Georgia Uniform Vehicle Accident Overlay – Fill Out and Use This PDF

ALCOHOL AND / OR DRUG TEST GIVEN

PEDESTRIAN MANEUVER

CONTRIBUTING FACTORS

VEHICLE TYPE

1 - Passenger Car

12 - Vehicle With Trailer

1 - Yes

2 - No

3 - Refused

1 - Crossing, Not At Crosswalk

2 - Pickup Truck

13 - Bus

6 - Other Working in Road

1 - No Contributing Factors

TYPE TEST

2 - Crossing at Crosswalk

7 - Playing Roadway

2 - D.U.I.

3 - Truck Tractor (Bobtail)

14 - Truck Towing House Trailer

3 - Walking with Traffic

8 - Standing in Roadway

4 - Tractor/Trailor

3 - Following Too Close

15 - Ambulance

1 - Blood 2 - Breath

3 - Urine

4 - Other

4 - Walking Against Traffic

9 - Off Roadway

5 - Tractor W /Twin Trailers

4 - Failed to Yield

16 - Motorized Recreational Vehicle

DRIVER CONDITION

5 - Pushing Or Working on

10 -Other

5 - Exceeding Speed Limit

6 - Logging Truck

17 - Motorcycle, Scooter, Minibike

Vehicle

11 -Darting Into Traffic

7 - Logging Tractor/Trailer

1 - Not Drinking

5 - U.I. Drugs

6 - Disregard Stop Sign /Signal

18 - Moped

8 - Single Unit Truck

19 - Pedalcycle, Bicycle

2 - Not Known if U .I.

6 - U.I.Alcohol & Drugs

7 - Wrong Side Of Road

9 - Panel Truck

20 - Farm or Construction . Equip.

3 - Drinking Not Impaired

7 - Physical

Impairment

8 - Weather Conditions

10 - Van

FIRST HARMFUL EVENT /MOST HARMFUL EVENT

21 - All Terrain Vehicle

4 - U.I. Alcohol

8 - Apparently Fell Asleep

9 - Improper Passing

11 - Utility Passenger Vehicle .

NON -COLLISION

22 - Other

10 - Driver Lost Control

DIRECTION OF TRAVEL

1 - Overturn

4 - Jackknife

11 - Changed Lanes Improperly

23 - Go cart

2 - Fire/Explosion

5 - Other Non -Collision

12 - Object Or Animal

1 - North

2 - South

3 - East

4 -

TRAFFIC CONTROL

13 - Improper Turn

3 - Immersion

West

5 - Stop Or Yield Sign

14 - Parked Improperly

0 - Gates

VISION OBSCURED BY

COLLISION WITH OBJECT NOT FIXED

15 - Mechanical Or Vehicle Failure

1 - No Control Present

6 - No Passing Zone

16 - Surface Defects

7 - Lanes

1 - Not Obscured

5 - Trees, Bushes

6 - Pedestrian

11 - Motor Vehicle In Motion

2 - Traffic Signal

2 - Headlights

6 - Rain, Snow, Ice on

17 - Misjudged Clearance

3 - RR Signal/Sign

8 - Other

7 - Pedalcycle

12 - Motor Vehicle In Motion –

In

18 - Improper Backing

4 - Warning Sign

9 - Flashing Lights

3 - Sunlight

Windshield

8 - Railway Train

Other Roadway

4 - Parked Vehicle

7 - Other

19 - No Signal/Improper Signal

9 - Animal

13 - Other Object (Not Fixed)

20 - Driver Condition

CARGO BODY TYPE

10 - Parked Motor Vehicle

14 - Deer

VEHICLE CONDITION

21 - Driver's Vehicle

1 - No Known Defects

5 - Steering Failure

COLLISION WITH FIXED OBJECT

22 - Too Fast For Conditions

1 - Van (Encl. Box)

4 - Dump

7 - Cargo Tanker

23 - Improper Passing Of School Bus

2 - Tire Failure

6 - Slick Tires

2 - Auto Carrier

5 - Garbage/Refuse

8 - Concrete Mixer

15 - Impact Attenuate

25 - Utility Pole

24 - Disregard Police Officer

3 - Bus

6 - Flatbed

9 - Other

3 - Brake Failure

7 - Other

16 - Bridge Pier/Abutment

26 - Other Post

25 - Distracted

4 - Improper Lights

17 - Bridge Parapet End

27 - Culvert

26 - Other

18 - Bridge Rail

28 - Curb

27 - Cell Phone

VEHICLE CONFIGURATION

VEHICLE MANEUVER

19 - Guardrail Face

29 - Ditch

28 - Inattentive

1 - Bus (Seating for More Than 15 Passengers)

1 - Turning Left

8 - Parked

20 - Guardrail End

30 - Embankment

2 - Turning Right

9 - Passing

21 - Median Barrier

31 - Fence

2 - Single Unit Truck: 2 Axles

VEHICLE CLASS

3 - Single Unit Truck: 3 or More Axles

3 - Making U-turn

10 - Negotiating A Curve

22 - Highway Traffic Sign

32 - Mailbox

1 - Privately Owned

6 - Military

4 - Truck Trailer

4 - Stopped

11 - Entering/Leaving

Post

33 - Tree

2 - Police

7 - Commercial Vehicle (For

5 - Truck Tractor (Bobtail)

5 - Straight

Parking

23 - Overhead Sign Support 34 - Other - Fixed Object

3 - Fire

Acc. Reporting Purposes

6 - Tractor Tralier

6 - Changing Lanes

12 - Entering/Leaving

24 - Luminaire light Support

4 - School

Only)

7 - Tractor With Twin Trailers

7 - Backing

Driveway

5 - Other Govt. Owned

8 - Other

8 - Unknown Heavy Truck (Cannot Classify)

TRAFFIC -WAY FLOW

LOCATION AT AREA OF IMPACT

AGE

SEX

1 - Two-way Traffic-way

00 - Up To One Year

1 - On Roadway

4 - Median

M - Male F - Female

With No Physical Separation

01 - 97 Actual Age

2 - On Shoulder

5 - Ramp

2 - Two-way Traffic-way

3 - Off Roadway

6 - Gore

98 - Ninety-eight Or Older

TAKEN FOR TREATMENT

With a Physical Separation

99 - Unknown

1 - Yes

2 - No

3 - Two-way Traffic-way

ROAD COMPOSITION

INJURY CODE

1

2

3

With a Physical Barrier

4

5

6

1 - Concrete

4 - Dirt

4 - One-way Traffic-way

0 - Not injured

3 - Visible

2 - Black Top

5 - Gravel

8

5 - Continuous Turning Lane

1 - Killed

4 - Complaint

7

8

3 - Tar And Gravel

6 - Other

2 - Serious

8

1 - Clear

WEATHER

CONSTRUCTION / MAINTENANCE ZONE CODES

SEATING POSITION

5 - Sleet

CONTRIBUTING ROAD DEFECTS

0 - None

1 - Construction

2 - Maintenance

3 - Utility

2 - Cloudy

6 - Fog

1- No Defects

4 - Unknown type

3 - Rain

7 - Other

POINTS OF INITIAL CONTACT

2 - Defective Shoulders

4 - Snow

3 - Holes, Deep Ruts , Bumps

EJECTION

00 - Overturned

SURFACE CONDITION

4 - Loose Material On Surface

1 - Not Ejected

3 - Totally Ejected

13 - Top

1 - Dry

6 - Mud

5 - Water Standing

2 - Trapped

4 - Partially Ejected

14 - Undercarriage

6 - Road Under Construction

2 - Wet

7 - Sand

15 - Non-Contact Vehicle

7 - Running Water

3 - Snowy

8 - Slush

SAFETY EQUIPMENT

8 - Other

4 - Icy

9 - Oil

0 - None Used

6 - Motorcycle Helmet

5 - Other

ROAD CHARACTER

1 - Shoulder Belt

7 - Bicycle Helmet

2 - Lap Belt

8 - Unknown

LIGHT CONDITION

1 - Straight And Level

3 - Lap and Shoulder Belt

1 - Daylight

4 - Dark - Lighted

2 - Straight On Grade

4 - Child Safety Seat (Property Used)

2 - Dusk

5 - Dark - Not Lighted

3 - Straight On Hillcrest

5 - Child Safety Seat (Improperly Used)

3 - Dawn

4 - Curve And Level

5 - Curve On Grade

EXTRICATION (Equipment Used )

MANNER OF COLLISION

6 - Curve On Hillcrest

1 - Yes

2 - No

1 - Angle

DAMAGE TO VEHICLE

AIR BAG FUNCTION

2 - Head On

3 - Rear End

1 - None

4 - Extensive

0 - No Air Bag In This Seat

5 - Deployed Multiple Directions

4 - Sideswipe - Same Direction

2 - Slight

5 - Fire Present

1 - Deployed Air Bag

6 - Non-Deployed Front

5 - Sideswipe - Opposite Direction

3 - Moderate

2 - Non -Deployed Air Bag

7 - Non-Deployed Side

6 - Not A Collision With a Motor Vehicle

3 - Deployed Side

8 - Non-Deployed Other Direction

4 - Deployed other Directions

9 - Non-Deployed Multiple Direction