Are you looking for a way to efficiently and effectively provide information about vehicle accidents in Virginia? If so, the Virginia Police Crash Report Form is the perfect tool! This form provides an easy-to-understand format that allows officers to record incident information quickly and accurately. We'll take a look at how it works, what its benefits are, and how it can help law enforcement professionals maintain comprehensive records of motor vehicle crashes.
| Question | Answer |
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| Form Name | Virginia Police Crash Report Form |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | fr300 crash report, va fr300 accident report, fr300p, fr300 manual |
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Commonwealth of Virginia • Department of Motor Vehicles |
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FR300P (Rev 1/12) |
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Revised Report |
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Police Crash Report |
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Page _______ of _______ |
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CRASH |
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GPS Lat. |
GPS Long. |
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Crash MM |
DD |
YYYY |
Day of Week |
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MILITARY Time (24 hr clock) |
County of Crash |
Official DMV Use |
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Date |
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City of |
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City or Town |
Name |
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Landmarks at Scene |
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Town of |
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Location of Crash (route/street) |
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Railroad Crossing ID no. (if within 150 ft.) |
Local Case Number |
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N S E W |
Location of Crash (route/street) |
Mile Marker Number |
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Number of Vehicles |
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At Intersection With or ______ |
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Miles |
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Feet |
of |
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VEHICLE # |
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DRIVER |
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Driver Fled Scene |
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Driver’s Name (Last, First, Middle) |
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Gender |
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M |
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Address (Street and Number) |
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City |
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State |
ZIP |
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Birth |
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Drivers License Number |
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State |
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DL |
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CDL |
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YYYY |
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Y |
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N |
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Y |
N |
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MM |
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Safety Equip. Used |
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Air Bag |
Ejected |
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Date of Death |
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Injury |
Type |
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EMS |
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Transport |
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MM |
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Summons |
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Offenses |
Charged |
to Driver |
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Issued As |
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Result of Crash |
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VEHICLE |
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Vehicle Owner ’s Name (Last, First, Middle) |
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Same as Driver |
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Address (Street and Number) |
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City |
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State |
ZIP |
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Vehicle Year |
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Vehicle Make |
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Vehicle Model |
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Disabled |
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CMV |
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Towed |
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Vehicle Plate Number |
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State |
Approximate Repair Cost |
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VIN |
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Oversize |
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Cargo Spill |
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Name of Insurance Company (not agent) |
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Override |
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Underride |
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Speed Before Crash |
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Speed Limit |
Maximum Safe Speed |
Under |
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ALL Passengers Age Count |
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Over |
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8 |
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21 |
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PASSENGER (only if injured or killed) |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
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Date of Death |
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Position |
Safety |
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Airbag |
Ejected |
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Injury Type |
Birthdate |
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Gender |
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In/On |
Equip |
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Vehicle |
Used |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
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Date of Death |
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Position |
Safety |
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Airbag |
Ejected |
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Injury Type |
Birthdate |
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Gender |
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In/On |
Equip |
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YYYY |
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Vehicle |
Used |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
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Date of Death |
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YY |
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Position |
Safety |
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Airbag |
Ejected |
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Injury Type |
Birthdate |
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Gender |
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In/On |
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MM |
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Vehicle |
Used |
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VEHICLE # |
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DRIVER |
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Driver Fled Scene |
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Driver’s Name (Last, First, Middle) |
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Gender |
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Address (Street and Number) |
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City |
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State |
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ZIP |
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Birth |
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Drivers License Number |
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State |
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DL |
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CDL |
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Date |
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Safety Equip. Used |
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Air |
Bag |
Ejected |
Date of Death |
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Injury Type |
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EMS |
Transport |
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Summons |
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Offenses |
Charged |
to Driver |
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Issued As |
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Result of Crash |
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VEHICLE |
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Vehicle Owner ’s Name (Last, First, Middle) |
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Same as Driver |
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Address (Street and Number) |
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City |
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State |
ZIP |
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Vehicle Year |
Vehicle Make |
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Vehicle Model |
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Disabled |
CMV |
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Towed |
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Vehicle Plate Number |
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State |
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Approximate Repair Cost |
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VIN |
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Oversize |
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Cargo Spill |
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Name of Insurance Company (not agent) |
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Override |
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Underride |
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Speed Before Crash |
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Speed Limit |
Maximum Safe Speed |
Under |
ALL Passengers Age Count |
Over |
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8 |
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21 |
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PASSENGER (only if injured or killed) |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
Date of Death |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
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Birthdate |
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Gender |
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In/On |
Equip |
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M |
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Vehicle |
Used |
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MM |
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YYYY |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
Date of Death |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
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Birthdate |
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Gender |
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In/On |
Equip |
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M |
F |
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Vehicle |
Used |
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MM |
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YYYY |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
Date of Death |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
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Birthdate |
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Gender |
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In/On |
Equip |
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M |
F |
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Vehicle |
Used |
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MM |
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YYYY |
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Codes
8
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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8 |
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7 |
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8 |
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POSITION IN/ON VEHICLE
1.Driver
7.Cargo Area
8.Riding/Hanging
8On Outside
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 |
|
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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
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 |
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1. |
Going Straight Ahead |
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2. |
Making Right Turn |
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3. |
Making Left Turn |
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4. Making |
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5. |
Slowing or Stopping |
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6. |
Merging Into Traffic Lane |
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7. |
Starting From Parked Position |
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8. |
Stopped in Traffic Lane |
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9. |
Ran Off Road – Right |
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10. |
Ran Off Road – Left |
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11. |
Parked |
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12. |
Backing |
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13. |
Passing |
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14. Changing Lanes |
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15. |
Other |
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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 –
3. Van
4. Truck – Single Unit Truck
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,
18. Special Vehicle – Farm Machinery
19. Special Vehicle – ATV
21. Special Vehicle –
22. Truck – Sport Utility Vehicle (SUV)
23. Truck – Single Unit Truck (3 Axles or More)
25. Truck – Truck Tractor
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 |
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Motor Vehicle |
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1. |
No Special Function |
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2. |
Taxi |
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3. School Bus (Public or Private) |
||
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4. |
Transit Bus |
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5. |
Intercity Bus |
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N/A |
N/A |
6. Charter Bus |
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7. Other Bus |
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8. |
Military |
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9. |
Police |
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10. Ambulance |
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11. Fire Truck |
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12. Tow Truck |
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13. Maintenance |
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14. Unknown |
|
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N/A |
N/A |
EMV in service |
V7 |
|
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1. |
Yes |
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2. No |
|
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N/A |
N/A |
Truck Cover |
V8 |
|
|
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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
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 |
|
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1. Dawn
2. Daylight
3. Dusk
4. Darkness
5. Darkness
6. Darkness
Road Lighting
7. Unknown
Traffic Control |
C4 |
Device |
|
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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 |
|
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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 |
|
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1. Concrete
2. Blacktop, Asphalt, Bituminous
3. Brick or Block
4. Slag, Gravel, Stone
5. Dirt
6. Other
Roadway Description |
C9 |
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1.
2.
Unprotected Median
3.
Median Barrier
4.
5. Unknown
Roadway Defects |
C10 |
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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.
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.
9. Within Intersection
10.
11.
Other Location:
12. Crossover Related
13. Driveway,
14. Railway Grade Crossing
15. Other Crossing (Crossings for Bikes, School, etc.)
Intersection Type |
C12 |
|
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1. Not at Intersection
2. Two Approaches
3. Three Approaches
4. Four Approaches
5.
6. Roundabout
Work Zone |
C13 |
1. Yes |
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2. No |
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Work Zone |
C14 |
Workers Present |
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1. With Law Enforcement |
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2. With No Law Enforcement |
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3. No Workers Present |
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Work Zone Location |
C15 |
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1. Advance Warning Area
2. Transition Area
3. Activity Area
4. Termination Area
Work Zone Type |
C16 |
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1. Lane Closure
2. Lane Shift/Crossover
3. Work on Shoulder or Median
4. Intermittent or Moving Work
5. Other
School Zone |
C17 |
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1. |
Yes |
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2. |
Yes - With School Activity |
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3. No |
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Type of Collision |
C18 |
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1. Rear End
2. Angle
3. Head On
4. Sideswipe – Same Direction
5. Sideswipe – Opposite Direction
6. Fixed Object in Road
7. Train
8.
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 |
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11 |
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1 |
10 |
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2 |
9 |
13 |
3 |
8 |
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4 |
7 |
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5 |
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6 |
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Veh Dir of Travel
VEHICLE #
Fill In Impact Area(s). Initial Impact.
|
12 |
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11 |
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1 |
10 |
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2 |
9 |
13 |
3 |
8 |
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4 |
7 |
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5 |
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6 |
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Veh Dir of Travel
CRASH DIAGRAM
Indicate North by Arrow
VEHICLE #
Fill In Impact Area(s). Initial Impact.
|
12 |
|
11 |
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1 |
10 |
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2 |
9 |
13 |
3 |
8 |
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4 |
7 |
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5 |
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6 |
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Veh Dir of Travel
VEHICLE #
Fill In Impact Area(s). Initial Impact.
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12 |
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11 |
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1 |
10 |
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2 |
9 |
13 |
3 |
8 |
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4 |
7 |
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5 |
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6 |
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Veh Dir of Travel
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 |
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Vehicle # |
First Event |
Second Event |
Third Event |
Fourth Event |
Most Harmful Event |
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Vehicle # |
First Event |
Second Event |
Third Event |
Fourth Event |
Most Harmful Event |
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Vehicle # |
First Event |
Second Event |
Third Event |
Fourth Event |
Most Harmful Event |
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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 |
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Culvert, etc. |
17. |
Traffic Sign Support |
8. |
Sign, Traffic Signal |
18. |
Mailbox |
9. Impact Cushioning Device
COLLISION WITH PERSON, MOTOR VEHICLE |
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OR |
24. Work Zone |
28. Ran Off Road |
35. Cross Median |
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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 |
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34. |
Separation of Units |
41. |
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42. |
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
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 |
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An injury: any person(s) injured as a |
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A |
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vehicle (truck, bus, car, etc.) involved in the crash or |
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OR |
result of the crash who immediately |
OR |
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bus, car, etc.) disabled as a result of the |
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who dies within 30 days of the crash as a result of |
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receives medical treatment away from |
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crash and transported away from the |
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an injury sustained in the crash |
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the crash scene |
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scene by a tow truck or other vehicle |
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VEHICLE # |
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Vehicle Configuration |
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V10 |
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Cargo Body Type |
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V11 |
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License P8 |
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Commercial |
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P9 |
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1. |
Passenger Car (Only if Vehicle Has Hazardous Materials Placard) |
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1. Bus (Seats |
10. Grain/Chips/Gravel |
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Class |
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Endorsement |
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2. |
Light Truck (Only if Vehicle Has Hazardous Materials Placard) |
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Including Driver) |
11. |
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Class A |
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3. |
Bus (Seats |
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2. Bus (Seats For 16 People or |
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12. Vehicle Towing Another |
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Class B |
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4. |
Bus (Seats for 16 People or More, Including Driver) |
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More, Including Driver) |
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Motor Vehicle |
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Class C |
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3. Van/Enclosed Box |
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5. |
Single Unit Truck (2 Axles, 6 Tires) |
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13. Intermodel Container |
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Class DRL |
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4. Cargo Tank |
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6. |
Single Unit Truck (3 or More Axles) |
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Chassis |
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(regular |
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Placarded for |
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5. Flatbed |
14. Logging |
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7. |
Truck Trailer(s) |
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drivers |
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Hazardous Materials |
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8. Truck Tractor (Bobtail) |
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6. Dump |
15. ther Cargo Body |
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license) |
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Class M |
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9. |
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7. Concrete Mixer |
(Not Listed Above) |
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8. Auto Transporter |
16. Not Applicable/ |
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10. Tractor/Doubles (Two Trailers) |
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11. Other Truck Greater Than 10,000 lbs. (Not Listed Above) |
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9. Garbage/Refuse |
No |
argo Body |
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GVWR/ V12 |
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1. 10,000 lbs. or Less |
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GCWR |
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2. |
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Hazardous Material |
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3. Greater Than 26,000 lbs. |
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Hazardous Material Placard: Y |
N |
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HM |
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HM Placard Name |
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HM Class |
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HM Cargo Present |
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HM Cargo Released |
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Y |
N |
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N |
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Carrier |
Identification |
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Commercial Motor Carrier Name |
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Address (P.O. Box if No Street Address) |
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Carrier’s ID |
Number |
State (Intrastate Only) |
City |
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Zip |
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US DOT# |
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1. Interstate Carrier
2. Intrastate Carrier
3. Not in
VEHICLE #
Vehicle Configuration |
V10 |
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Cargo Body Type |
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V11 |
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License |
P8 |
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Commercial |
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P9 |
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1. |
Passenger Car (Only if Vehicle Has Hazardous Materials Placard) |
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1. Bus (Seats |
10. Grain/Chips/Gravel |
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Class |
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Endorsement |
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2. |
Light Truck (Only if Vehicle Has Hazardous Materials Placard) |
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Including Driver) |
11. |
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Class A |
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3. |
Bus (Seats |
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2. Bus (Seats For 16 People or |
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12. Vehicle Towing Another |
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Class B |
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More, Including Driver) |
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4. |
Bus (Seats for 16 People or More, Including Driver) |
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Motor Vehicle |
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Class C |
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3. Van/Enclosed Box |
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5. |
Single Unit Truck (2 Axles, 6 Tires) |
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13. Intermodel Container |
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Class DRL |
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4. Cargo Tank |
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6. |
Single Unit Truck (3 or More Axles) |
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Chassis |
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(regular |
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Placarded for |
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5. Flatbed |
14. Logging |
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7. |
Truck Trailer(s) |
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drivers |
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Hazardous Materials |
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6. Dump |
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license) |
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8. |
Truck Tractor (Bobtail) |
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15. Other Cargo Body |
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Class M |
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7. Concrete Mixer |
(Not Listed Above) |
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9. |
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8. Auto Transporter |
16. Not Applicable/ |
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10. Tractor/Doubles (Two Trailers) |
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9. Garbage/Refuse |
No Cargo Body |
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GVWR/ V12 |
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1. 10,000 lbs. or Less |
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11. Other Truck Greater Than 10,000 lbs. (Not Listed Above) |
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GCWR |
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2. |
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Hazardous Material |
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3. Greater Than 26,000 lbs. |
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Hazardous Material Placard: Y |
N |
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HM |
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HM Placard Name |
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HM Class |
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HM Cargo Present |
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HM Cargo Released |
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Y |
N |
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Y |
N |
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Carrier |
Identification |
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Commercial Motor Carrier Name |
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Address (P.O. Box if No Street Address) |
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Carrier’s ID |
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US DOT# |
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1. Interstate Carrier
2. Intrastate Carrier
3. Not in
Officer Initials________ Badge # __________ |
Commonwealth of Virginia • Department of Motor Vehicles |
FR300P (Rev 1/12) |
Revised Report |
Police Crash Report |
Page _______ of _______ |
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CRASH
Crash MM DD YYYY Date
MILITARY Time (24 hr clock)
County of Crash
City of Town of
Local Case Number
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PEDESTRIAN # |
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Injured |
Name of Injured (Last, First, Middle) |
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Driver’s License # |
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EMS Transport |
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PEDESTRIAN # |
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Injured |
Name of Injured (Last, First, Middle) |
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Driver’s License # |
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EMS Transport |
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Ped # |
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Ped # |
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Ped # |
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Ped # |
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Ped # |
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Ped # |
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Ped # |
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Ped # |
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N/A |
N/A |
Pedestrian Actions |
P10 |
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1. |
Crossing At Intersection |
11. Hitching On Vehicle |
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With Signal |
12. Walking In Roadway |
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2. |
Crossing At Intersection |
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With Traffic – Sidewalks |
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Against Signal |
Available |
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3. |
Crossing At Intersection |
13. Walking In Roadway |
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No Signal |
With Traffic – Sidewalks |
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4. |
Crossing At Intersection |
Not Available |
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Diagonally |
14. Walking In Roadway |
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5. |
Crossing Not At |
Against Traffic |
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Intersection – Rural |
– Sidewalks Available |
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6. Crossing Not At |
15. Walking In Roadway |
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Intersection – Urban |
Against Traffic – Side |
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7. Coming From Behind |
Walks Not Available |
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16. Working In Roadway |
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Parked Cars |
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8. Getting Off Or On |
17. Standing In Roadway |
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School Bus |
18. Lying In Roadway |
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9. Playing In Roadway |
19. Not In Roadway |
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10. Getting Off Or On |
20. Other |
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Another Vehicle |
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N/A N/A Pedestrian Drinking P11
1. Had Not Been Drinking
2.
3. Drinking
4. Drinking
5. Drinking
Whether Impaired
N/A N/A Condition of |
P12 |
Pedestrian |
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ontributing |
to |
the rash |
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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 |
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Alcohol |
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Determination |
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by Police |
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1. |
Blood |
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2. |
Breath |
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3. |
Refused |
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4. |
No Test |
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N/A |
N/A |
Pedestrian Drug Use P14 |
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1. |
Yes |
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2. No |
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3. Unknown |
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N/A |
N/A |
Pedestrian Wear |
P15 |
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Reflective Clothing |
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1. |
Yes |
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2. No
Use sections below for additional passengers.
VEHICLE #
PASSENGER (only if injured or killed)
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
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Date of Death |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
Birthdate |
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Gender |
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In/On |
Equip |
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Vehicle |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
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Date of Death |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
Birthdate |
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Gender |
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In/On |
Equip |
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YYYY |
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Vehicle |
Used |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
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Date of Death |
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Y |
N |
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MM |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
Birthdate |
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Gender |
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In/On |
Equip |
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MM |
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DD |
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YYYY |
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F |
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Vehicle |
Used |
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VEHICLE #
PASSENGER (only if injured or killed)
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
Date of Death |
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Injured |
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Y |
N |
MM |
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YY |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
Birthdate |
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Gender |
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In/On |
Equip |
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M |
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F |
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Vehicle |
Used |
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MM |
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YYYY |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
Date of Death |
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InjuredPosition |
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Y |
N |
MM |
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DD |
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YY |
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Safety |
Airbag |
Ejected |
Injury Type |
Birthdate |
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Gender |
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In/On |
Equip |
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M |
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F |
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Vehicle |
Used |
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MM |
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DD |
YYYY |
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Name of Injured |
(Last, First, Middle) |
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EMS Transport |
Date of Death |
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Y |
N |
MM |
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DD |
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YY |
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Position |
Safety |
Airbag |
Ejected |
Injury Type |
Birthdate |
YYYY |
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Gender |
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InjuredVehicle |
Used |
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MM |
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DD |
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In/On |
Equip |
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M |
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F |
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Codes
8
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1 |
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2 |
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3 |
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4 |
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6 |
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5 |
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8 |
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7 |
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8 |
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POSITION IN/ON VEHICLE
1.Driver
7.Cargo Area
8.Riding/Hanging
8On Outside
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