Dr 2447 Form PDF Details

At the heart of traffic incident documentation in Colorado lies the DR 2447 form, a comprehensive report designed to capture the nuance and details of road accidents meticulously. Crafted by the Colorado Department of Revenue, this form serves the essential purpose of chronicling occurrences on state roads, from highways to private properties, ensuring a structured and detailed account of incidents for follow-up and analysis. Its structure facilitates the recording of various accident dynamics including, but not limited to, the location, involved parties, vehicle details, and specifics of the incident like weather conditions, road status, and potential violations or contributory factors like alcohol or drug use. Moreover, it includes sections on the accident's investigation details, such as officer information, injured or killed numbers, and property damage. The form stands as a vital instrument for law enforcement and other agencies, offering insights into patterns that might improve road safety or influence policy adjustments. Its importance cannot be overstressed, not just for legal or administrative actions that might follow an accident but also as a tool for data collection and traffic safety analysis, aiming at preventing future accidents through informed decisions and strategies.

QuestionAnswer
Form NameDr 2447 Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namescolorado department of revenue law enforcement form dr2447, state 80261 accident online, dr 2447 accident, colorado revenue accident

Form Preview Example

STATE OF COLORADO TRAFFIC ACCIDENT REPORT
DR 2447 (02/01/06)
COLORADO DEPARTMENT OF REVENUE

MAIL TO: STATE OF COLORADO MOTOR VEHICLE TRAFFIC RECORDS DENVER, CO 80261-0016

AMENDED/SUPPL.

UNDER $1,000

COUNTER REPORT

PRIVATE PROPERTY PAGE ______ OF ______ PAGES

 

CDOT Code

 

 

 

 

 

 

 

 

 

 

 

 

INTERSTATE HWY

 

HWY NUMBER

 

 

 

 

 

 

DOR Code

 

 

 

 

 

 

 

 

 

 

 

K

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE HWY

 

 

 

MILEPOINT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

K

 

Case #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY ST/CNTY RD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Accident

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

Agency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

 

 

 

 

County #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Time (24 Hr.)

Officer Number

 

 

 

Officer Name

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Detail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number Killed

Number Injured

Location Route, Street, Road

______ Miles ______ Feet

N

 

 

 

S

 

E

 

 

 

W

 

OF:

 

 

 

 

 

 

B

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

___________________________________

 

 

 

At: ___________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Report

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Latitude _________

_________

 

_________

 

Longitude _________

_________

________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Code

 

 

 

Investigated

 

Total Vehicles

District Number

Public Property/

Photos Taken

Railroad Crossing

Const. Zone

Highway

 

 

Bridge

 

 

 

 

 

M

 

 

 

 

 

 

@ Scene

 

 

 

 

 

 

 

 

Employee

 

 

 

 

 

 

Related

 

 

Related

 

Interchg.

 

 

Related

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

Traffic Unit #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Traffic Unit #

Veh.

Parked

Bicycle

Pedestrian

Non-Vehicle

 

 

Non-Contact Veh.

M

 

1 or _______

 

Veh.

Parked

 

Bicycle

Pedestrian

Non-Vehicle

Non-Contact Veh. 2 or _______

 

 

 

 

 

 

 

 

 

Last Name

 

 

 

 

 

 

 

 

First

 

 

 

 

MI

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Phone

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

City

 

 

 

 

 

State

 

ZIP

 

Bus. Phone

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

ZIP

 

Bus. Phone

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

Driver License Number

CDL

State

Sex

DOB

Driver License Number

CDL State

Sex

DOB

N

 

 

 

 

 

 

 

 

 

 

 

Primary Violation

 

 

 

 

Primary Violation

 

 

 

 

C

DUI

 

 

 

 

 

DUI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Violation Code

Citation Number

 

 

Common Code

Violation Code

Citation Number

 

Common Code

P

 

 

 

 

 

 

 

 

 

 

 

Year

Make

Model

 

 

Body Type

Year

Make

Model

 

Body Type

 

 

 

 

 

 

 

 

 

 

 

 

P

License Plate Number

State or Country

 

Color

License Plate Number

State or Country

 

Color

 

D

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification Number

 

 

 

Vehicle Identification Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Owner Last Name Same

First

 

MI

Vehicle Owner Last Name

Same

First

 

MI

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

Address Same

City

State ZIP

Address Same

 

City

State ZIP

 

 

 

Q

 

Towed Due to Damage

By:

 

 

 

Towed Due to Damage

By:

 

 

 

Q

 

To:

 

 

 

 

To:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

Trailer VIN#___________________________

 

 

 

 

 

 

 

Trailer VIN#___________________________

 

 

 

 

 

 

 

1- Slight

 

 

 

 

1- Slight

 

 

 

 

 

 

2- Moderate

 

 

 

 

2- Moderate

 

G

_____ Undercarriage

 

____ Undercarriage

3- Severe

_____ Undercarriage

____ Undercarriage

 

3- Severe

 

 

 

 

 

 

 

 

 

 

 

 

 

Insurance Company

None

No Proof

Exp. Date

Insurance Company

None

No Proof

Exp. Date

R

 

Policy Number

 

 

 

 

Policy Number

 

 

 

 

R

H

 

 

 

 

 

 

 

 

 

 

 

 

Owner Damaged Prop.

Last Name

First

MI

Address

 

City

State

ZIP

 

 

 

Owner Damaged Prop.

Last Name

First

MI

 

Address

City

State ZIP

J

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T.U.

SAFETY

 

SUSPECTED

INJ.

 

NAME / ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

# POS. REST. ENDO.

 

 

 

SEV. AGE

SEX

 

 

 

S

 

 

EQUIP.

AIR BAG EJECT ALCO DRUG

 

 

 

 

 

 

 

 

 

 

S

T

T

Approved By

I.D. #

Date

AA

AA

BB

BB

CC

CC

DD

DD

EE

EE

FF

FF

GG

GG

GG

GG

PAGE ______ OF ______ PAGES

Case #

DOR CODE

Accident Date

Agency

HH

Describe Accident

HH

JJ

JJ

KK

KK

LL

LL

MM

MM

 

 

 

 

 

 

 

NN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier Name

US DOT

ICC

State DOT

 

NN

#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T.U.

Address

Carrier Identification #

 

 

 

 

 

 

 

 

 

 

 

NN

 

 

 

 

 

 

 

 

 

Carrier Name

US DOT

ICC

State DOT

 

 

 

 

 

 

 

#

 

 

 

 

 

 

 

 

 

NN

T.U.

 

 

 

 

 

 

 

Address

Carrier Identification #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAFFIC ACCIDENT REPORT

OVERLAY A

A. LOCATION

01. On Roadway

02. Ran Off Left Side

03. Ran Off Right Side

04. Ran Off ‘T’ Intersection

05.Vehicle Crossed Center Median Into Opposing Lanes

06.On Private Property

B.HARMFUL EVENT SEQUENCE

 

NON-COLLISION ACCIDENT

COLLISION WITH OBJECT

 

01.

Overturning

19.

Light Pole / Utility Pole

 

02.

Other Non-Collision

20.

Traffic Signal Pole

 

COLLISION WITH PEDESTRIAN

21.

Sign

 

03.

School Age To / From School

22.

Guard Rail

 

04.

Pedestrian on Toy Motorized Veh.

23.

Cable Rail

1st

05.

All Other Peds

24.

Concrete Highway Barrier

25.

Bridge Structure

 

COLLISION WITH MOTOR VEHICLE

 

IN TRANSPORT

26.

Vehicle Debris or Cargo

 

06.

Front to Front

27.

Culvert or Headwall

2nd

28.

Embankment

07.

Front to Rear

 

08.

Front to Side

29.

Curb

 

30.

Delineator Post

 

09.

Rear to Side

 

31.

Fence

MOST

10.

Rear to Rear

32.

Tree

 

11. Side to Side-Same Direction

33.

Large Rocks or Boulder

 

12.

Side to Side-Opposite Direction

 

34.

Railroad Crossing Equipment

 

COLLISION WITH OTHER VEHICLE

 

35.

Barricade

 

13.

Parked Motor Vehicle

 

36.

Wall or Building

 

14.

Railway Vehicle/Light Rail

 

37.

Crash Cushion / Traffic Barrel

 

15.

Bicycle

 

38.

Mailbox

 

16.

Road Maintenance Equipment

 

39.

Other Fixed Object (Specify in

 

COLLISION WITH ANIMAL

 

 

Narrative)

 

17.

Domestic Animal

 

 

40.

Other Object (Specify in

 

18.

Wild Animal

 

 

Narrative)

 

 

 

 

 

 

 

C. APPROACH/OVERTAKING TURN

 

01.

Approach Turn

 

 

 

02.

Overtaking Turn

 

 

 

03.

Not Applicable

 

 

 

 

 

 

 

D. ROAD DESCRIPTION

 

 

 

01.

At Intersection

05.

Alley Related

 

02.

Driveway Access Related

06.

Roundabout

 

03.

Intersection Related

07.

Highway Interchange

 

04.

Non-Intersection

08.

Parking Lot

 

 

 

 

 

E. ROAD CONTOUR

 

 

 

01.

Straight On-Level

04.

Curve On-Grade

 

02.

Straight On-Grade

05.

Hillcrest

 

03. Curve On-Level

 

 

 

 

 

 

 

F. ROAD SURFACE

 

 

 

01.

Concrete

05.

Dirt

 

02.

Blacktop

06.

Other (Describe in Narrative)

 

03.

Brick or Block

07.

Unknown

 

04.

Gravel, Slag or Stone

 

 

 

 

 

 

 

G. ROAD CONDITION

 

 

 

01.

Dry

08.

Dry W/Visible Icy Road Treatment

 

02.

Wet

09.

Wet W/Visible Icy Road

 

03.

Muddy

 

Treatment

 

04.

Snowy

10.

Snowy W/Visible Icy Road

 

05.

Icy

 

Treatment

 

06.

Slushy

11.

Icy W/Visible Icy Road Treatment

 

07.

Foreign Material

12.

Slushy W/Visible Icy Road

 

 

 

 

Treatment

H. LIGHTING CONDITION

01. Daylight

02. Dawn or Dusk

03. Dark - Lighted

04. Dark - Unlighted

J. ADVERSE WEATHER CONDITION

00.

None

03.

Fog

01.

Rain

04.

Dust

02.

Snow / Sleet / Hail

05.

Wind

K. VEHICLE / VEHICLE COMBINATION

FMC (Overlay C) Required

08.

Pickup Truck / Utility Van W/Trailer

01.

Vehicle / Vehicle Combination

09.

SUV

 

(10,001 lbs. and over)

10.

SUV W/Trailer

02.

School Bus (all school buses)

11.

Motor Home

03.

Non-school Bus (9 occupants or more

12.

Motorcycle

 

including driver) in commerce

13.

Bicycle

04.

Transit Bus

14.

Motorized Bicycle

GVWR 10,000 lbs. or Less

15.

Farm Equipment

05.

Passenger Car / Passenger Van

16.

Hit & Run Unknown

06.

Passenger Car / Passenger Van W/ Trailer

17.

Light Rail

07.

Pickup Truck / Utility Van

18.

Other (Describe in Narrative)

L. DIRECTION OF TRAVEL – PRIOR TO IMPACT

01.

North

05.

South

02.

Northeast

06.

Southwest

03.

East

07.

West

04.

Southeast

08.

Northwest

M. VEHICLE MOVEMENT – PRIOR TO IMPACT

01.

Going Straight

10.

Parked

02.

Slowing

11.

Changing Lanes

03.

Stopped in Traffic

12.

Avoiding Object in Roadway

04.

Making Right Turn

13.

Weaving

05.

Making Left Turn

14.

Spun Out of Control

06.

Making U-Turn

15.

Drove Wrong Way

07.

Passing

16.

Other (Describe in Narrative)

08.

Backing

 

 

09.

Entering / Leaving Parked Position

 

 

N. ROADWAY SPEED LIMIT - Vehicles Only

 

 

 

Traffic Unit #1 or ________

 

 

 

Traffic Unit #2 or ________

P. ESTIMATED VEHICLE SPEED - Vehicles Only

 

 

 

Traffic Unit #1 or ________

 

 

 

Traffic Unit #2 or ________

Q. DRIVER ACTIONS (Officer Opinion Only)

00.

No Action

10.

Lane Violation

01.

Exceeded Safe/ Posted Speed

11.

Improper Passing on Left

02.

Impeded Traffic

12.

Improper Passing on Right

03.

Failed to Yield ROW

13.

Followed Too Closely

04.

Disregard Stop Sign

14.

Improper Backing

05.

Failed to Stop at Signal

15.

Signaling Violation

06.

Disregarded Other Device

16.

Reckless Driving

07.

Improper Turn

17.

Careless Driving (if used,

08.

Turned from Wrong Lane or Position

 

block R can not be coded "00")

09.

Other Improper Turns

 

 

R. DRIVER - MOST APPARENT HUMAN CONTRIBUTING FACTOR (Officer Opinion Only)

00.

No Apparent Contributing Factor

09.

Physical Disability

01.

Asleep at the Wheel

10.

DUI, DWAI, DUID

02.

Driver Fatigue

11.

Distracted / Passenger

03.

Illness / Medical

12.

Distracted / Cell Phone

04.

Driver Inexperience

13.

Distracted / Radio

05.

Aggressive Driving

14.

Distracted / Other

06.

Driver Unfamiliar With Area

 

i.e. Food, Objects, Pet, etc.

15.

Other Factor (Describe

07.

Driver Emotionally Upset

 

in Narrative)

08.

Evading Law Enforcement Officer

 

 

 

S. BY PEDESTRIAN ACTION (Officer Opinion Only) 01. Cross Against Signal

02. Cross / Enter at Intersection

03. Cross / Enter NOT at Intersection

04. Standing in Roadway

05. Playing in Roadway

06. Soliciting Rides

07. Walking in Roadway in Direction of Traffic

08. Walking in Roadway Against Direction of Traffic

09.Entering / Exiting Vehicle

10.Pushing / Working on Vehicle

11.Lying in Roadway

12.Other (Describe in Narrative)

T. VEHICLE DEFECT / CONDITION (Officer Opinion Only)

00.

No Vehicle Defects

10.

Improper Load

01.

Defective Head Light(s)

11.

Spilled Load – Commercial

02.

Defective Brake/Tail Light(s)

 

Aggregate

03.

Defective Signaling Device

12.

Spilled Load – Commercial

04.

Brakes Defective/Out of Adjustment

 

Non- Aggregate

05.

Defective Tires

13.

Spilled Load – Other

06.

Sudden Tire Failure

14.

Parking Violation

07.

Improper Tires for Conditions

15.

Other Defect(s) (Describe

08.

Mechanical Failure

 

in Narrative)

09.

Obstructed Window(s)

 

 

OVERLAY B

Traffic Unit #

Position In / On Vehicle

14

 

 

03

06

09

 

 

 

01.

Driver

 

 

 

 

 

02-09.

Passengers

 

 

 

 

 

 

 

 

10.

Other ENCLOSED passenger/cargo area

 

 

 

10/11

 

 

11.

Other UN-ENCLOSED passenger/cargo area

02

05

08

 

13

12.

Sleeper Section of Truck

 

 

12

 

 

 

 

 

 

 

 

13.

Trailer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

Riding/Hanging on to Exterior of vehicle or trailer

 

 

 

 

 

 

 

 

 

 

01

04

07

 

 

 

15.

Pedestrian

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Compliance with Driving Restrictions 00. Not Restricted

 

 

 

 

 

 

 

 

 

01. Complied With Restrictions

 

 

 

 

 

 

 

 

02. Did Not Comply With Restrictions

 

 

 

 

 

 

 

03. Compliance With Restrictions Not Known

Compliance with Driving Endorsements 00. No Driving Endorsements

01.Endorsements Required and Complied With

02.Endorsements Required and Not Complied With

03.Endorsements Required and Compliance Not Known

 

 

 

 

Safety equipment used

SYSTEM

 

 

 

 

 

USE (Restraints & MC Eye

 

HELMET

 

F. Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. None

 

 

 

 

 

 

Protection)

 

 

A. N/A (Cars/Trucks)

 

 

 

 

 

 

 

 

 

 

 

 

B. Shoulder and Lap Belt

 

 

00. Not used

 

 

B. No Helmet

 

G. Bicycle Helmet

 

 

 

 

 

 

 

 

 

 

 

 

C. Shoulder belt only

 

 

01. Properly used

 

 

C. Available, not used

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Lap belt only

 

 

 

02. Improperly used

 

D. Helmet Improperly used

 

 

 

 

 

 

 

 

 

 

 

 

E. Child safety restraint

 

 

03. Unknown

 

 

E. Helmet Properly used

 

 

 

 

 

 

 

 

 

 

 

 

F. Motorcycle

 

 

 

 

 

04. Bicycle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. Bicycle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Air Bag

00. Not Equipped

 

 

 

04. Not deployed at pos.,

 

 

A. None

D. Curtain

 

 

 

 

 

 

 

 

 

 

 

01. Not Deployed

 

 

 

 

 

deployed at others

 

 

B. Front

E. Rear

 

 

 

 

 

 

 

 

 

 

 

 

02. Deployed at pos. only

 

05. Unknown

 

 

 

 

C. Side

F. Multiple

 

 

 

 

 

 

 

 

 

 

 

03. Deployed at pos. & others

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ejection

00.

 

No

 

 

02.

Yes - Full

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

01.

 

Yes - Partial

03.

Extricated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suspected alcohol

 

00.

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Officer Opinion Only)

01.

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02. Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suspected drugs

 

00.

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Officer Opinion Only)

01.

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02. Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Injury Severity

 

00.

No injury

 

 

 

03.

Evident - incapacitating

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

01.

Complaint of injury

04.

Fatal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02. Evident - non-incapacitating

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Age Age MUSTBEin whole Numbers (Under the Age of 1 year Age = 0 )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

)

Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

=0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suspectedalcohol(OfficersOpinionOnly)

 

 

 

 

AgeAgeinwholeNumbers(UndertheAgeof1yearAgeMUSTBE

 

 

Name / Address

 

 

 

 

 

 

TrafficUnit#

PositionIn/OnVehicle

CompliancewithDrivingRestrictions

CompliancewithDrivingEndorsements

SafetyEquipmentUsed -System

-Use

-Helmet

AirBag -Deployment

 

AirBag -Type

Ejection

Suspecteddrugs(OfficersOpinionOnly)

 

InjurySeverity

 

Sex

Name / Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FEDERAL MOTOR CARRIER INFORMATION

 

OVERLAY C

AA. CARRIER TYPE

HH. HAZARDOUS MATERIALS

01.

Interstate

Did the vehicle have a hazardous material placard?

02.

Intrastate

00.

No

03.

Government Vehicle (10,001lbs. GVWR and over)

01.

Yes

04.Not in Commerce (10,001lbs. GVWR and over)

(If #4 is chosen, complete onlyblocks CC, DD, EE, FF, and GG or NN.)

BB. SOURCE OF NAME

 

 

 

 

 

 

 

 

 

 

 

 

01.

Log Book

 

 

 

 

 

 

 

 

 

 

 

 

02.

Shipping Papers, Truck, Bus, or Trip Manifest

 

 

 

 

 

 

 

 

 

 

 

 

JJ. HAZARDOUS MATERIALS

 

 

 

 

 

 

03.

Driver

 

 

 

 

 

 

04.

Side of Vehicle

Was hazardous cargo from the placarded truck released?

 

 

 

 

 

 

 

 

 

(Do not count fuel from the vehicle fuel tank)

 

 

 

 

 

 

 

 

 

00.

No

 

 

 

 

 

 

CC. GROSS VEHICLE WEIGHT RATING

 

 

 

 

 

 

01.

Yes

 

 

 

 

 

 

01.

Under 10,001 Pounds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02.

10,001 to 26,000 Pounds

 

 

 

 

 

 

 

 

 

 

 

 

03.

26,001 Pounds and Over

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD. TOTAL NUMBER OF AXLES

KK. HAZARDOUS MATERIALS

 

 

 

 

 

 

Enter the total number of axles including truck and trailer.

Enter the fourdigit number from the placard. If no number on the placard

 

 

 

enter the fourdigit identification number from the shipping paper(s).

 

 

 

 

 

 

 

 

 

 

 

 

 

KK

 

 

 

 

 

 

 

1

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EE. VEHICLE CONFIGURATION

 

 

 

 

 

 

 

Sample

 

 

 

 

 

 

 

 

 

 

 

 

01.

Passenger Car (only if HM placarded)

LL. HAZARDOUS MATERIALS

 

 

 

 

 

 

02.

Light Truck (only if HM placarded)

Enter the one digit number taken from the bottom of the placard.

 

 

 

 

03.

Bus/ Limousine

 

 

 

 

 

 

 

 

 

 

 

 

04.

Single-unit Truck (2 axles)

 

 

 

 

 

 

 

 

 

 

 

 

05.

Single-unit Truck (3 or more axles)

 

 

 

 

 

 

 

 

 

 

 

 

06.

Truck and Trailer

 

 

 

 

 

 

 

 

 

 

 

 

07.

Truck Tractor (Bobtail)

 

 

 

 

 

 

 

 

 

 

 

 

08.

Truck Tractor and Semi-Trailer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

09.Truck Tractor and Double Trailers

10.Truck Tractor and Triple Trailers

11.Other (Describe in narrative)

FF. CARGO BODY TYPE

MM. LIQUID HAZARDOUS MATERIALS

01.

Bus/ Limousine (seats 9-15 occupants including the driver)

Enter the amount of bulk liquid cargo at time of accident.

02.

Bus/Limousine (seats 16 or more occupants including the driver)

01.

0 to 1,000 gallons

03.

Van/ Enclosed Box

02.

1,001 to 2,000 gallons

04.

Cargo Tank

03.

2,001 to 3,000 gallons

05.

Flatbed/Pickup

04.

3,001 to 4,000 gallons

06.

Dump Bed

05.

4,001 to 5,000 gallons

07.

Concrete Mixer

06.

5,001 to 6,000 gallons

08.

Auto Transporter

07.

6,001 to 7,000 gallons

09.

Garbage Refuse

08.

7,001 to 8,000 gallons

10.

Grain, Chips, Gravel

09.

8,001 gallons and over

11.Pole

12.Intermodal Container

13.Vehicle Towing another Vehicle

14.Fire Aparatus

15.Ambulance

16.No Cargo Body

17.Other (Describe in Narrative)

GG.

Block AA Top

1st

2nd

3rd

SEQUENCE OF ACCIDENT EVENTS

NON-COLLISION

COLLISION

01.

Ran Off the Road

11.

Pedestrian

02.

Jackknifed

12.

Motor Vehicle inTransport

03.

Overturning

13.

Parked Motor Vehicle

04.

Downhill Runaway

14.

Train

05.

Cargo Loss or Shift

15.

Pedal Cycle (Bicycle, Tricycle, etc.)

06.

Explosion or Fire

16.

Animal

07.

Separation of Units

17.

Fixed Object

08.

Crossed the Median/Center Line

18.

Work Zone Maintenance Equipment

09.

Equipment Failure (Tires, etc.)

19.

Other Movable Object

10.

Other (Describe in Narrative)

20.

Other (Describe in Narrative)

NN.

Block AA Bottom

1st

2nd

3rd

4th

4th

COLORADO INVESTIGATOR’S FATAL TRAFFIC ACCIDENT SUPPLEMENTAL REPORT

PAGE ______ OF ______ PAGES

Case #

DOR CODE

Accident Date

Agency

EMERGENCY MEDICAL SERVICES

(Record all time using 24 Hr. time)

Time Notified

Time Arrived @ Scene

Time Arrived @ Hospital

 

 

 

If times are unknown provide name of responding services

TRAFFICWAY FLOW

01. Not Divided (Two Way)

02.Divided, Median W/O Barrier

03.Divided, Median W/Barrier

04.One Way

NUMBER OF TRAVEL LANES

If the accident is totally contained on half of a divided highway (physical barrier not painted median), only count the number of travel lanes on that half.

ACCIDENT AVOIDANCE MANEUVER

00. No Avoidance Maneuver

01. Braking (Skid marks evident)

02.Braking (Per driver, no skid marks evident)

03.Braking (Per witness, no skid marks evident)

04.Steering (Evidence or stated)

05.Steering & Braking (Evidence or stated)

06.Other Avoidance Maneuver

FIRE/HAZARDOUS MATERIALS INVOLVEMENT

00. No Fire/No Haz-Mat Cargo

01.No Fire/Haz-Mat Cargo Not Involved

02.No Fire/Haz-Mat Incident

03.Vehicle Fire/No Haz-Mat Cargo

04.Vehicle Fire/Haz-Mat Cargo Not Involved

05.Vehicle Fire/Haz-Mat Incident

 

Traffic

Traffic

 

Traffic

 

Traffic

Unit #1

Unit #2

Unit #3

Unit #4

 

or ___

or ___

or ___

or ___

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Traffic

Traffic

 

Traffic

 

Traffic

Unit #1

Unit #2

Unit #3

Unit #4

 

or ___

or ___

or ___

or ___

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAFFIC CONTROL DEVICE FUNCTIONING

01.No Controls

02.Not Functioning

03.Functioning Improperly

04.Functioning Properly

05.Unknown

List the Most Significant Types of Traffic Control Devices

MUST BE COMPLETED FOR ALL PERSONS INVOLVED EXCEPT UNINJURED BUS/RAILWAY PASSENGERS.

(A)Traffic Unit Number (list Traffic Unit Number as on DR 2447)

(B)Position in Vehicle

14

03

06

09

 

 

 

 

 

 

 

02

05

08

10/11

 

12

 

 

 

 

 

 

 

 

 

 

01

04

07

 

 

 

 

 

 

 

13

01. Driver

02-09. Passengers

10.Other ENCLOSED passenger/cargo area

11.Other UN-ENCLOSED passenger/cargo area

12.Sleeper Section of Truck

13.Trailer

14.Riding/Hanging on to Exterior of Vehicle or Trailer

15.Pedestrian

(C) Ejection Path 00.

Not Ejected/ Not applicable

04.

Through Back Window

 

 

 

 

08. Other Path (e.g. back of pickup truck)

01.

Through Side Door Opening

05.

Through Back Door/Tailgate Opening

09.

Unknown

 

 

02.

Through Side Window

06.

Through Roof Opening (sun roof/convertible top down)

 

 

 

 

03.

Through Windshield

 

07.

Through Roof (convertible top up)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(D) Alcohol Suspected

Yes > 01.

Preliminary Breath Test

04.

Passive Alcohol Sensor

 

No > 06.

Preliminary Breath Test

09.

Passive Alcohol Sensor

 

(Officer Opinion Only)

 

02.

SFST

 

 

05.

Other method

 

07.

SFST

10.

Other method

 

 

03.

Observed

 

 

 

 

 

 

08.

Observed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(E) Tested for Alcohol

00.

Not Tested

03.

Urine

06. By Coroner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

01.

Blood

 

04.

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02.

Breath

 

05.

Refusal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(F) Other Drug/Impairment Suspected

Yes > 01.

Drug Recognition Expert

 

No > 05.

Drug Recognition Expert

 

 

 

 

 

 

(Officer Opinion Only)

 

 

 

02.

SFST

 

 

06.

SFST

 

 

 

 

 

 

 

 

 

03.

Observed

 

 

07.

Observed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04.

Other

 

 

08.

Other Method

 

 

 

 

 

 

 

(G) Tested for Other Drugs

00. Not Tested

02. Breath

04. Other

06. By Coroner

 

 

 

 

 

 

 

 

 

 

 

 

 

01. Blood

 

03. Urine

05. Refusal

 

 

 

 

 

 

(H)Dead at Scene 00. No

01.Yes

Name

Taken to

Date Expired Time