Massachusetts Accident Report Details

Have you been in a car accident? If so, you will need to complete a Ma Vehicle Accident Report Form. This form is used to report the details of the accident to the Massachusetts Registry of Motor Vehicles. In this blog post, we will provide an overview of the Vehicle Accident Report Form and explain how to complete it. We will also discuss some important things to keep in mind after a car accident.

Below is the data relating to the form you were looking for to complete. It will tell you how much time it may need to fill out ma vehicle accident report, exactly what fields you will need to fill in and some additional specific facts.

QuestionAnswer
Form NameMa Vehicle Accident Report
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namescommonwealth of massachusetts motor vehicle, ma motor vehicle crash report, vehicle accident report, mass rmv

Form Preview Example

Commonwealth of Massachusetts Motor Vehicle Crash Operator Report

When Must a Crash Report be filed with the Registrar?

M.G.L. Chapter 90, Section 26 requires a person who was operating a motor vehicle involved in a crash in which (i) any person was killed or (ii) injured or (iii) in which there was damage in excess of $1,000 to any one vehicle or other property, to complete and file aCrash Operator Report with the Registrar within five (5) days after such crash (unless the person is physically incapable of doing so due to incapacity). The person completing the report must also send a copy of the report to the police department having jurisdiction on the way where the crash occurred. If the operator is incapacitated but is not the vehicle's owner, the owner is required to file the crash report within the five (5) days based on his/her knowledge and information obtained about the crash. The Registrar may require the owner or operator to supplement the report and he/she can revoke or suspend the license of any person violating any provision of this legal requirement. A police department is required to accept a report filed by an owner or operator whose vehicle has been damaged in a crash in which another person unlawfully left the scene even if damage to the vehicle does not exceed $1,000.

How To Complete This Form

Please carefully complete all sections of this form that apply to your crash, circling the answer where appropriate. Illegible reports will be returned to you.

Section A: Crash Location

nProvide the city/town where the crash occurred, the date and time of the crash, and the number of vehicles involved.

nComplete section A1or A2.

nUse official names of all locations, streets and landmarks.

nUse street name and route #, if applicable.

nBe as precise as possible when describing the location.

nProvide enough information to locate the crash to a specific point, not just a street or roadway.

Section F: Crash Conditions

nUse the codes provided to indicate the conditions at the time of the crash.

Section G: Crash Diagram

nDraw a diagram of how the crash occurred.

nOn the diagram, Vehicle 1 represents your vehicle.

Section H: Witness Information

nList all the people who saw the crash but were not involved.

Section B: Vehicle You Were Driving

nProvide information on your license and the vehicle you were driving.

nUse the codes provided to indicate the cause of the crash.

Section C: You and Your Passengers

nProvide information on you and your passengers at the time of the crash.

nUse the codes provided to indicate occupant information.

Section D: Other Vehicles Involved in the Crash

nProvide information on the other vehicle(s) and operator(s) involved in the crash.

nIf more than one vehicle involved, please use additional form completing Section D only.

Section E: Non-Motorist(s) Involved

nProvide information on the non-motorist(s) involved in the crash.

nIf more than one non-motorist involved, please use additional form completing Section E only.

Section I: Property Damage Information

nIndicate all non-vehicular property that was damaged in the crash.

Section J: Description of What Happened

nDescribe the crash including events prior to the crash for your vehicles and all other vehicles.

Section K: Signature

nPlease sign and print your name and indicate the date you completed the form.

Where to send completed reports:

qMail or deliver one copy to the local police department or state police in the city or town where the crash occurred.

qMail one copy to your Insurance Company.

qMail one copy to the RMV at the following address:

Crash Records

Registry of Motor Vehicles P.O. Box 55889 Boston, MA 02205-5889

CRA-23

Page 1

T21278_0312

 

 

Section A: Crash Location

City/Town Where Crash Occurred

 

Date of Crash

Time of Crash

# Vehicles

 

 

 

 

____ : ____ __ AM __ PM

Involved:

Please complete Section A1 or A2 below to indicate the location of the crash.

 

 

If you need additional space to describe the crash location, please use Section J on the last page of this form.

 

 

SECTION A1: Complete this Section if the crash

OR

 

SECTION A2: Complete this Section if the crash did NOT occur at an

occurred at an intersection of two or more streets:

 

 

intersection:

 

 

Step 1: Please indicate the route or roadway where you

 

 

Step 1: Please indicate the route, roadway and address where the crash occurred:

 

 

were travelling when the crash occurred:

 

 

 

 

 

The crash occurred on Route #: _______ at Street or Address Number: ________________

____________

__________________________________

Route#

Name of Roadway/Street

Step 2: What was the name (or names) of the intersecting streets?

____________

__________________________________

Route#

Name of Roadway/Street

on the Street/Roadway known as: ______________________________________________

Step 2: Please provide as much of the following specific location information as possible:

The crash occurred (estimate number of feet)

_______________ feet

(indicate direction as N/S/E/W) _______________ of

a) Mile Marker number

___ ___ ___ ___

OR: b) Exit Number

________________

____________

__________________________________

OR: c) Intersecting Street/Roadway __________

___________________________

Route#

Name of Roadway/Street

Route#

Name of Roadway/Street

OR: d) Landmark _______________________________________________________

Section B: Vehicle You Were Driving

Number of occupants in vehicle (including yourself): _________

Was vehicle damage above $1000?

Driver’s License Number

License State Date of Birth Age

Sex

License Class

 

 

 

__ D __ A __B __C

__ M __ F

__ M __ Unknown

 

__Yes __No

CommercialDriver’sLicenseEndorsements

H __ Hazardous

N__ Tankvehicles

P__Passenger

T__ Doubles/Triples

X__ Tank and Hazardous

transport

Your Full Name (Last, First, Middle)

Street Address

 

 

 

City/Town

 

State

Zip

 

 

 

 

 

 

 

 

 

 

Insurance Company

 

 

Vehicle

Registration #

Reg. Type

 

Reg. State

Vehicle Year

Vehicle Make

 

Indicate your type of vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Passenger car

4

Bus (15 or more passengers)

8

Truck/trailer

12

Tractor/triples

97

Other

 

2 Light truck (van, mini-van,

5

Bus (7-15 passengers)

 

9

Truck tractor (bobtail)

13

Unknown heavy truck

99

Unknown

 

 

pick-up, sport utility)

6

Single-unit truck (2 axles)

10 Tractor/semi-trailer

14

Motor home/recreational vehicle

 

 

 

3

Motorcycle

7

Single-unit truck (3 or more axles)

11 Tractor/doubles

 

 

 

 

 

 

Full Name of Vehicle Owner (Last, First, Middle)

 

 

Street Address

 

 

City/Town

 

State

Zip

What Was Your Vehicle Doing Prior to the Crash?

Vehicle Travel Direction

1

Travelling straight ahead

4

Turning left

7

Leaving traffic lane

10

Backing

97 Other

__N __S __E __W

2 Slowing or stopped

5

Changing lanes

8

Making U-turn

11

Parked

99 Unknown

3

Turning right

6

Entering traffic lane

9

Overtaking/passing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please Indicate the Sequence of Events as they occurred to YOUR Vehicle by writing the corresponding number (1-52, or 97, 99) in up to 4 boxes below.

What happened first?

What happened 2nd (if applicable)?

What happened 3rd (if applicable)?

What happened 4th (if applicable)?

Collision with

1Motor vehicle in traffic

2 Parked motor vehicle

3 Pedestrian

4 Cyclist

5 Animal- deer

6 Animal- other

7 Moped

8 Work zone maintenance equipment

9 Railway vehicle (train, engine)

10 Other movable object

11 Unknown movable object

20 Curb

21 Tree

22 Utility pole

23Light pole or other post/support

24Guardrail

25Median barrier

26Ditch

27Embankment/Sloping shoulder

28Highway traffic signpost

29Overhead sign support

30Fence

31Mailbox

32Crash cushion/Impact attenuator

33Bridge

34Bridge overhead structure

35Other fixed object (wall, building, tunnel)

36Unknown fixed object

Vehicle Damaged Area

Non-Collision

40Ran off road right

41Ran off road left

42Cross median/centerline

43Overturn/rollover

44Equipment failure (blown tire, brakes, etc)

45Fire/explosion

46Immersion

47Jackknife

48Cargo/equipment loss or shift

49Separation of units

50Downhill runaway

51Other non-collision

52Unknown non-collision

97

Other

 

 

99

Unknown

 

 

2

3

4

0 None

 

 

 

10 Undercarriage

Was your Vehicle Towed From the Scene Due to Damage? __Yes __No

(circle up to three)

 

 

 

 

 

 

11

Totaled

1

 

 

9

5

 

 

97

Other

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

7

6

99

Unknown

 

 

 

 

Page 2

Section C: You and Your Passengers

Please provide the full name, address, and DOB or Age for all passengers in your vehicle. Then write the corresponding code in each of the boxes for each occupant of the vehicle (yourself and all passengers). A list of the possible codes is provided at the bottom of this section.

Driver (See previous page)

Name of Passenger 1 (Last, First, Middle)

Name of Passenger 2 (Last, First, Middle)

Name of Passenger 3 (Last, First, Middle)

 

Address

 

City/Town

State

Zip

 

Address

 

City/Town

State

Zip

 

Address

 

City/Town

State

Zip

Date of Sex Birth/Age M/F

A

B

C

D

E

F

G

H

Name of

Medical Facility

A. Seating Position

 

 

 

 

 

 

 

 

 

 

 

 

 

B.

Safety System Used

C. Air Bag Status

D. Air Bag Switch

 

1

Front seat - left side (or motorcycle driver)

9

Third row - right side

 

 

 

 

0

None used

 

1

Deployed-front

1 Switch in ON position

2

Front seat - middle

 

 

 

 

10

Sleeper section of cab

 

 

 

 

1

Shoulder and lap belt

2

Deployed-side

2 Switch in OFF position

3

Front seat - right side

 

 

 

 

11

Enclosed passenger area

 

 

2

Lap belt only

 

3

Deployed both

3 ON-OFF switch not present

4

Second seat - left side (or motorcycle passenger)

12

Unenclosed passenger area

 

3

Shoulder belt only

 

front and side

4

Unknown if switch is present

5

Second seat - middle

 

 

 

 

13

Trailing unit

 

 

 

 

 

 

4

Child safety seat

4

Not deployed

99

Unknown

 

 

 

6

Second seat - right side

 

 

 

 

14

Riding on vehicle exterior

 

 

5

Helmet

 

 

5

Not applicable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

Third row - left side (or motorcycle passenger)

97

Other

 

 

 

 

 

 

99 Unknown

 

 

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

Third row - middle

 

 

 

 

99

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E.

Ejected From Vehicle?

F.

Trapped?

 

 

 

G.

Injured?

 

 

 

 

 

 

H. Transported

for Medical Care?

 

 

0

Not ejected

0

Not trapped

 

 

 

1

Fatal injury

 

 

 

 

 

 

1

Not transported

 

 

97

Other

1

Totally ejected

1

Freed by mechanical means

Non-fatal injury:

 

 

 

 

 

 

2

EMS (emergency service)

99

Unknown

 

 

 

 

 

 

 

 

 

 

 

2

Partially ejected

2

Freed by non-mechanical means

2

Incapacitating

 

 

5

No injury

3

Police

 

 

 

 

 

 

3

Not applicable

99

Unknown

 

 

 

3

Non-incapacitating

 

99 Unknown

 

 

 

 

 

 

 

 

99 Unknown

 

 

 

 

 

 

 

4

Possible

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section D: Other Vehicle(s) Involved in the Crash

 

 

 

 

 

 

Number of occupants in the Vehicle: _____ Number of injured occupants: _____

Was Vehicle Damage __Yes

___No

Moped? __Yes __No

Hit and Run? __Yes __No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

above $1000?

 

 

 

 

 

 

 

 

 

 

Driver’s License Number

 

 

 

License State

Date of Birth

Age

 

Sex

 

License Class

 

Commercial Driver’s License Endorsements

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__ M __ F

__ D __ A

__ B

__C

H __ Hazardous

N __ Tank vehicles

 

P__Passenger

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__ M __ Unknown

 

T __ Doubles/Triples

X __

Tank and Hazardous

transport

Full Name of Vehicle Driver (Last, First, Middle)

 

Street Address

 

 

 

 

 

 

City/Town

 

 

 

State

 

 

Zip

Insurance Company

 

 

 

 

 

 

 

 

 

 

Reg. Type

Reg. State

Vehicle Year

 

Vehicle Make

 

 

 

 

 

 

 

Vehicle Registration #

 

 

 

Indicate type of vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Passenger car

 

4

Bus (15 or more passengers)

 

 

8

Truck/trailer

 

 

12

Tractor/triples

97

Other

 

 

 

2

Light truck (van, mini-van,

5

Bus (7-15 passengers)

 

 

9

Truck tractor (bobtail)

13

Unknown heavy truck

99

Unknown

 

 

 

pick-up, sport utility)

 

6

Single-unit truck (2 axles)

 

 

10

Tractor/semi-trailer

14

Motor home/recreational vehicle

 

 

 

 

 

3

Motorcycle

 

7

Single-unit truck (3 or more axles)

11

Tractor/doubles

 

 

 

 

 

 

 

 

 

 

Full Name of Vehicle Owner (Last, First, Middle)

 

 

 

 

 

 

 

 

 

Street Address

 

 

City/Town

 

 

State

 

 

Zip

Vehicle Travel

What Was the Vehicle Doing Prior to the Crash?

 

 

 

 

 

 

Direction

 

 

 

 

 

 

 

 

 

 

 

1

Travelling straight ahead

4

Turning left

7

Leaving traffic lane

10

Backing

97

Other

__N __S

2

Slowing or stopped

5

Changing lanes

8

Making U-turn

11

Parked

99

Unknown

__E __W

3

Turning right

6

Entering traffic lane

9

Overtaking/passing

 

 

 

 

 

 

 

 

 

Vehicle Damaged Area (circle up to three)

2

 

 

3

4

0

None

 

 

 

 

 

 

10

Undercarriage

1

 

 

9

5

11 Totaled

 

 

 

 

 

 

 

 

97

Other

 

 

 

 

 

 

8

 

 

7

6

99

Unknown

Section E: Non-Motorist(s) Involved in the Crash

Indicate the type of non-motorist involved

 

 

1 Pedestrian

2 Cyclist

3 Skater

97 Other

99 Unknown

What was the non-motorist doing prior to the crash?

Where was the non-motorist prior to the crash?

 

1

Entering or crossing location

6

Working on vehicle

1

Marked crosswalk at intersection

6

Median (but not on shoulder)

2

Walking, running, or cycling

7

Standing

2

At intersection but no crosswalk

7

Island

 

3

Working

97

Other

3

Non-intersection crosswalk

8

Shoulder

 

4

Pushing vehicle

99

Unknown

4

In roadway

 

9

Sidewalk

 

5

Approaching or leaving vehicle

 

 

5

Not in roadway

 

10

Shared-use path or trails

 

 

 

 

 

 

 

99

Unknown

 

Date of Birth/Age Sex

Full Name of Non-Motorist (Last, First, Middle) Street Address

 

 

__M __ F

 

 

 

 

 

 

 

Safety Equipment?

 

 

 

Injured?

 

 

0

None used

 

9

Lighting

1

Fatal injury

 

 

6

Helmet

 

10

Other

Non-fatal injury:

 

 

7

Protective pads (elbows, knees, etc.)

99

Unknown

2

Incapacitating

5

No injury

8

Reflective clothing

 

 

 

3

Non-incapacitating

99

Unknown

 

 

 

 

 

4

Possible

 

 

 

City/Town

State

Zip

Transported for Medical Care?

 

 

 

1

Not transported

97

Other

 

2

EMS (emergency service)

99

Unknown

3

Police

 

 

 

If transported, please indicate Hospital/Medical Facility:

Page 3

Section F: Crash Conditions

Light Conditions

Weather Conditions (up to two)

Traffic Control Device

 

Was the traffic

Road Surface

Roadway Intersection Type

1

Daylight

1

Clear

 

 

1

No controls

 

control device

1

Dry

 

 

 

2

Dawn

2

Cloudy

 

 

2

Stop signs

 

functioning at

2

Wet

 

 

 

3

Dusk

3

Rain

 

 

3

Traffic control signal

 

the time of the

3

Snow

 

1

Not at intersection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

Dark - lighted roadway

4

Snow

 

 

4

Flashing traffic control signal crash?

4

Ice

 

2

Four-way intersection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

Dark - roadway not lighted

5

Sleet, hail, freezing rain

5

Yield signs

 

 

 

5

Sand, mud, dirt, oil, gravel

3

T-intersection

6

Dark - unknown roadway

6

Fog, smog, smoke

6

School zone signs

 

1

___ Yes

6

Water (standing, moving)

4

Y-intersection

 

lighting

7

Severe crosswinds

7

Warning signs

 

 

 

7

Slush

 

5

On ramp

97

Other

8

Blowing sand, snow

8

Railroad crossing device

2

___ No

97

Other

 

 

6

Off ramp

99

Unknown

97

Other

 

 

99 Unknown

 

 

 

99

Unknown

 

 

 

 

 

7

Traffic circle

 

 

99

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

Five-point or more

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trafficway Description

 

 

School Bus

 

Work Zone

Manner of Collision

 

 

 

9

Driveway

1

Two-way, not divided

 

 

Related?

 

Related?

1

Single vehicle crash

 

6

Head on

 

 

 

 

10

Railway grade crossing

2 Two-way, divided, unprotected median

 

 

 

 

 

2

Rear-end

 

 

7

Rear to rear

 

 

 

 

 

 

 

99

Unknown

3 Two-way, divided, protected median

1

___ Yes

 

1

___ Yes

3

Angle

 

 

99

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

One-way, not divided

 

 

2

___ No

 

2

___ No

4

Sideswipe, same direction

 

 

 

 

99

Unknown

 

 

 

5

Sideswipe, opposite direction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section G: Crash Diagram

 

 

Please draw a diagram of the

 

roadway or streets where the crash

 

occurred, indicating the vehicles

Indicate

involved and direction of travel

using the following symbols:

North by

Arrow

 

= Direction

 

1

= Vehicle 1 (Your Vehicle)

 

2

= Vehicle 2

 

O

= Pedestrian/Non-motorist

 

 

= North

 

Select one of the following if

 

the crash did not occur on a

 

public way:

 

___

Off-street parking lot

 

___

Garage

 

___

Mall/shopping center

 

___

Other private way

 

Section H: Witness Information

 

Witness Name (Last, First, Middle)

Address

Phone

Section I: Property Damage Information (Other than Vehicles)

Owner Name (Last, First, Middle)

Address

Phone

Property and Damage Description

Section J: Description of What Happened

Section K: Signature

_______________________________________________

Print ________________________________________

Date ___________________________

“Signed under Pains and Penalties of Perjury”

Page 4