Wisconsin Accident Form – Fill Out and Use This PDF

The Wisconsin Driver Report of Accident form, also known as form MV4002, is a vital document for drivers involved in an incident that meets specific criteria, including property damage of $1,000 or more, any injury, or government property damage of $200 or more. Drivers must complete this form, providing detailed information about the accident, unless a law enforcement officer has already filed a report. It serves as a crucial record for the Wisconsin Department of Transportation and aids in processing insurance claims and potential legal issues. Ensure your compliance and ease your post-accident process by filling out the form through the button below.

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Wisconsin Accident Form PDF Details

When residents of Wisconsin find themselves in the aftermath of a vehicular accident, the Wisconsin Driver Report of Accident form becomes a crucial document. It serves as a self-reported account of the incident, but its completion comes with specific criteria. This form is necessary only if a law enforcement officer hasn't already filed a report and the accident results in either $1000 or more damage to any single person's property, any injury regardless of severity, or at least $200 worth of damage to government property excluding vehicles. Its comprehensive nature demands detailed information from involved parties, including personal details, insurance information, a narrative, and even a diagram of the accident. Ensuring all fields are accurately filled is vital, as incomplete reports may be rejected, delaying processing times and possibly complicating insurance claims. The form, identified by its code MV4002 and revised in March 2014, underscores the Wisconsin Department of Transportation's commitment to streamlined accident reporting procedures, emphasizing the importance of prompt, clear communication following vehicular accidents. Whether for record-keeping, insurance purposes, or assisting with any subsequent legal issues, this form stands as a vital step in the post-accident process for drivers across Wisconsin.

Question	Answer
Form Name	Wisconsin Accident Form
Form Length	2 pages
Fillable?	Yes
Fillable fields	60
Avg. time to fill out	10 min
Other names	dot report accident, Wisconsin gov crash reporting, self accident report Wisconsin, Wisconsin dot accident

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Wisconsin

DRIVER REPORT OF ACCIDENT

DO NOT COMPLETE this Driver Report of Accident if a law enforcement officer completed a Wisconsin Motor Vehicle Accident Report.

COMPLETE this Wisconsin Driver Report of Accident if:

•There was $1000 or more damage to any one person’s property

•

— OR — Anyone was injured

— OR —

There was $200 or more damage to government property, other than vehicles.

MV4002 3/2014 s.346.70(2) Wis. Stats.

Wisconsin Department of Transportation

Please provide all requested information. Print clearly.

1.You are “Unit 1”.

2.An individual involved in the accident must sign the report.

3.Provide all information on the other driver(s)/owner(s) involved. Incomplete reports may be returned requesting missing information. If you need assistance, contact your insurance agent, local law enforcement agency, or Wisconsin Department of Transportation (WisDOT) at: (608) 266-8753.

4.Use the “Narrative” and “Diagram” sections to explain how the accident happened.

5.If more space is needed, use plain paper and attach to this report.

6.This form is available at: www.dot.wisconsin.gov/drivers/drivers/traffic/accident.htm

Retain a copy of this report for your records before mailing.

Mail completed report to address shown below.

(Fold report so that address panel shows to outside – tape bottom edge closed and mail – Do not staple)

Important – Please print your return address:

TRAFFIC ACCIDENT SECTION

WISCONSIN DEPT OF TRANSPORTATION

PO BOX 7919

MADISON WI 53707-7919

______

PLACE STAMP HERE

______

Clear Form

WISCONSIN

DRIVER REPORT

CONTINUE ONLY ...if there was $1000 or more damage to any one person’s property,

OF ACCIDENT

OR ...if anyone was injured,

OR ...if there was $200 or more damage to government property, other than vehicles.

(See instructions on reverse side

before completing – Please Print)

Hit and Run Accident?

ACCIDENT

County of

City, Village or Township of

ACCIDENT Month

Day

Year

Day of Week

Time

 a.m.

 YES

DATE

 p.m.

Total Units Involved

Total Injured *

LOCATION

Name and Number of Street(s) or Highway or Parking Lot

TYPE OF

(Please check one)

 Hit another motor

 Hit a parked vehicle

 Hit a deer

 Hit a bicyclist

 Other

ACCIDENT

1 vehicle in operation

4/5 or pedestrian

U Driver Full Name (Last, First, MI)

Sex

U Driver Full Name (Last, First, MI)

Sex

Address

Birth Date

Address

Birth Date

City, State

ZIP Code

Daytime Telephone Number

City, State

ZIP Code

Daytime Telephone Number

(

)

(

)

1 Driver License Number

Issuing State

2 Driver License Number

Issuing State

Vehicle Legally Parked

Operating a commercial vehicle?

If yes, check

Vehicle Legally Parked

Operating a commercial vehicle?

If yes, check

 YES

appropriate classification

 YES

appropriate classification

 A  B  C

Owner Full Name (Last, First, MI)

Address

City, State

ZIP Code

Daytime Telephone Number

City, State

ZIP Code

Daytime Telephone Number

(

)

(

)

License Plate Number

Exp Yr

Issuing State

Vehicle Make

Year

Color

License Plate Number

Exp Yr

Issuing State

Vehicle Make

Year

Color

Vehicle Identification Number

Was a motor vehicle liability insurance policy

Policy Holder’s Name

Was a motor vehicle liability insurance policy

Policy Holder’s Name

in effect on the day of the accident?

 YES  NO

 YES

 NO

Exact Name of Insurance Company

*INJURED Important:

Number of injuries reported must equal number entered in “Total Injured” box above.

For additional injuries, provide the information on a separate piece of paper and attach. Injury Codes: A=Severe, B=Moderate, C=Minor

Unit No.

Name (Last, First, MI)

Address

City, State

ZIP Code

Sex

Birth Date

Injury Code

Unit No.

Name (Last, First, MI)

Address

City, State

ZIP Code

Sex

Birth Date

Injury Code

VEHICLE Unit 1 Important: Circle the numbers closest to the damaged areas.

Unit 2 Important: Circle the numbers closest to the damaged areas.

DAMAGE Damage Estimate

Damage Estimate

(Required)

REAR

FRONT

(If Known)

REAR

FRONT

$______________

PROPERTY Describe what was damaged. Property damage includes structures, trees, fences, towed items, etc. Do NOT include vehicle damage.

DAMAGE

Property Owner Full Name (Last, First, MI)

Address

City, State

ZIP Code

Daytime Telephone Number

(

)

NARRATIVE Print a brief description of the accident.

DIAGRAM Draw a basic picture of

Indicate NORTH by putting

the accident and location.

an arrow in the circle.

(Signature Required)

How to Edit Wisconsin Accident Form Online for Free

This Wisconsin Accident Form is used when no law enforcement officer is present to file a report and is required under significant property damage, injuries, or damage to government property. Below is a guide on how to correctly fill out this document.

1. Determine Eligibility

First, ensure no law enforcement officer has completed a report on the accident. You do not need to complete this form if an officer has filed a report. Otherwise, proceed if at least $1000 in damage to someone's property, any injury occurred, or $200 or more damage to government property.

step 1 to writing wi dot accident report

2. Fill Out Your Information

As "Unit 1", provide all your details, including your full name, address, birth date, driver's license number, and contact information. If you own the vehicle, ensure that your vehicle's information, such as the license plate and vehicle identification numbers, are accurately recorded.

3. Provide Other Driver's Information

Include complete information for the other driver or property owner involved in the accident, referred to as "Unit 2". This includes their name, address, contact information, and details about their vehicle and insurance, if applicable.

wi dot accident report CONTINUE ONLY if there was or, City Village or Township of, County of, Month, ACCIDENT DATE, ACCIDENT, WISCONSIN DRIVER REPORT OF, Day of Week, Year, Total Units Involved, Total Injured, LOCATION, Name and Number of Streets or, TYPE OF ACCIDENT, and Please check one fields to complete

4. Describe the Accident

Use the "Narrative" section to describe how the accident occurred. Be detailed in your explanation to ensure a clear understanding of the events. Additionally, a diagram of the designated area should be drawn to represent the accident scene. Include arrows to indicate directions and positions of the vehicles or properties involved.

5. Document Damage and Injuries

Detail any property damage and list injuries according to severity as categorized by codes A (Severe), B (Moderate), or C (Minor). If the space is insufficient, attach additional sheets of plain paper to accommodate all necessary information.

Filling in wi dot accident report step 3

6. Verify Insurance Information

Confirm whether a car insurance policy was in effect during the accident. Provide the insurance company's name and the policyholder's name.

7. Review and Sign

Review the form to ensure all information is complete and accurate. Sign the form as required. It confirms that you have provided truthful and complete information to the best of your knowledge.

Finishing wi dot accident report stage 4

8. Mail the Form

Fold the report so that the address panel shows on the outside. Secure the bottom edge with tape (do not use staples) and mail it to the address provided on the form. Retain a copy of this report for your records.

Wisconsin Accident Form – Fill Out and Use This PDF

Wisconsin Accident Form PDF Details

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