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.
| Question | Answer |
|---|---|
| Form Name | Ma Vehicle Accident Report |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | commonwealth of massachusetts motor vehicle, ma motor vehicle crash report, vehicle accident report, mass rmv |
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:
nProvide information on the
nIf more than one
Section I: Property Damage Information
nIndicate all
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
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, |
5 |
Bus |
|
9 |
Truck tractor (bobtail) |
13 |
Unknown heavy truck |
99 |
Unknown |
|
|||
|
6 |
10 |
14 |
Motor home/recreational vehicle |
|
|
|
||||||
3 |
Motorcycle |
7 |
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 |
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
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
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
52Unknown
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 |
1 Switch in ON position |
|||||||||||||||
2 |
Front seat - middle |
|
|
|
|
10 |
Sleeper section of cab |
|
|
|
|
1 |
Shoulder and lap belt |
2 |
2 Switch in OFF position |
||||||||||||
3 |
Front seat - right side |
|
|
|
|
11 |
Enclosed passenger area |
|
|
2 |
Lap belt only |
|
3 |
Deployed both |
3 |
||||||||||||
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 |
|
|
|
|
|
|
2 |
EMS (emergency service) |
99 |
Unknown |
||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||
2 |
Partially ejected |
2 |
Freed by |
2 |
Incapacitating |
|
|
5 |
No injury |
3 |
Police |
|
|
|
|
|
|
||||||||||
3 |
Not applicable |
99 |
Unknown |
|
|
|
3 |
|
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, |
5 |
Bus |
|
|
9 |
Truck tractor (bobtail) |
13 |
Unknown heavy truck |
99 |
Unknown |
|
|
||||||||||||||
|
|
6 |
|
|
10 |
14 |
Motor home/recreational vehicle |
|
|
|
|
|
|||||||||||||||
3 |
Motorcycle |
|
7 |
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 |
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:
Indicate the type of |
|
|
1 Pedestrian |
2 Cyclist |
3 Skater |
97 Other |
99 Unknown |
||
What was the |
Where was the |
|
|||||||
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 |
8 |
Shoulder |
|
||
4 |
Pushing vehicle |
99 |
Unknown |
4 |
In roadway |
|
9 |
Sidewalk |
|
5 |
Approaching or leaving vehicle |
|
|
5 |
Not in roadway |
|
10 |
||
|
|
|
|
|
|
|
99 |
Unknown |
|
Date of Birth/Age Sex |
Full Name of |
|
||||||
|
__M __ F |
|
|
|
|
|
|
|
Safety Equipment? |
|
|
|
Injured? |
|
|
||
0 |
None used |
|
9 |
Lighting |
1 |
Fatal injury |
|
|
6 |
Helmet |
|
10 |
Other |
|
|
||
7 |
Protective pads (elbows, knees, etc.) |
99 |
Unknown |
2 |
Incapacitating |
5 |
No injury |
|
8 |
Reflective clothing |
|
|
|
3 |
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 |
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
5 |
Dark - roadway not lighted |
5 |
Sleet, hail, freezing rain |
5 |
Yield signs |
|
|
|
5 |
Sand, mud, dirt, oil, gravel |
3 |
|||||
6 |
Dark - unknown roadway |
6 |
Fog, smog, smoke |
6 |
School zone signs |
|
1 |
___ Yes |
6 |
Water (standing, moving) |
4 |
|||||
|
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 |
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
Trafficway Description |
|
|
School Bus |
|
Work Zone |
Manner of Collision |
|
|
|
9 |
Driveway |
|||||
1 |
|
|
Related? |
|
Related? |
1 |
Single vehicle crash |
|
6 |
Head on |
||||||
|
|
|
|
10 |
Railway grade crossing |
|||||||||||
2 |
|
|
|
|
|
2 |
|
|
7 |
Rear to rear |
||||||
|
|
|
|
|
|
|
99 |
Unknown |
||||||||
3 |
1 |
___ Yes |
|
1 |
___ Yes |
3 |
Angle |
|
|
99 |
Unknown |
|||||
|
|
|
|
|
||||||||||||
|
|
|
|
|
|
|
|
|
||||||||
4 |
|
|
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 |
= |
|
|
|
= North |
|
|
Select one of the following if |
||
|
the crash did not occur on a |
||
|
public way: |
||
|
___ |
||
|
___ |
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