Virginia Police Crash Report Form PDF Details

The Commonwealth of Virginia's Department of Motor Vehicles provides the Virginia Police Crash Report Form FR300P as a comprehensive tool for law enforcement officers to document the specifics of vehicular accidents thoroughly. This form captures a wide array of data points, from the basic details of the crash, like date, time, and location, marked by GPS coordinates, to intricate specifics about the involved parties, including drivers, passengers, and vehicles. Characteristics of the crash scene, such as the roadway conditions, weather, and lighting, are systematically recorded alongside a description of the accident, delineating the sequence of events leading to the crash. Moreover, the form addresses commercial vehicle involvement with sections dedicated to cargo details, vehicle configuration, and hazardous material information, if applicable. This structured approach not only facilitates a detailed investigation post-incident but also assists in compiling statistical data to inform future road safety measures. Additionally, the inclusion of diagrams for depicting vehicle positions and movements at the time of the crash offers a visual understanding of the event, further enriching the report's utility in analyses and legal proceedings. Through this form, Virginia aims to streamline accident reporting processes, ensuring accuracy and completeness in capturing crash data.

QuestionAnswer
Form NameVirginia Police Crash Report Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesfr300 crash report, va fr300 accident report, fr300p, fr300 manual

Form Preview Example

 

 

 

 

 

 

 

 

Commonwealth of Virginia Department of Motor Vehicles

 

 

 

 

 

 

 

 

 

FR300P (Rev 1/12)

Revised Report

 

 

 

 

 

 

Police Crash Report

 

 

 

 

 

 

Page _______ of _______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CRASH

 

 

 

 

 

 

 

 

GPS Lat.

GPS Long.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Crash MM

DD

YYYY

Day of Week

 

MILITARY Time (24 hr clock)

County of Crash

Official DMV Use

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City of

 

City or Town

Name

 

 

Landmarks at Scene

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Town of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Location of Crash (route/street)

 

 

 

 

 

 

Railroad Crossing ID no. (if within 150 ft.)

Local Case Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N S E W

Location of Crash (route/street)

Mile Marker Number

 

 

 

 

Number of Vehicles

At Intersection With or ______

 

 

Miles

 

Feet

of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver Fled Scene

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s Name (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (Street and Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth

 

 

 

 

 

Drivers License Number

 

 

 

 

 

 

 

State

 

DL

 

 

CDL

 

Date

 

DD

 

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

N

 

 

Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Safety Equip. Used

 

 

 

 

Air Bag

Ejected

 

Date of Death

 

 

 

Injury

Type

 

EMS

 

Transport

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

 

 

 

 

 

 

 

 

Y

 

 

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Summons

 

 

 

 

Offenses

Charged

to Driver

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issued As

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Result of Crash

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Owner ’s Name (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

Same as Driver

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (Street and Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Year

 

 

Vehicle Make

 

Vehicle Model

 

 

 

 

Disabled

 

CMV

 

 

Towed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Plate Number

 

 

 

 

 

 

 

 

State

Approximate Repair Cost

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oversize

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cargo Spill

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Insurance Company (not agent)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Override

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Underride

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Speed Before Crash

 

 

 

Speed Limit

Maximum Safe Speed

Under

 

ALL Passengers Age Count

 

 

Over

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

 

 

8-17

 

 

18-21

 

 

 

21

 

 

 

 

PASSENGER (only if injured or killed)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

 

 

 

 

 

 

 

EMS Transport

 

 

 

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

 

MM

 

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

 

Airbag

Ejected

 

Injury Type

Birthdate

 

 

 

 

 

 

 

Gender

 

 

In/On

Equip

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

 

 

 

M

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

 

 

 

 

 

 

 

EMS Transport

 

 

 

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

 

MM

 

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

 

Airbag

Ejected

 

Injury Type

Birthdate

 

 

 

 

 

 

 

Gender

 

 

In/On

Equip

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

 

 

 

M

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

 

 

 

 

 

 

 

EMS Transport

 

 

 

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

 

MM

 

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

 

Airbag

Ejected

 

Injury Type

Birthdate

 

 

 

 

 

 

 

Gender

 

 

In/On

Equip

 

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

 

YYYY

 

 

 

M

F

 

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE #

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver Fled Scene

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s Name (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (Street and Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth

 

 

 

 

Drivers License Number

 

 

 

State

 

 

DL

 

CDL

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

Y

N

 

MM

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Safety Equip. Used

 

Air

Bag

Ejected

Date of Death

 

 

Injury Type

 

EMS

Transport

 

 

 

 

 

 

 

 

 

 

MM

DD

 

YYY

 

 

 

 

 

Y

 

N

 

 

Summons

 

 

 

Offenses

Charged

to Driver

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issued As

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Result of Crash

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Owner ’s Name (Last, First, Middle)

 

 

 

 

 

 

 

 

 

Same as Driver

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (Street and Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Year

Vehicle Make

 

Vehicle Model

 

 

 

 

Disabled

CMV

 

Towed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Plate Number

 

 

 

 

 

 

 

 

 

State

 

Approximate Repair Cost

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oversize

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cargo Spill

 

Name of Insurance Company (not agent)

 

 

 

 

 

 

 

 

 

 

 

 

Override

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Underride

 

Speed Before Crash

 

Speed Limit

Maximum Safe Speed

Under

ALL Passengers Age Count

Over

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

 

8-17

 

 

18-21

 

21

 

 

 

PASSENGER (only if injured or killed)

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

 

 

 

 

 

EMS Transport

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

MM

DD

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

 

 

Birthdate

 

 

 

 

Gender

 

In/On

Equip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

 

 

 

 

 

EMS Transport

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

MM

DD

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

 

 

Birthdate

 

 

 

 

Gender

 

In/On

Equip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

 

 

 

 

 

EMS Transport

Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

MM

DD

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

 

 

Birthdate

 

 

 

 

Gender

 

In/On

Equip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

F

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

MM

 

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Codes

8

 

 

1

 

 

2

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

5

 

 

6

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

 

 

 

POSITION IN/ON VEHICLE

1.Driver

2-6. Passengers

7.Cargo Area

8.Riding/Hanging

8On Outside

9-98. All Other Passengers

SAFETY EQUIPMENT USED

1.Lap Belt Only

2.Shoulder Belt Only

3.Lap and Shoulder Belt

4.Child Restraint

5.Helmet

6.Other

7.Booster Seat

8.No Restraint Used

9.Not Applicable

AIRBAG

1.Deployed – Front

2.Not Deployed

3.Unavailable/Not Applicable

4.Keyed Off

5.Unknown

6.Deployed – Side

7.Deployed – Other (Knee, Air Belt, etc.)

8.Deployed – Combination

EJECTED FROM VEHICLE

1.Not Ejected

2.Partially Ejected

3.Totally Ejected

SUMMONS ISSUED AS A RESULT OF CRASH

1.Yes

2.No

3.Pending

INJURY TYPE

1.Dead

2.Serious Injury

3.Minor/Possible Injury

4.No Apparent Injury

6. No Injury (driver only)

Investigating Officer

Badge/Code Number

Agency/Department Name and Code

Reviewing Officer

Report File Date

Officer Initials________ Badge # __________

Commonwealth of Virginia Department of Motor Vehicles

FR300P (Rev 1/12)

Revised Report

Police Crash Report

Page _______ of _______

 

CRASH

Crash MM DD YYYY Date

MILITARY Time (24 hr clock)

County of Crash

City of Town of

Local Case Number

DRIVER INFORMATION

VEHICLE INFORMATION

Veh

 

Veh

 

Veh

 

Veh

 

 

 

 

 

 

 

Veh Veh

Veh Veh

N/A N/A Driver’s Action

P1

1. No Improper Action

2. Exceeded Speed Limit

3. Exceeded Safe Speed

But Not Speed Limit

4. Overtaking On Hill

5. Overtaking On Curve

6. Overtaking at Intersection

7. Improper Passing of School Bus

8. Cutting In

9. Other Improper Passing

10. Wrong Side of Road – Not Overtaking

11. Did Not Have Right-of-Way

12. Following Too Close

13. Fail to Signal or Improper Signal

14. Improper Turn – Wide Right Turn

15. Improper Turn –

Cut Corner on Left Turn

16. Improper Turn From Wrong Lane

17. Other Improper Turn

18. Improper Backing

19. Improper Start From Parked Position

20. Disregarded Officer or Flagger

21. Disregarded Traffic Signal

22. Disregarded Stop or Yield Sign

23. Driver Distraction

24. Fail to Stop at Through High way – No Sign

25. Drive Through Work Zone

26. Fail to Set Out Flares or Flags

27. Fail to Dim Headlights

28. Driving Without Lights

29. Improper Parking Location

30. Avoiding Pedestrian

31. Avoiding Other Vehicle

32. Avoiding Animal

33. Crowded Off Highway

34. Hit and Run

35. Car Ran Away – No Driver

36. Blinded by Headlights

37. Other

38. Avoiding Object in Roadway

39. Eluding Police

40. Fail to Maintain Proper Control

41. Improper Passing

42. Improper or Unsafe Lane Change

43. Over Correction

N/A N/A Condition of

Driver

P2

Contributing

to the

Crash

 

 

 

1. No Defects

2. Eyesight Defective

3. Hearing Defective

4. Other Body Defects

5. Illness

6. Fatigued

7. Apparently Asleep

8. Other

9. Unknown

N/A N/A Driver Vision Obscured P3

1. Not Obscured

2. Rain, Snow, etc. on Windshield

3. Windshield Otherwise Ob scured

4. Vision Obscured by Load on Vehicle

5. Trees, Crops, etc.

6. Building

7. Embankment

8. Sign or Signboard

9. Hillcrest

10. Parked Vehicle(s)

11. Moving Vehicle(s)

12. Sun or Headlight Glare

13. Other

14. Blind Spot

15. Smoke/Dust

16. Stopped Vehicle(s)

N/A N/A Type of Driver

P4

Distractions

 

1. Looking at Roadside Incident

2. Driver Fatigue

3. Looking at Scenery

4. Passenger(s)

5. Radio/CD, etc.

6. Cell Phone

7. Eyes Not on Road

8. Daydreaming

9. Eating/Drinking

10. Adjusting Vehicle Controls

11. Other

12. Navigation Device

13. Texting

14. No Driver Distraction

N/A N/A Drinking

P5

1. Had Not Been Drinking

2. Drinking – Obviously Drunk

3. Drinking – Ability Im paired

4. Drinking – Ability Not Impaired

5. Drinking – Not Known Whether Impaired

6. Unknown

N/A N/A Method of Alcohol P6

Determination (by police)

1. Blood

2. Breath

3. Refused

4. No Test

N/A N/A Drug Use

P7

1. Yes

2. No

3. Unknown

N/A

N/A

Vehicle Maneuver

V1

 

 

1.

Going Straight Ahead

 

 

 

2.

Making Right Turn

 

 

 

3.

Making Left Turn

 

 

 

4. Making U-Turn

 

 

 

5.

Slowing or Stopping

 

 

 

6.

Merging Into Traffic Lane

 

 

 

7.

Starting From Parked Position

 

 

 

8.

Stopped in Traffic Lane

 

 

 

9.

Ran Off Road – Right

 

 

 

10.

Ran Off Road – Left

 

 

 

11.

Parked

 

 

 

12.

Backing

 

 

 

13.

Passing

 

 

 

14. Changing Lanes

 

 

 

15.

Other

 

 

 

16.

Entering Street From arking Lot

N/A

N/A

Skidding Tire/Mark

V2

1. Before Application of Brakes

2. After Application of Brakes

3. Before and After Application of Brakes

4. No Visible Skid Mark/Tire Mark

N/A N/A Vehicle Body Type

V3

1. Passenger car

2. Truck – Pick-up/Passenger Truck

3. Van

4. Truck – Single Unit Truck (2-Axles)

7. Motor Home, Recreational Vehicle

8. Special Vehicle – Oversized Vehicle/Earthmover/Road Equipment

9. Bicycle

10. Moped

11. Motorcycle

12. Emergency Vehicle (Regardless of Vehicle Type)

13. Bus – School Bus

14. Bus – City Transit Bus/Privately Owned Church Bus

15. Bus – Commercial Bus

16. Other (Scooter, Go-cart, Hearse, Bookmobile, Golf Cart, etc.

18. Special Vehicle – Farm Machinery

19. Special Vehicle – ATV

21. Special Vehicle – Low-Speed Vehicle

22. Truck – Sport Utility Vehicle (SUV)

23. Truck – Single Unit Truck (3 Axles or More)

25. Truck – Truck Tractor (Bobtail-No Trailer)

N/A N/A Vehicle Damage

V4

1. Unknown

2. No damage

3. Overturned

4. Motor

5. Undercarriage

6. Totaled

7. Fire

8. Other

N/A N/A Vehicle Condition

V5

1. No Defects

2. Lights Defective

3. Brakes Defective

4. Steering Defective

5. Puncture/Blowout

6. Worn or Slick Tires

7. Motor Trouble

8. Chains In Use

9. Other

10. Vehicle Altered

11. Mirrors Defective

12. Power Train Defective

13. Suspension Defective

14. Windows/Windshield Defective

15. Wipers Defective

16. Wheels Defective

17. Exhaust System

N/A

N/A

Special Function

V6

 

 

Motor Vehicle

 

 

 

1.

No Special Function

 

 

 

2.

Taxi

 

 

 

3. School Bus (Public or Private)

 

 

4.

Transit Bus

 

 

 

5.

Intercity Bus

 

N/A

N/A

6. Charter Bus

 

 

 

7. Other Bus

 

 

 

8.

Military

 

 

 

9.

Police

 

 

 

10. Ambulance

 

 

 

11. Fire Truck

 

 

 

12. Tow Truck

 

 

 

13. Maintenance

 

 

 

14. Unknown

 

N/A

N/A

EMV in service

V7

 

 

1.

Yes

 

 

 

2. No

 

N/A

N/A

Truck Cover

V8

 

 

1.

Yes

 

2. No

Officer Initials________ Badge # __________

Commonwealth of Virginia

Department of Motor Vehicles

FR300P (Rev 1/12)

 

 

 

 

Revised Report

Police

Crash Report

Page _______ of _______

 

 

CRASH

Crash MM DD YYYY Date

MILITARY Time (24 hr clock)

County of Crash

City of Town of

Local Case Number

CRASH INFORMATION

Location

of First Harmful

C1

Event in

Relation to Roadway

 

1. On Roadway

2. Shoulder

3. Median

4. Roadside

5. Gore

6. Separator

7. In Parking Lane or Zone

8. Off Roadway, Location Unknown

9. Outside Right-of-Way

Weather Condition

C2

1. No Adverse Condition

(Clear/Cloudy)

3. Fog

4. Mist

5. Rain

6. Snow

7. Sleet/Hail

8. Smoke/Dust

9. Other

10. Blowing Sand, Soil,

Dirt, or Snow

11. Severe Crosswinds

Light Conditions

C3

 

 

1. Dawn

2. Daylight

3. Dusk

4. Darkness –Road Lighted

5. Darkness –Road Not Lighted

6. Darkness –Unknown

Road Lighting

7. Unknown

Traffic Control

C4

Device

 

 

 

1. Yes – Working

2. Yes – Working and Obscured

3. Yes – Not Working

4. Yes – Not Working and Obscured

5. Yes – Missing

6. No Traffic Control Device Present

Traffic Control Type

C5

 

 

1. No Traffic Control

2. Officer or Flagger

3. Traffic Signal

4. Stop Sign

5. Slow or Warning Sign

6. Traffic Lanes Marked

7. No Passing Lines

8. Yield Sign

9. One Way Road or Street

10. Railroad Crossing With

Markings and Signs

11. Railroad Crossing With Signals

12. Railroad Crossing With Gate and Signals

13. Other

14. Pedestrian Crosswalk

15. Reduced Speed – School Zone

16. Reduced Speed – Work Zone

17. Highway Safety Corridor

Roadway Alignment

C6

 

 

1. Straight – Level

2. Curve – Level

3. Grade – Straight

4. Grade – Curve

5. Hillcrest – Straight

6. Hillcrest – Curve

7. Dip – Straight

8. Dip – Curve

9. Other

10. On/Off Ramp

Roadway Surface Condition C7

1. Dry

2. Wet

3. Snowy

4. Icy

5. Muddy

6. Oil/Other Fluids

7. Other

8. Natural Debris

9. Water (Standing, Moving)

10. Slush

11. Sand, Dirt, Gravel

Roadway Surface Type

C8

 

 

1. Concrete

2. Blacktop, Asphalt, Bituminous

3. Brick or Block

4. Slag, Gravel, Stone

5. Dirt

6. Other

Roadway Description

C9

 

 

1. Two-Way, Not Divided

2. Two-Way, Divided,

Unprotected Median

3. Two-Way, Divided, Positive

Median Barrier

4. One-Way, Not Divided

5. Unknown

Roadway Defects

C10

 

 

1. No Defects

2. Holes, Ruts, Bumps

3. Soft or Low Shoulder

4. Under Repair

5. Loose Material

6. Restricted Width

7. Slick Pavement

8. Roadway Obstructed

9. Other

10. Edge Pavement Drop Off

Relation to Roadway

C11

Interchange Area:

 

1. Main-Line Roadway

2. Acceleration/Deceleration Lanes

3. Gore Area (Between Ramp and Highway Edgelines)

4. Collector/Distributor Road

5. On Entrance/Exit Ramp

6. Intersection at end of Ramp

7. Other location not listed above within an interchange area (median, shoulder and roadside)

Intersection Area:

8. Non-Intersection

9. Within Intersection

10. Intersection-Related - Within 150’

11. Intersection-Related - Outside 150’

Other Location:

12. Crossover Related

13. Driveway, Alley-Access - Related

14. Railway Grade Crossing

15. Other Crossing (Crossings for Bikes, School, etc.)

Intersection Type

C12

 

 

1. Not at Intersection

2. Two Approaches

3. Three Approaches

4. Four Approaches

5. Five-Point, or more

6. Roundabout

Work Zone

C13

1. Yes

 

2. No

 

 

 

 

 

Work Zone

C14

Workers Present

 

1. With Law Enforcement

 

2. With No Law Enforcement

 

3. No Workers Present

 

 

 

 

 

Work Zone Location

C15

 

 

1. Advance Warning Area

2. Transition Area

3. Activity Area

4. Termination Area

Work Zone Type

C16

 

 

1. Lane Closure

2. Lane Shift/Crossover

3. Work on Shoulder or Median

4. Intermittent or Moving Work

5. Other

School Zone

C17

1.

Yes

 

2.

Yes - With School Activity

 

3. No

 

 

 

 

 

 

Type of Collision

C18

 

 

 

1. Rear End

2. Angle

3. Head On

4. Sideswipe – Same Direction

5. Sideswipe – Opposite Direction

6. Fixed Object in Road

7. Train

8. Non-Collision

9. Fixed Object – Off Road

10. Deer

11. Other Animal

12. Pedestrian

13. Bicyclist

14. Motorcyclist

15. Backed Into

16. Other

Officer Initials________ Badge # __________

Commonwealth of Virginia

Department of Motor Vehicles

FR300P (Rev 1/12)

Revised Report

Police

Crash Report

Page _______ of _______

 

 

CRASH

Crash MM DD YYYY Date

MILITARY Time (24 hr clock)

County of Crash

City of Town of

Local Case Number

VEHICLE #

Fill In Impact Area(s). Initial Impact.

 

12

 

11

 

1

10

 

2

9

13

3

8

 

4

7

 

5

 

6

 

Veh Dir of Travel –N/S/E/W

VEHICLE #

Fill In Impact Area(s). Initial Impact.

 

12

 

11

 

1

10

 

2

9

13

3

8

 

4

7

 

5

 

6

 

Veh Dir of Travel –N/S/E/W

CRASH DIAGRAM

Indicate North by Arrow

VEHICLE #

Fill In Impact Area(s). Initial Impact.

 

12

 

11

 

1

10

 

2

9

13

3

8

 

4

7

 

5

 

6

 

Veh Dir of Travel –N/S/E/W

VEHICLE #

Fill In Impact Area(s). Initial Impact.

 

12

 

11

 

1

10

 

2

9

13

3

8

 

4

7

 

5

 

6

 

Veh Dir of Travel –N/S/E/W

DAMAGE TO PROPERTY OTHER THAN VEHICLES

Approx. Repair Cost

Object Struck (Tree, Fence, etc.)

Property Owners Name (Last, First, iddle)

Address (Street and Number)

VDOT Property

Yes No

CRASH DESCRIPTION

CRASH EVENTS

Vehicle #

First Event

Second Event

Third Event

Fourth Event

Most Harmful Event

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle #

First Event

Second Event

Third Event

Fourth Event

Most Harmful Event

 

 

 

 

 

 

Vehicle #

First Event

Second Event

Third Event

Fourth Event

Most Harmful Event

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle #

First Event

Second Event

Third Event

Fourth Event

Most Harmful Event

 

 

 

 

 

 

First Harmful Event of Entire Crash that Results in First Injury or Damage.

COLLISION WITH FIXED OBJECT

1. Bank Or Ledge

10. Other

2.

Trees

11.

Jersey Wall

3.

Utility Pole

12.

Building/Structure

4.

Fence Or Post

13.

Curb

5.

Guard Rail

14.

Ditch

6.

Parked Vehicle

15.

Other Fixed Object

7.

Tunnel, Bridge, Underpass,

16.

Other Traffic Barrier

 

Culvert, etc.

17.

Traffic Sign Support

8.

Sign, Traffic Signal

18.

Mailbox

9. Impact Cushioning Device

COLLISION WITH PERSON, MOTOR VEHICLE

NON-COLLISION

 

 

OR NON-FIXED OBJECT

24. Work Zone

28. Ran Off Road

35. Cross Median

19.

Pedestrian

29.

Jack Knife

36.

Cross Centerline

20.

Motor Vehicle In Transport

Maintenance Equipment

30.

Overturn (Rollover)

37.

Equipment Failure (Tire, etc)

21.

Train

25. Other Movable Object

31.

Downhill Runaway

38.

Immersion

22.

Bicycle

26. Unknown Movable Object

32.

Cargo Loss or Shift

39.

Fell/Jumped From Vehicle

23.

Animal

27. Other

33.

Explosion or Fire

40.

Thrown or Falling Object

 

 

 

34.

Separation of Units

41.

Non-Collision Unknown

 

 

 

 

 

42.

Other Non-Collision

Officer Initials________ Badge # __________

Commonwealth of Virginia Department of Motor Vehicles

FR300P (Rev 1/12)

Revised Report

Police Crash Report

Page _______ of _______

 

CRASH

Crash MM DD YYYY Date

MILITARY Time (24 hr clock)

County of Crash

City of Town of

Local Case Number

COMMERCIAL MOTOR VEHICLE SECTION

This form is being completed because the vehicle is:

A Truck or Truck Combination Rating Greater Than 10,000 lbs. (GVWR/GCWR)

Any Motor Vehicle That Seats

9 or More People, Including the Driver

A Vehicle of Any Type with a Hazardous Materials Placard Regardless of Weight

AND The crash resulted in:

A fatality: any person(s) killed in or outside of any

 

 

 

An injury: any person(s) injured as a

 

 

 

 

 

 

A tow-away: any motor vehicle (truck,

 

vehicle (truck, bus, car, etc.) involved in the crash or

 

OR

result of the crash who immediately

OR

 

 

bus, car, etc.) disabled as a result of the

 

who dies within 30 days of the crash as a result of

 

 

 

receives medical treatment away from

 

 

crash and transported away from the

 

an injury sustained in the crash

 

 

 

 

the crash scene

 

 

 

 

 

 

 

scene by a tow truck or other vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Configuration

 

V10

 

Cargo Body Type

 

 

V11

 

 

License P8

 

Commercial

 

P9

1.

Passenger Car (Only if Vehicle Has Hazardous Materials Placard)

 

1. Bus (Seats 9-15 People,

10. Grain/Chips/Gravel

 

 

Class

 

 

Endorsement

 

2.

Light Truck (Only if Vehicle Has Hazardous Materials Placard)

 

 

 

Including Driver)

11. Pole-Trailer

 

 

 

Class A

 

 

 

T–Double Trailer

 

3.

Bus (Seats 9-15 People, Including Driver)

 

 

 

2. Bus (Seats For 16 People or

 

 

 

 

 

 

 

 

 

 

12. Vehicle Towing Another

 

 

 

Class B

 

 

 

P–Passenger Vehicle

4.

Bus (Seats for 16 People or More, Including Driver)

 

 

 

More, Including Driver)

 

 

 

 

 

 

 

 

 

Motor Vehicle

 

 

 

Class C

 

 

 

N–Tank Vehicle

 

 

 

 

3. Van/Enclosed Box

 

 

 

 

 

 

 

5.

Single Unit Truck (2 Axles, 6 Tires)

 

 

 

 

13. Intermodel Container

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Class DRL

 

 

H–Required To Be

 

 

 

 

 

4. Cargo Tank

 

 

 

 

 

 

6.

Single Unit Truck (3 or More Axles)

 

 

 

Chassis

 

 

 

 

 

 

 

 

 

 

 

 

(regular

 

 

 

Placarded for

 

 

 

 

5. Flatbed

14. Logging

 

 

 

 

 

 

 

7.

Truck Trailer(s) [Single-Unit Truck Pulling Trailer(s)]

 

 

 

 

 

 

drivers

 

 

 

Hazardous Materials

8. Truck Tractor (Bobtail)

 

 

 

 

6. Dump

15. ther Cargo Body

 

 

 

license)

 

 

 

X–Combined Tank/HAZMAT

 

 

 

 

 

 

 

Class M

 

 

9.

Tractor/Semi-trailer (One Trailer)

 

 

 

 

7. Concrete Mixer

(Not Listed Above)

 

 

 

 

 

O–Other

 

 

 

 

 

 

8. Auto Transporter

16. Not Applicable/

 

 

 

 

 

 

 

 

 

10. Tractor/Doubles (Two Trailers)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Other Truck Greater Than 10,000 lbs. (Not Listed Above)

 

 

 

9. Garbage/Refuse

No

argo Body

 

 

GVWR/ V12

 

 

1. 10,000 lbs. or Less

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GCWR

 

 

 

2. 10,001–26,000 lbs.

 

Hazardous Material

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Greater Than 26,000 lbs.

Hazardous Material Placard: Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HM 4–Digit

 

 

 

 

 

 

 

HM Placard Name

 

 

 

 

 

HM Class

 

 

 

 

 

HM Cargo Present

 

HM Cargo Released

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier

Identification

 

 

 

 

 

 

 

 

Commercial Motor Carrier Name

 

 

 

Address (P.O. Box if No Street Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier’s ID

Number

State (Intrastate Only)

City

 

State

Zip

 

US DOT#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial/Non-Commercial V13

1. Interstate Carrier

2. Intrastate Carrier

3. Not in Commerce-Government (Trucks and Buses) 4. Not in Commerce-Other Truck (Over 10,000 lbs.)

VEHICLE #

Vehicle Configuration

V10

 

Cargo Body Type

 

 

V11

 

 

License

P8

 

Commercial

 

P9

1.

Passenger Car (Only if Vehicle Has Hazardous Materials Placard)

 

1. Bus (Seats 9-15 People,

10. Grain/Chips/Gravel

 

 

Class

 

 

Endorsement

 

2.

Light Truck (Only if Vehicle Has Hazardous Materials Placard)

 

Including Driver)

11. Pole-Trailer

 

 

 

Class A

 

 

 

T–Double Trailer

 

3.

Bus (Seats 9-15 People, Including Driver)

 

2. Bus (Seats For 16 People or

 

 

 

 

 

 

 

 

12. Vehicle Towing Another

 

 

 

Class B

 

 

 

P–Passenger Vehicle

 

 

 

 

 

 

 

 

 

 

More, Including Driver)

 

 

 

 

 

 

4.

Bus (Seats for 16 People or More, Including Driver)

 

Motor Vehicle

 

 

 

Class C

 

 

 

N–Tank Vehicle

 

 

3. Van/Enclosed Box

 

 

 

 

 

 

 

5.

Single Unit Truck (2 Axles, 6 Tires)

 

 

 

13. Intermodel Container

 

 

 

 

 

 

 

 

 

 

 

 

 

Class DRL

 

 

H–Required To Be

 

 

 

 

4. Cargo Tank

 

 

 

 

 

 

6.

Single Unit Truck (3 or More Axles)

 

Chassis

 

 

 

 

 

 

 

 

 

 

(regular

 

 

 

Placarded for

 

 

5. Flatbed

14. Logging

 

 

 

 

 

 

 

7.

Truck Trailer(s) [Single-Unit Truck Pulling Trailer(s)]

 

 

 

 

drivers

 

 

 

Hazardous Materials

 

6. Dump

 

 

 

 

 

 

 

license)

 

 

 

8.

Truck Tractor (Bobtail)

 

 

 

15. Other Cargo Body

 

 

 

 

 

 

X–Combined Tank/HAZMAT

 

 

 

 

 

 

Class M

 

 

 

 

 

 

7. Concrete Mixer

(Not Listed Above)

 

 

 

 

 

 

9.

Tractor/Semi-trailer (One Trailer)

 

 

 

 

 

 

 

 

 

O–Other

 

 

 

 

 

8. Auto Transporter

16. Not Applicable/

 

 

 

 

 

 

 

 

 

10. Tractor/Doubles (Two Trailers)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Garbage/Refuse

No Cargo Body

 

 

GVWR/ V12

 

 

1. 10,000 lbs. or Less

 

11. Other Truck Greater Than 10,000 lbs. (Not Listed Above)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GCWR

 

 

 

2. 10,001–26,000 lbs.

 

Hazardous Material

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Greater Than 26,000 lbs.

Hazardous Material Placard: Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HM 4–Digit

 

 

 

 

 

HM Placard Name

 

 

 

 

HM Class

 

 

 

 

 

HM Cargo Present

 

HM Cargo Released

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier

Identification

 

 

 

 

 

 

Commercial Motor Carrier Name

 

Address (P.O. Box if No Street Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Carrier’s ID

Number

State (Intrastate Only)

City

 

State

Zip

 

US DOT#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial/Non-Commercial V13

1. Interstate Carrier

2. Intrastate Carrier

3. Not in Commerce-Government (Trucks and Buses) 4. Not in Commerce-Other Truck (Over 10,000 lbs.)

Officer Initials________ Badge # __________

Commonwealth of Virginia Department of Motor Vehicles

FR300P (Rev 1/12)

Revised Report

Police Crash Report

Page _______ of _______

 

CRASH

Crash MM DD YYYY Date

MILITARY Time (24 hr clock)

County of Crash

City of Town of

Local Case Number

 

PEDESTRIAN #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Injured

Name of Injured (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (Street and Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

State

 

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s License #

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender

 

EMS Transport

Injury Type

Birthdate

 

 

 

Date of Death

 

 

 

M

F

 

 

 

 

 

DD

 

YYYY

MM

 

DD

 

YYYY

 

 

Y

N

 

MM

 

 

 

 

 

PEDESTRIAN #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Injured

Name of Injured (Last, First, Middle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (Street and Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

State

 

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s License #

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender

 

EMS Transport

Injury Type

Birthdate

 

 

 

Date of Death

 

 

 

M

F

 

 

 

 

 

 

DD

 

YYYY

MM

 

DD

 

YYYY

 

 

Y

N

 

MM

 

 

 

 

Ped #

 

Ped #

 

Ped #

 

Ped #

 

Ped #

 

Ped #

 

Ped #

 

Ped #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

N/A

Pedestrian Actions

P10

 

 

1.

Crossing At Intersection

11. Hitching On Vehicle

 

 

 

With Signal

12. Walking In Roadway

 

 

2.

Crossing At Intersection

 

 

With Traffic – Sidewalks

 

 

 

Against Signal

Available

 

 

3.

Crossing At Intersection

13. Walking In Roadway

 

 

 

No Signal

With Traffic – Sidewalks

 

 

4.

Crossing At Intersection

Not Available

 

 

 

Diagonally

14. Walking In Roadway

 

 

5.

Crossing Not At

Against Traffic

 

 

 

Intersection – Rural

– Sidewalks Available

 

 

6. Crossing Not At

15. Walking In Roadway

 

 

 

Intersection – Urban

Against Traffic – Side

 

 

7. Coming From Behind

Walks Not Available

 

 

16. Working In Roadway

 

 

 

Parked Cars

 

 

8. Getting Off Or On

17. Standing In Roadway

 

 

 

School Bus

18. Lying In Roadway

 

 

9. Playing In Roadway

19. Not In Roadway

 

 

10. Getting Off Or On

20. Other

 

 

 

Another Vehicle

 

N/A N/A Pedestrian Drinking P11

1. Had Not Been Drinking

2. Drinking-Obviousl y Drunk

3. Drinking -Ability Impaired

4. Drinking -Ability Not Impaired

5. Drinking -Not Known

Whether Impaired

N/A N/A Condition of

P12

Pedestrian

 

ontributing

to

the rash

 

 

 

1. No Defects

2. Eyesight Defective

3. Hearing Defective

4. Other Body Defects

5. Illness

6. Fatigued

7. Apparently Asleep

8. Other

N/A

N/A

Method of

P13

 

 

Alcohol

 

 

 

Determination

 

 

 

by Police

 

 

 

1.

Blood

 

 

 

2.

Breath

 

 

 

3.

Refused

 

 

 

4.

No Test

 

N/A

N/A

Pedestrian Drug Use P14

 

 

1.

Yes

 

 

 

2. No

 

 

 

3. Unknown

 

N/A

N/A

Pedestrian Wear

P15

 

 

Reflective Clothing

 

 

 

1.

Yes

 

2. No

Use sections below for additional passengers.

VEHICLE #

PASSENGER (only if injured or killed)

 

Name of Injured

(Last, First, Middle)

 

 

EMS Transport

 

Date of Death

 

 

 

 

 

 

Y

N

 

MM

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

Birthdate

 

 

 

Gender

 

In/On

Equip

 

 

 

MM

 

DD

 

YYYY

 

M

 

F

 

 

 

 

 

 

 

 

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

EMS Transport

 

Date of Death

 

 

 

 

 

 

Y

N

 

MM

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

Birthdate

 

 

 

Gender

 

In/On

Equip

 

 

 

MM

 

DD

 

YYYY

 

M

 

F

 

 

 

 

 

 

 

 

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

EMS Transport

 

Date of Death

 

 

 

 

 

 

Y

N

 

MM

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

Birthdate

 

 

 

Gender

 

In/On

Equip

 

 

 

MM

 

DD

 

YYYY

 

M

 

F

 

 

 

 

 

 

 

 

 

Vehicle

Used

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE #

PASSENGER (only if injured or killed)

 

Name of Injured

(Last, First, Middle)

 

 

EMS Transport

Date of Death

 

Injured

 

 

 

 

 

Y

N

MM

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

Birthdate

 

 

 

Gender

 

In/On

Equip

 

 

 

 

 

 

 

 

 

M

 

F

 

Vehicle

Used

 

 

 

MM

 

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

EMS Transport

Date of Death

 

InjuredPosition

 

 

 

 

 

Y

N

MM

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

Safety

Airbag

Ejected

Injury Type

Birthdate

 

 

 

Gender

 

In/On

Equip

 

 

 

 

 

 

 

 

 

M

 

F

 

Vehicle

Used

 

 

 

MM

 

DD

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Injured

(Last, First, Middle)

 

 

EMS Transport

Date of Death

 

 

 

 

 

 

 

Y

N

MM

 

DD

 

YY

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

Safety

Airbag

Ejected

Injury Type

Birthdate

YYYY

 

Gender

 

InjuredVehicle

Used

 

 

 

MM

 

DD

 

 

 

 

 

In/On

Equip

 

 

 

 

 

 

 

 

 

M

 

F

 

 

 

 

 

 

 

 

 

 

 

 

 

Codes

8

 

 

1

 

 

2

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

6

 

 

 

 

5

 

 

 

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

 

 

POSITION IN/ON VEHICLE

1.Driver

2-6. Passengers

7.Cargo Area

8.Riding/Hanging

8On Outside

9-98. All Other Passengers

SAFETY EQUIPMENT USED

1.Lap Belt Only

2.Shoulder Belt Only

3.Lap and Shoulder Belt

4.Child Restraint

5.Helmet

6.Other

7.Booster Seat

8.No Restraint Used

9.Not Applicable

AIRBAG

1.Deployed – Front

2.Not Deployed

3.Unavailable/Not Applicable

4.Keyed Off

5.Unknown

6.Deployed – Side

7.Deployed – Other (Knee, Air Belt, etc.)

8.Deployed – Combination

EJECTED FROM VEHICLE

1.Not Ejected

2.Partially Ejected

3.Totally Ejected

SUMMONS ISSUED AS A RESULT OF CRASH

1.Yes

2.No

3.Pending

INJURY TYPE

1.Dead

2.Serious Injury

3.Minor/Possible Injury

4.No Apparent Injury