Minnesota Accident Report – Fill Out and Use This PDF

The Minnesota Accident Report is a bi-monthly publication of the Department of Public Safety that includes information on traffic accidents, arrests and citations issued over the last two months.

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Minnesota Accident Report PDF Details

The Minnesota Accident Report Form is a document that must be completed following any motor vehicle accident in the state of Minnesota. The form requires information about both drivers involved in the crash, as well as details about the accident itself. Drivers are responsible for completing and submitting the form to the appropriate authorities. Failing to do so may result in fines or other penalties. Completing the form correctly is essential in order to ensure that all necessary information is collected following an accident.

The following are some specifics about minnesota accident report. It is suggested that you read this info before you start fiddling with the PDF.

Question	Answer
Form Name	Minnesota Accident Report
Form Length	2 pages
Fillable?	Yes
Fillable fields	145
Avg. time to fill out	29 min 34 sec
Other names	minnesota state patrol accident report, accident report mn, mn highway patrol accident reports, minnesota accident report

12

Form Preview Example

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

<![endif]>*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

<![endif]>MY	<![endif]>VEHICLE
<![endif]>OTHER	<![endif]>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

<![endif]>VEHICLE	<![endif]>MY
<![endif]>VEHICLE	<![endif]>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

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minnesota accident report online empty fields to fill out

Within the area Name, of, PolicyHolder FULL, NAME OTHER, DRIVER, DRIVERS, LICENSE, NUMBER FULL, NAME OTHER, OWNER, LICENSE, PLATE, NUMBER Address, Your, Signature, X ADDRESS, CITY, STATE, ZIP, CODE INJURY, CODE CLASS, STATE, OF, ISSUE and DATEOFBIRTH write down the particulars which the software demands you to do.

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Completing minnesota accident report online stage 3

The DATEOFBIRTH, OR, AGE, SEX SEAT, TYPE, USE, AIRBAG, EJECT, INJURY, PASSENGER, NAME PASSENGER, NAME PASSENGER, NAME CITY, CITY, CITY, STATE, and DATEOFBIRTH, OR, AGE field is the place where each party can insert their rights and responsibilities.

stage 4 to completing minnesota accident report online

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minnesota accident report online NAMEOFPROPERTYOWNER, SIGNHEREX, ADDRESS, ESTIMATECOSTOFREPAIR, MAILTHISREPORTTO, DVSACCIDENTRECORDS, DATEOFREPORT, MINNESOTASTREETSUITE, and STPAULMN fields to fill

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