Oregon DMV Accident Report PDF Details

When you are in an accident, the Oregon DMV requires you to fill out an accident report form. This form is used to collect information about the accident, and can help with investigations and insurance claims. Here are some important things to be aware of with respect to this form:

When to Submit: Under Oregon law, this report must be filed within 72 hours of the accident. If for some reason, you're unable to file within 72 hours, it's advised to do so as soon as possible. Failing to report the accident can lead to the suspension of your driving privileges.

Who Should Submit: All drivers involved in an accident that results in any of the following must file the report: damage to your vehicle over $2500, any injury (regardless of how minor), any death, damage to any one person's property over $2500, or any vehicle towed from the scene due to damages over $2500.

Form Completion: Complete all fields. If additional vehicles were involved in the accident, you're required to complete a Supplemental Report (Form 735-32B). Provide all necessary information such as insurance details, vehicle details, and a description of the incident. You should retain a copy of the report as the DMV is not authorized to provide you with a copy of the report that you file.

Question	Answer
Form Name	Oregon DMV Accident Report
Form Length	7 pages
Fillable?	Yes
Fillable fields	1
Avg. time to fill out	1 min 57 sec
Other names	dmv oregon forms, oregon report dmv, dmv accident report, oregon accident report

Form Preview Example

OREGON TRAFFIC CRASH AND INSURANCE REPORT

Tear this sheet off your report, read and carefully follow the directions.

ONLY drivers involved in a crash resulting in any of the following MUST file a Crash & Insurance Report:
•	Damage to your vehicle is over $2500	•	Damage to any one person’s property over $2500
•	Injury (No matter how minor)	•	Any vehicle has damage over $2500 and any vehicle is
•	Death	•	towed from the scene as a result of damages

Oregon law requires these reports be filed within 72 hours of the crash. If you are not able to file within the 72 hours, submit it as soon as possible. If you fail to report the crash to DMV, it may result in suspension of your driving privileges. If the police department files a police report, you are still required to file your own Crash and Insurance Report with DMV. When required to report, even if you are licensed in another state, or you are not an Oregon resident, you still must file a report with Oregon DMV. DMV does not determine fault in a crash, but does post the crash to the driving record of those drivers required to report, unless the vehicle is parked. If you have questions, please call DMV Crash Reporting Unit at (503) 945-5098.

INSTRUCTIONS

PRINT OR TYPE ALL INFORMATION. (Use black or dark blue ink and press firmly.)

• Complete both sides of the form.

• If additional vehicles were involved in the crash, complete the attached Supplemental Report (Form 735-32B), or on a blank piece of paper, write all the information as requested in Section 4, the “Other Driver” Section.

• DMV Headquarters will verify the insurance information submitted. Complete the insurance section or a suspension of your driving privileges may occur.

SECTION 1

DATE, LOCATION AND TIME — Clearly identify the date, location and time of the crash. The correct date, location and time is critical to processing your report. If you are unsure of the county, contact any local law enforcement agency for assistance.

SECTION 2

Your vehicle is Vehicle #1. Complete ALL fields. Provide Insurance company name (not agent), policy number, and Vehicle identification number (VIN). Failure to provide complete insurance and vehicle information may result in DMV issuing Notice of Suspension due to incomplete information.

SECTION 3

Failure to complete this section may result in DMV sending Notice of Suspension for failure to file a report. Principle purpose of driving and being paid to drive does not mean driving to reach a destination to perform a service. Property: Includes, but is not limited to, fixed or real property, landscaping, signs, parked vehicles, and animals.

COMMERCIAL MOTOR VEHICLE OPERATORS: In addition to this report, Oregon Administrative Rule requires that Form

735-9229, Motor Carrier Crash Report, MUST be filed within 30 days of a commercial motor vehicle crash when there is a FATALITY, INJURY (requiring treatment away from the scene), or when a vehicle is TOWED from the scene because of disabling damage. Form 735-9229 (attached on back) MUST be submitted with Oregon Traffic Crash and Insurance Report (Form 735-32) to DMV. Call (503) 986-3507 for questions regarding the Motor Carrier Crash Report.

You may now file the Motor Carrier Crash Report at: www.oregontruckingonline.com/cf/MCAD/pubMetaEntry/accidentRpt/

SECTION 4

OTHER VEHICLE (# 2) — Completion of this information will help DMV match all driver's crash reports more efficiently. If additional vehicles were involved in the crash, complete attached Supplemental Report (Form 735-32B).

SECTION 5

DESCRIPTION AND SIGNATURE — Describe what happened. It is important for you to sign and date the form. Only a family member may sign and date this form on behalf of a driver when the driver is incapacitated or physically unable to sign. No other signatures will be accepted.

COMPLETING AND FILING REPORT

HOW TO SUBMIT A REPORT TO DMV:

•Email to OregonDMVAccidents@odot.oregon.gov

•Fax to 503-945-5267

•Mail to DMV Crash Reporting Unit 1905 Lana Ave NE, Salem, Oregon 97314

•Deliver to a DMV office

Keep a copy of the report and documentation that shows when you submitted your report to Oregon DMV. Under ORS 802.220(5), DMV is not authorized to provide you with a copy of the report that you file. If submitting by:

•Email, DMV sends an autoreply that your email was received. Save that autoreply.

•Fax, many fax machines provide the option to generate a fax confirmation report. Save that report.

•DMV Field Office, request and save that receipt.

PURSUANT TO OREGON INSURANCE LAW, AN INSURANCE COMPANY CAN NOT REQUIRE REPAIRS BE MADE TO A MOTOR VEHICLE BY A PARTICULAR PERSON OR REPAIR SHOP.

735-32 (3-23)

STK# 300009

INSTRUCTIONS

TOTALED VEHICLE NOTICE

DEFINITIONS AND INSTRUCTIONS FOR TOTALED VEHICLES

IF YOUR CRASH HAS RESULTED IN A “TOTALED” VEHICLE, YOU ARE REQUIRED BY LAW TO

FOLLOW APPROPRIATE INSTRUCTIONS IN THIS NOTICE.

DEFINITION OF “TOTALED” VEHICLE

“Totaled Vehicle” or “Totaled” as defined in Oregon law (ORS 801.527) means:

•A vehicle that is declared a total loss by an insurer who is obligated to cover the loss or a vehicle that the insurer takes possession of or title to.

•A vehicle that has sustained damage that is not covered by an insurer and the estimated cost to repair the vehicle is equal to at least 80% of the retail market value prior to the damage. “Retail market value” is defined as the amount shown in publications used by financial institutions (banks or lenders) in this state.

•A vehicle that is stolen, if it is not recovered within 30 days of theft and the loss is not covered by an insurer. In this situation, you must notify DMV within 60 days of the theft.

▼ FOLLOW THESE INSTRUCTIONS IF YOUR VEHICLE IS TOTALED ▼

If your vehicle is totaled, in addition to completing the crash report, follow the instruction that is applicable to your case. Either:

1.SURRENDER the title to the insurer if the damage is covered by an insurer who declares the vehicle to be a “total loss,” and the insurer takes possession of the vehicle; or

2.SURRENDER the title to DMV and apply for salvage title if the damage is covered by an insurer who declares the vehicle to be a “total loss,” but you keep possession of the vehicle; or

3.SURRENDER the title to DMV and apply for salvage title if the damage was not covered by an insurer and the estimated cost of repair is at least 80% of the retail market value of the vehicle before the damage; or

4.NOTIFY DMV that your vehicle has been totaled if, for some reason, you are unable to obtain the title for surrender. You must provide DMV with a signed statement which includes:

•A description of the vehicle which includes the year model, make, plate number and vehicle identification number.

•A statement indicating the vehicle has been totaled.

•A statement that you are unable to obtain the title and why.

DO NOT SUBMIT THE TITLE WITH THE CRASH REPORT. You can obtain the Application for Salvage Title (Form 735-229) from any DMV office, by calling (503) 945-5000, or on-line at www.oregondmv.com. Application instructions and fee information are on the back of the form 735-229. If you have questions about salvage titles, call (503) 945-5122.

NOTE: It is a Class A misdemeanor with a penalty of imprisonment and/or fine if you fail to comply with the above requirements. (ORS 819.012)

OREGON TRAFFIC CRASH AND INSURANCE REPORT

COMPLETE BOTH SIDES

Print Form

Reset Form

Complete this form if the traffic crash occurred on a highway or premise open to the public and meets at least one of the reporting requirements outlined in Section 3. Failure to report when required may result in DMV issuing Notice of Suspension. Call 503-945-5098 for assistance in completing the report.

SECTION 1

CRASH DATE

DAY OF WEEK TIME OF DAY

COUNTY

DMV USE ONLY

M T W TH F

CRASH REF # _________________________________ ALIR

INS CO

S SN

ROAD ON WHICH CRASH OCCURRED (Name of street, road or route )

MILE POST

TYPE OF CRASH - The crash involved one or more of the following:

(Mark all that apply)

Two vehicles

ATV / Snowmobile

Parked vehicle

NAME OF NEAREST INTERSECTING ROAD

WITHIN

FEET

More than two vehicles

Motorcycle

Overturned vehicle

Motor Home / RV

NEAR

MILES

Fatality

Animal

Motorized Scooter

NAME OF NEAREST CITY / TOWN

WITHIN

FEET

Bicycle

Personal (assisted)

Fixed object / property

NEAR

MILES

Pedestrian

mobility device

Other ____________________

Train

SECTION 2 (YOUR INFORMATION)

Complete ALL fields. Failure to provide complete information may result in DMV issuing Notice of Suspension.

DRIVER’S LAST NAME

FIRST NAME

MIDDLE NAME

DRIVER’S LICENSE NUMBER

STATE DATE OF BIRTH

GENDER

			M	F	X
DRIVER’S RESIDENCE ADDRESS	CITY	STATE	ZIP CODE	CHECK BOX
				IF ADDRESS
MAILING ADDRESS (IF DIFFERENT THAN RESIDENCE)	CITY	STATE	ZIP CODE	CHANGE

VEHICLE OWNER’S NAME AND ADDRESS		CITY	STATE	ZIP CODE
SAME
RENTAL?
INSURANCE COMPANY NAME (NOT AGENT) AND ADDRESS		CITY	STATE	ZIP CODE
POLICY NUMBER	VEHICLE IDENTIFICATION NUMBER		STATE VEHICLE PLATE NUMBER	YEAR MAKE & MODEL

Check all statements that apply:

SECTION 3

Damage to your vehicle was more than $2500.

Damage to any one person’s property (other than vehicle) was more than $2500.

Your vehicle was towed from the scene as a result of damages.

You or passengers in your vehicle were injured.

Collision with a parked vehicle.

The crash occurred while you were driving your employer’s vehicle.

You were driving on your job and being paid for the principal purpose of driving.

You were being paid to drive and/or deliver persons or property.

You were operating a government owned vehicle marked for transporting mail in accordance with government rules. You were operating an authorized emergency vehicle.

The crash occurred in a work or maintenance zone. ORS 811.230
A police officer came to the scene.	City	County	State Police
Name of police department: __________________________

You were operating a commercial motor vehicle requiring you to have a commercial driver license. You were transporting hazardous material.

A citation was issued to you. The citation was: ________________________________________________________

SECTION 4 (OTHER VEHICLE # 2)

DRIVER’S NAME (LAST, FIRST, MIDDLE)	DRIVER’S LICENSE NUMBER	STATE	DATE OF BIRTH		GENDER
					M F X

DRIVER’S ADDRESS	CITY		STATE	ZIP CODE

VEHICLE OWNER’S NAME AND ADDRESS	CITY		STATE	ZIP CODE

SAME

INSURANCE COMPANY NAME (NOT AGENT) AND ADDRESS
POLICY NUMBER	VEHICLE IDENTIFICATION NUMBER	STATE VEHICLE PLATE NUMBER YEAR MAKE & MODEL

IF ADDITIONAL VEHICLES WERE INVOLVED IN THE CRASH, USE ATTACHED SUPPLEMENTAL REPORT (Form 735-32B).

DESCRIBE WHAT HAPPENED: (IF MORE SPACE IS NEEDED, SUBMIT ADDITIONAL PAGE)

5
SECTION	I certify all information given on this report is true and accurate to the best of my knowledge.

	SIGNATURE OF PERSON MAKING REPORT	PRINTED NAME OF PERSON MAKING REPORT
	X	REASON DRIVER IS UNABLE TO SIGN REPORT
	IF NOT DRIVER’S SIGNATURE, STATE RELATIONSHIP	REASON DRIVER IS UNABLE TO SIGN REPORT

735-32 (3-23) COMPLETE THE OTHER SIDE OF THIS PAGE

DMV COPY

DAYTIME PHONE #				DATE SIGNED
DAYTIME PHONE #				DATE SIGNED
(	)
		PHONE NUMBER OF DRIVER
		(	)

					STK# 300009

WEATHER CONDITIONS

YOU INTENDED TO...

YOUR VEHICLE

YOUR RESIDENCE

Go straight ahead

Passenger car, pickup, van

Clear

Local resident

Make right turn

Military vehicle

Raining

(within 25 miles of crash site)

Make left turn

Taxicab

Snowing

Residing elsewhere in state

Make “U” turn

Emergency vehicle

Fog

Non–resident of this state:

Back–Up

Any of the above and trailer

Other

College student

Enter driveway (also

Private or public agency

ROAD SURFACE

Military

mark left or right turn)

transit vehicle

Dry

Temporary job

Remain stopped in traffic

Bus

Wet

YOU WERE HEADED

Enter parked position

School bus

Snowy

North

East

Slow or Stop

Other publicly-owned veh.

Icy

South

West

Leave driveway (also

Motorcycle

Other

On: ____________________

mark left or right turn)

Motor Home / RV

LIGHT CONDITIONS

Start in traffic lane

Motor–scooter/bike

Daylight

(name of street, road or route)

OTHER DRIVER WAS HEADED

Leave parked position

Personal (assisted) mobility device

Dawn or dusk

North

East

Truck tractor & semi trailer

Remain parked

Darkness (lighted)

South

West

Overtake and pass

Truck/truck tractor

Darkness (unlighted)

Other truck combination

Other

On: ____________________

Farm tractor/farm equip.

(name of street, road or route)

WITNESS INFORMATION:

If this crash involved a pedestrian or

bicyclist, complete the following:

PEDESTRIAN NAME

BICYCLIST NAME

Pedestrian or bicyclist was going:

OCCUPANT INJURY AND SAFETY EQUIPMENT INFORMATION

SAFETY EQUIPMENT CODES

INJURY CODE FOR OCCUPANTS

ALONG OR ACROSS: (name of street, road or route)

WRITE one of the codes (0–10) in column C

WRITE one of the codes (1–5) in column D

0 No seat belt available

Fatal

From:

1 Seat belt available but NOT used

Suspected Serious: severe laceration, broken

2 Seat belt available and in use

or distorted limb, crush injury, significant burns,

3 Child restraint device available but NOT used

unconsciousness, paralysis

To:

4 Child restraint device in use

3 Suspected Minor: lump, abrasions, bruises,

5 Child restraint device not available

minor lacerations

EXAMPLE: (From: NE corner To: SE corner (or) From: East side To: West side, etc.)

6 Helmet NOT in use

4 Possible

Helmet in use

5 No apparent

Gender and age of pedestrian / bicyclist:

Air bag deployed

Age: _____

Air bag available - NOT deployed

Air bag NOT available

GENDER CODE

Extent of pedestrian / bicyclist injury:

WRITE M, F or X in column A

Fatal

Complaint of Pain

SEAT

OCCUPANTS' NAMES

(your vehicle)

Suspected Serious

No apparent injury

POSITION

GENDER

AGE

SFTY

AIR

INJURY

EQP

BAG

Visible injury

(or none noted)

DRIVER

Pedestrian / bicyclist action: (mark one)

FRONT

CENTER

Crossing at intersection or crosswalk

FRONT

Crossing not at intersection or crosswalk

RIGHT

MIDDLE

Walking / riding in roadway with traffic

LEFT

Walking / riding in roadway against traffic

MIDDLE

CENTER

Standing in roadway

MIDDLE

Pushing or working on vehicles in roadway

RIGHT

Other working in road

REAR

LEFT

Playing in road

REAR

Hitchhiking

CENTER

REAR

Not in roadway

RIGHT

Other________________________________

*Use only for vehicles with middle row of seats (i.e., vans, SUVs, etc.)

(specify)

Vehicle Damage

Diagram

Number each vehicle:

street,

route)

FRONT

Show path by:

(nameof roador

Show pedestrian/bicyclist by:

Show railroad tracks by:

USE ARROW TO SHOW

Vehicle towed

Show fixed object by:

FIRST IMPACT (SHADE

Rollover

IN DAMAGED AREA)

Under car

Totaled

Unknown

Your Vehicle (No. 1) damage: $ __________ .

(name of street,

road or route)

SUPPLEMENTAL REPORT

OREGON TRAFFIC CRASH

Supplemental for more than two drivers involved in the crash.

Attach this form to your OREGON TRAFFIC CRASH AND INSURANCE REPORT.

CRASH DATE

DAY OF WEEK

TIME OF DAY

COUNTY

M T W TH F

DO NOT WRITE

S SN

IN THIS SPACE

ROAD ON WHICH CRASH OCCURRED (Name of street, road or route )

MILE POST

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

POLICY NUMBER

VEHICLE IDENTIFICATION NUMBER

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

DRIVER’S LICENSE NUMBER

STATE

DATE OF BIRTH

GENDER

DRIVER’S ADDRESS

CITY

STATE

ZIP CODE

VEHICLE OWNER’S NAME AND ADDRESS

CITY

STATE

ZIP CODE

SAME

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

POLICY NUMBER

VEHICLE IDENTIFICATION NUMBER

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

DRIVER’S LICENSE NUMBER

STATE

DATE OF BIRTH

GENDER

DRIVER’S ADDRESS

CITY

STATE

ZIP CODE

VEHICLE OWNER’S NAME AND ADDRESS

CITY

STATE

ZIP CODE

SAME

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

POLICY NUMBER

VEHICLE IDENTIFICATION NUMBER

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

DRIVER’S LICENSE NUMBER

STATE

DATE OF BIRTH

GENDER

DRIVER’S ADDRESS

CITY

STATE

ZIP CODE

VEHICLE OWNER’S NAME AND ADDRESS

CITY

STATE

ZIP CODE

SAME

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

POLICY NUMBER

VEHICLE IDENTIFICATION NUMBER

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

DRIVER’S LICENSE NUMBER

STATE

DATE OF BIRTH

GENDER

DRIVER’S ADDRESS

CITY

STATE

ZIP CODE

VEHICLE OWNER’S NAME AND ADDRESS

CITY

STATE

ZIP CODE

SAME

VEHICLE

INSURANCE COMPANY NAME (NOT AGENCY)

POLICY NUMBER

VEHICLE IDENTIFICATION NUMBER

VEHICLE PLATE NUMBER

STATE

YEAR

MAKE & MODEL

OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE)

DRIVER’S LICENSE NUMBER

STATE

DATE OF BIRTH

GENDER

DRIVER’S ADDRESS

CITY

STATE

ZIP CODE

VEHICLE OWNER’S NAME AND ADDRESS

CITY

STATE

ZIP CODE

SAME

735-32B (3-23)

SUPPLEMENTAL REPORT – USE IF MORE THAN TWO VEHICLES

CRASH ANALYSIS & REPORTING UNIT OREGON DEPARTMENT OF TRANSPORTATION POLICY, DATA & ANALYSIS DIVISION

555 13th ST NE STE 2 SALEM OR 97301 TELEPHONE 503-986-3507 FAX 503-986-3592

MOTOR CARRIER CRASH REPORT

(For CMV Drivers Only)

INSTRUCTIONS: IF YOU CHECKED A BOX UNDER THE QUALIFYING VEHICLE COLUMN AND A BOX UNDER THE CRITERIA COLUMN, COMPLETE THE MOTOR CARRIER CRASH REPORT AND SUBMIT TO THE ADDRESS SHOWN ABOVE. IF YOU HAVE ANY QUESTIONS REGARDING FILLING

OUT THE MOTOR CARRIER CRASH REPORT, PLEASE CALL (503) 986-3507. www.oregontruckingonline.com/cf/MCAD/pubMetaEntry/accidentRpt/

QUALIFYING VEHICLE

CRITERIA

COMMERCIAL TRUCK (GVWR OVER 10,000 LBS OR ACTUAL WT

ANY PERSON SUSTAINING A FATALITY (WITHIN 30 DAYS OF THE

AT TIME OF CRASH EVEN IF GVWR IS SET UNDER 10,000 LBS )

CRASH)

HAZARDOUS MATERIAL PLACARD

ANY PERSON SUSTAINING INJURIES REQUIRING TREATMENT AWAY

COMMERCIAL BUS (DESIGNED FOR 8 OR MORE PASSENGERS)

FROM THE SCENE

FARM TRUCK INTERSTATE (OVER 10,000 LBS.)

ANY VEHICLE INCURRING DISABLING DAMAGE REQUIRING

FARM TRUCK FOR-HIRE (4 OR MORE AXLES)

REMOVAL FROM THE SCENE BY A TOW TRUCK OR ANOTHER

FARM TRUCK TOWING TRIPLE TRAILERS

MOTOR VEHICLE

FARM TRUCK (OVER 80,000 LBS.)

MOTOR CARRIER NAME

US DOT NUMBER

AUTHORITY/FILE NUMBER

ADDRESS

CITY

STATE

ZIP CODE

DRIVER INFORMATION

DRIVER NAME (LAST, FIRST, MIDDLE)

DATE OF BIRTH

LENGTH OF EMPLOYMENT

MONTHS

YEARS

CDL / DL NUMBER

STATE

LICENSE CLASS

EXPIRATION DATE OF MEDICAL CERTIFICATE

COMPLETE THE FOLLOWING TWO QUESTIONS AS IF DOING A RECAP OF HOURS IN TIME DOCUMENTS AT TIME OF THE CRASH.

AT TIME OF THE CRASH, TOTAL HOURS

TOTAL HOURS ON DUTY DURING THE PREVIOUS

7 CONSECUTIVE DAYS ____________

DRIVING SINCE LAST OFF-DUTY PERIOD.

(FILL OUT ONE ONLY, BASED ON TIME DOCUMENTS)

8 CONSECUTIVE DAYS ____________

DOES YOUR DRIVER HAVE A MEDICAL WAIVER

TYPE OF WAIVER (SIGHT, DIABETES, AMPUTEE, ETC.)

YES

DRIVER INJURY INFORMATION

YOUR DRIVER KILLED

YOUR DRIVER INJURED

RELIEF DRIVER KILLED

RELIEF DRIVER INJURED

TOTAL NUMBER OF PASSENGERS

YES

_____KILLED

_____ INJURED

OTHER DRIVER INJURY INFORMATION

TOTAL NUMBER OF OTHER DRIVERS

_____KILLED

_____ INJURED

TOTAL NUMBER OF OTHER PASSENGERS		TOTAL NUMBER OF PEDESTRIANS		TOTAL NUMBER OF BICYCLISTS
_____KILLED	_____ INJURED	_____KILLED	_____ INJURED	_____KILLED	_____ INJURED

OTHER MOTOR CARRIER INFORMATION (IF 2 OR MORE MOTOR CARRIERS WERE INVOLVED)

MOTOR CARRIER NAME

VEHICLE LICENSE # AND STATE

DRIVER'S NAME

DRIVER'S LICENSE # AND STATE

MOTOR CARRIER VEHICLE INFORMATION

YEAR

MAKE

UNIT NUMBER

LICENSE PLATE # & STATE - TRUCK/TRACTOR/BUS	TOTAL NO. OF AXLES
	INCLUDING TRAILERS

	TRACTOR TYPE (SELECT APPROPRIATE TYPE)
1				5	Standard		9	Heavy Haul
			Triples (tractor with 3 trailers


				6	Tractor/Semi Trailer			Bus/Van (8 or more
					Tractor/Semi Trailer
2			Triples (truck with 2 trailers)		Straight Truck	10


3				7		11		passenger capacity)
								passenger capacity)
			Straight truck-full trailer					Auto/Pickup



4			Doubles (any)	8	Saddlemount
4				8




	735-9229 (3-23)	COMPLETE REVERSE SIDE

SUPPLEMENTAL – MOTOR CARRIER CRASH REPORT

TRAILER TYPE (CHECK ONE)

VAN

FLATBED

TANKER

CONTAINER

POLE/LOG

DUMP

BELLY-DUMP

CAR CARRIER

LIVESTOCK

MOBILE HOME TOTER

PASSENGER

DROP-BOX

GARBAGE

BULK-HOPPER

MIXER

SADDLEMOUNT

WRECKER

FIXED LOAD

HEAVY HAUL

UTILITY

COMMODITY INFORMATION

COMMODITY BEING TRANSPORTED AT TIME OF CRASH

WAS A HAZARDOUS COMMODITY BEING HAULED

YES NO

WAS HAZARDOUS MATERIAL RELEASED FROM THE VEHICLE CARGO(NOT A FUEL RELEASE)

YES NO

HAZARD CLASS

CRASH INFORMATION

LOCATION OF CRASH (NEAREST CITY OR TOWN)

HIGHWAY AND MILEPOINT/STREET/COUNTY ROAD

DIRECTION OF YOUR VEHICLE (CHECK)

DATE OF CRASH

TIME

DAY OF THE WEEK (CHECK ONE)

MON

TUES WED THU

FRI

SAT

SUN

CONDITIONS AT TIME OF CRASH

WEATHER (CHECK ONE)

1. CLEAR

2. RAIN

3. SNOW

4. CLOUDY

5. SLEET

6. FOG

7. OTHER

ROAD SURFACE (CHECK ONE)

1. DRY

2. WET

3. SNOWY

4. ICY

5. OTHER

LIGHT CONDITION (CHECK ONE)

1. DAY

2. DAWN

3. DUSK

4. ARTIFICIAL LIGHTS

5. DARK

6. OTHER

DESCRIBE WHAT HAPPENED BY CHECKING ALL BOXES THAT APPLY. YOUR VEHICLE IS ALWAYS NO.1. IF OTHER VEHICLES WERE INVOLVED, COMPLETE COLUMNS 2 & 3 TO CORRESPOND TO THE ACTIONS OF THE SAME NUMBERED VEHICLES LISTED ABOVE UNDER "OTHER DRIVER INFORMATION".

VEHICLES 1 2 3

ACTION

SLOWING - STOPPING

STOPPED

REAR-END

BACKING

MAKING RIGHT TURN

MAKING LEFT TURN

MAKING U TURN

PROCEEDING STRAIGHT

INTERSECTION

ENTERING TRAFFIC (FROM SHOULDER, MEDIAN, PARKING STRIP OR PRIVATE DRIVE)

VEHICLES 1 2 3

ACTION

PASSING

CHANGING LANES

SIDESWIPE

HEAD-ON

SKIDDING

VEHICLE OUT OF CONTROL

ROLL-AWAY

CONTROLLED RR CROSSING

UNCONTROLLED RR CROSSING

RAN OFF ROAD

VEHICLES 1 2 3

ACTION

JACKKNIFE

OVERTURN

SEPARATION OF UNITS

FIRE

EXPLOSION

CARGO SHIFT

CARGO SPILL (HAZARDOUS)

CARGO SPILL (NON-HAZARDOUS)

OTHER (DEER, GUARDRAIL, ETC)

DID YOUR VEHICLE STRIKE A PARKED VEHICLE

YES NO

WAS YOUR PARKED VEHICLE STRUCK BY ANOTHER VEHICLE

YES NO

DESCRIPTION OF CRASH (BY CARRIER OR DRIVER)

NAME AND TITLE OF PERSON SIGNING REPORT	TELEPHONE NUMBER(S)

SIGNATURE I CERTIFY THE INFORMATION PROVIDED IS TRUE AND ACCURATE	DATE
X

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The program will demand you to prepare the OREGON TRAFFIC CRASH AND INSURANCE, COMPLETE BOTH SIDES, Complete this form if the traffic, CRASH DATE, DAY OF WEEK, TIME OF DAY, COUNTY, DMV USE ONLY, M T W TH F, S SN, AM PM, CRASH REF, ALIR, INS CO, and ROAD ON WHICH CRASH OCCURRED Name box.

In the Check all statements that apply, Damage to your vehicle was more, Name of police department, City County State Police, You were operating a commercial, You were transporting hazardous, DRIVERS NAME LAST FIRST MIDDLE, DRIVERS LICENSE NUMBER, STATE, DATE OF BIRTH, GENDER, A citation was issued to you The, DRIVERS ADDRESS, VEHICLE OWNERS NAME AND ADDRESS, and SAME field, identify the valuable data.

Spell out the rights and obligations of the parties inside the box IF ADDITIONAL VEHICLES WERE, DESCRIBE WHAT HAPPENED IF MORE, I certify all information given on, PRINTED NAME OF PERSON MAKING, IF NOT DRIVERS SIGNATURE STATE, REASON DRIVER IS UNABLE TO SIGN, COMPLETE THE OTHER SIDE OF THIS, DMV COPY, DAYTIME PHONE, DATE SIGNED, PHONE NUMBER OF DRIVER, STK, and N O T C E S.

dmv crash report IF ADDITIONAL VEHICLES WERE, DESCRIBE WHAT HAPPENED IF MORE, I certify all information given on, PRINTED NAME OF PERSON MAKING, IF NOT DRIVERS SIGNATURE STATE, REASON DRIVER IS UNABLE TO SIGN, COMPLETE THE OTHER SIDE OF THIS, DMV COPY, DAYTIME PHONE, DATE SIGNED, PHONE NUMBER OF DRIVER, STK, and N O T C E S fields to insert

Finalize by reading the next fields and filling out the relevant details: YOU INTENDED TO, Go straight ahead Make right turn, WITNESS INFORMATION, YOUR VEHICLE, Passenger car pickup van Military, WEATHER CONDITIONS Clear Raining, ROAD SURFACE, Dry Wet Snowy Icy Other, LIGHT CONDITIONS, Daylight Dawn or dusk Darkness, YOUR RESIDENCE, Local resident within miles of, North South, East West, and On name of street road or route.

Step 3: Once you choose the Done button, your ready file can be simply transferred to each of your devices or to email specified by you.

Step 4: Generate duplicates of the document - it will help you stay clear of possible issues. And don't get worried - we cannot display or view the information you have.

Oregon DMV Accident Report – Fill Out and Use This PDF

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