured or killed. This criteria means that even relatively minor accidents can necessitate filling out the form.

  • Misconception #2: You do not need to report the accident if it occurred on private property.

    This is not true. The location of the accident doesn't exempt you from filing a report. Whether the collision occurred on a public road, in a parking lot, or on private property, if it meets the reporting criteria, you must complete the form.

  • Misconception #3: The form acts as an official admission of guilt.

    Many people fear that providing detailed information on the form is equivalent to admitting fault for the accident. However, this report is for statistical and data collection purposes to help build safer roads. While the details you provide should be accurate, this report cannot be used against you as evidence in any civil or criminal proceeding, ensuring that your version of events is kept confidential.

  • Misconception #4: If you complete the form, you don't need to notify your insurance company.

    Even though you've filled out the report, this does not fulfill your obligation to report the accident to your insurance company. The Minnesota Motor Vehicle Accident Report form and informing your insurance provider are separate actions. Failing to report the incident to your insurer could result in coverage issues down the line.

Understanding these key points will help you navigate the aftermath of a vehicle accident more effectively in Minnesota. It's always better to be informed and prepared, minimizing the stress involved in these situations.

Key takeaways

Filling out the Minnesota Motor Vehicle Accident Report is more than a formality—it's a critical step in the process of any road incident involving $1,000 or more in damages, personal injury, or, unfortunately, fatalities. Here are nine key takeaways to keep in mind:

  • Timeliness is crucial: You must submit this form to the Driver and Vehicle Services (DVS) within 10 days of the accident. Procrastination can lead to legal repercussions.
  • Detailed accuracy matters: The form helps to build safer roads by using the gathered information for statistical purposes. Filling it out accurately ensures the data used to enhance road safety and policies is reliable.
  • Misdemeanor charges for non-compliance: Failing to provide the detailed report as stipulated can result in misdemeanor charges under Minnesota Statute 169.09, subdivision 7.
  • Online accessibility: For convenience, an e-form is available at www.mndriveinfo.org, making it easier to comply with the submission requirements.
  • Police presence: Indicate whether a police officer was at the scene as this can have implications for the legal and insurance processes that may follow.
  • Insurance information is vital: You must provide full liability insurance information. Without it, the assumption will be that you were uninsured, potentially leading to further legal and financial consequences.
  • Data privacy compliance: The Minnesota Data Privacy Act protects the submitted information. It specifies that your report can't be used against you in any civil or criminal matter, ensuring your privacy and legal protection.
  • Detail on accident location is necessary: Whether the accident occurred at an intersection, not at an intersection, or in a parking lot, detailed location information helps in understanding and analyzing accident patterns.
  • Comprehensiveness: The form requires information on the driver, the vehicle, the accident, seat and airbag use, and even the weather conditions at the time. This comprehensive approach ensures a full record of the incident for statistical and safety improvement purposes.

Completing the Minnesota Motor Vehicle Accident Report form diligently not only fulfills a legal requirement but also contributes to a broader effort towards safer roads. It's an example of how individual responsibility can have a collective benefit.

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