How To Wi Report Accident Details

If you have been in an accident in the state of Wisconsin, it is important to know about the Wisconsin accident form. This document is used to report accidents and collect information about them. Filling out the form correctly can help ensure that your case proceeds smoothly. Here are some tips on how to complete the form correctly.

Below is some information that may be beneficial in case you're aiming to learn how much time it'll require you to fill out wisconsin accident form and how many PDF pages it includes.

QuestionAnswer
Form NameWisconsin Accident Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform report accident, wisconsin driver report accident, self accident report wisconsin, how to wi report accident

Form Preview Example

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

 

 

 

2

 

 

 

 

 

3

 

 

 

 

4/5 or pedestrian

 

 

 

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U Driver Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

 

U Driver Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

 

NI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth Date

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth Date

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

YES

 

 

 

 

 

 

appropriate classification

 

 

 

YES

 

 

 

YES

 

 

 

 

 

appropriate classification

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A B C

 

 

 

 

 

 

 

 

 

 

 

 

A B C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

in effect on the day of the accident?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exact Name of Insurance Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

6

 

 

 

7

8

 

 

 

 

 

 

 

Damage Estimate

 

6

7

8

 

 

 

 

 

 

 

 

 

 

 

 

(Required)

5

REAR

 

 

 

 

 

 

 

 

 

FRONT

 

1

 

 

 

 

 

(If Known)

5

REAR

 

 

 

 

 

 

FRONT

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

3

2

 

 

 

 

 

 

 

4

3

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

 

X

(Signature Required)

Print