Homepage Fill Out Your Ma Vehicle Accident Report Form
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The Massachusetts Vehicle Accident Report Form serves a critical role in documenting motor vehicle crashes throughout the Commonwealth. This form is mandated by state law, specifically M.G.L. Chapter 90, Section 26, and is essential for operators involved in accidents resulting in injuries, fatalities, or property damage exceeding $1,000. Upon completion, the form must be submitted to the Registrar within five days following the crash. This report is not only a legal requirement but serves as an official record that may be used for insurance claims, legal proceedings, or further investigations. Various sections within the form require detailed information, including the crash location, the vehicles involved, and the individuals present at the time of the incident. Overall, the completion of the form must be precise, as inaccurate or illegible submissions may be returned for correction. Operators are advised to provide comprehensive information about crash conditions, witness details, and non-motorists involved, if applicable. Importantly, failing to submit the report may lead to penalties, including the suspension of one’s driver’s license. This requirement underscores the form's significance in promoting accountability and transparency in roadway safety matters.

Ma Vehicle Accident Report Example

Commonwealth of Massachusetts

Motor Vehicle Crash Operator Report

When should I complete a Crash Report?

M.G.L. Chapter 90, Section 26 requires a person who was operating a motor vehicle involved in a crash in which (i) any person was killed or (ii) injured or (iii) in which there was damage in excess of $1,000 to any one vehicle or other property, to complete and file a Crash Operator Report with the Registrar within five (5) days after such crash (unless the person is physically incapable of doing so due to incapacity). The person completing the report must also send a copy of the report to the police department having jurisdiction on the way where the crash occurred. If the operator is incapacitated but is not the vehicle’s owner, the owner is required to file the crash report within the five (5) days based on his/her knowledge and information obtained about the crash. The Registrar may require the owner or operator to supplement the report and he/ she can revoke or suspend the license of any person violating any provision of this legal requirement. A police department is required to accept a report filed by an owner or operator whose vehicle has been damaged in a crash in which another person unlawfully left the scene even if damage to the vehicle does not exceed $1,000.

How To Complete This Form

Please carefully complete all sections of this form that apply to your crash, circling the answer where appropriate. Illegible reports will be returned to you.

Section A: Crash Location

Provide the city/town where the crash occurred, the date and time of the crash, and the number of vehicles involved.

Complete section A1 or A2.

Use official names of all locations, streets and landmarks.

Use street name and route #, if applicable.

Be as precise as possible when describing the location.

Provide enough information to locate the crash to a specific point, not just a street or roadway.

Section B: Vehicle Yon Were Driving

Provide information on your license and the vehicle you were driving.

Use the codes provided to indicate the cause of the crash.

Section C: You and Your Passengers

Provide information on you and your passengers at the time of the crash.

Use the codes provided to indicate occupant information.

Section D: Other Vehicles Involved in the Crash

Provide information on the other vehicle(s) and operator(s) involved in the crash.

If more than one vehicle involved, please use additional form completing Section D only.

Section E: Non-Motorist(s) Involved

Provide information on the non-motorist(s) involved in the crash.

If more than one non-motorist involved, please use additional form completing Section E only.

Section F: Crash Conditions

Use the codes provided to indicate the conditions at the time of the crash.

Section G: Crash Diagram

Draw a diagram of how the crash occurred.

On the diagram, Vehicle 1 represents your vehicle.

Section H: Witness Information

List all the people who saw the crash but were not involved.

Section I: Property Damage Information

Indicate all non-vehicular property that was damaged in the crash.

Section J: Description of What Happened

Describe the crash including events prior to the crash for your vehicles and all other vehicles.

Section K: Signature

Please sign and print your name and indicate the date you completed the form.

Where to send completed reports:

Mail or deliver one copy to the local police department or state police in the city or town where the crash occurred.

Mail one copy to your Insurance Company.

Mail one copy to the RMV at the following address:

Registry of Motor Vehicles Crash Records

P.O. Box 55889 Boston, MA 02205-5889

CRASH102_1119

A. Crash Location

A1. City/Town Where Crash Occurred

 

A2. Date of Crash

 

 

 

 

A3. Time of Crash

 

 

AM

A4. # Vehicles Involved:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please complete Section A1 or A2 below to indicate the location of the crash. If you need

 

A5. Did the crash occur at an

 

Yes

No

additional space to describe the crash location, please use Section J on the last page of this form.

intersection of two or more streets?

 

 

 

 

 

 

 

If Yes.

Step 1. Please indicate the route or roadway where

If No.

 

Step 1. Please

indicate the route, roadway and address where the

 

you were travelling when the crash occurred:

 

crash occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

at Street or Address Number:

 

 

 

 

 

 

 

 

 

 

 

 

The crash occurred on Route #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

on the Street/Roadway known as

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 2. What was the name (or names) of the intersecting streets?

Step 2. Please provide as much of the following specific location information as possible:

 

 

 

 

 

 

 

 

The crash occurred

 

 

 

(indicate direction as N/S/E/W)

 

 

 

 

 

 

 

 

 

 

 

 

 

(estimate number of feet)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of:

a) Mile Marker number

 

 

 

 

 

 

 

 

 

 

OR: b) Exit Number

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR: c) Intersecting

 

 

 

 

 

 

 

Route# Name of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/Roadway

 

 

 

 

 

 

 

Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

OR: d) Landmark

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Vehicle You Were Driving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B1. Number of occupants in vehicle (including yourself):

 

 

B2. Was vehicle damage above $1000?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B3. Driver’s License Number

B4. License State

B5. DOB

 

B6. Age

B7. Sex

 

 

M

 

X

B8. License Class

D

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

 

U

 

Unknown

C

B

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B9. Commercial Driver’s License Endorsements

P (Passenger transport)

T (Doubles/Triples)

H (Hazardous)

X (Tank and Hazardous)

N (Tank vehicles)

S School Bus

B11. Your Full Name (Last, First, Middle)

B12. Street Address

City

B10. Vehicle Travel Direction

N

S

E

W

State

 

 

Zip Code

B13. Insurance Company

B14. Vehicle Registration #

B15. Reg. Type

B16. Reg. State

B17. Vehicle Year

B18. Vehicle Make

B19. Indicate your type of vehicle

4

Bus (16 or more passengers)

9 Truck tractor (bobtail)

1

Passenger car

5

Bus (9-15 passengers)

 

10 Tractor/semi-trailer

2

Light truck (van, mini-van,

 

6

Single-unit truck (2 axles)

11 Tractor/doubles

 

pick-up, sport utility)

 

7

Single-unit truck (3 or more axles)

12 Tractor/triples

 

3

Motorcycle

 

8 Truck/trailer

 

13 Unknown heavy truck

 

 

 

B20. Full Name of Vehicle Owner (Last, First, Middle)

 

 

B21. Street Address

City

 

 

 

 

 

 

 

 

 

 

14 Motor home/ recreational vehicle

15 Moped

16 Low Speed

Vehicle

State

17 All terrain vehicle( ATV)

18Snowmobile

97Other

99Unknown

Zip Code

B22. What Was Your Vehicle Doing Prior to the Crash?

 

5 Changing lanes

 

8 Making U-turn

 

 

11 Parked

1 Travelling straight ahead

3 Turning right

6 Entering traffic lane

 

9 Overtaking/passing

 

97 Other

2 Slowing or stopped

 

 

4 Turning left

 

 

 

 

7 Leaving traffic lane

 

10 Backing

 

 

 

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B23. Please Indicate the Sequence of Events as they occurred to YOUR Vehicle

What happened first?

Second?

 

Third?

 

Fourth?

by writing the corresponding number (1-52, or 97, 99) in up to 4 boxes below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Collision with

9

Railway vehicle

 

25

Median barrier

32 Crash cushion/

Non-Collision

 

47

Jackknife

1 Motor vehicle in traffic

10

(train, engine)

 

26

Ditch

Impact attenuator

40 Ran off road right

48

Cargo/equipment loss

2 Parked motor vehicle

Other movable object

27

Embankment/

33 Bridge

41 Ran off road left

 

 

or shift

3 Pedestrian

11

Unknown movable

 

Sloping shoulder

34 Bridge overhead

42 Cross median/

 

49

Separation of units

4 Cyclist

 

object

 

28

Highway traffic

structure

 

centerline

 

50

Downhill runaway

5 Animal- deer

20

Curb

 

 

signpost

35 Other fixed

43 Overturn/rollover

51

Other non-collision

21

Tree

 

29

Overhead sign

object (wall,

44 Equipment failure

6 Animal- other

 

building, tunnel)

52

Unknown non-collision

22

Utility pole

 

 

support

36 Unknown fixed

 

(blown tire, brakes,

7 Moped

 

30

Fence

 

etc)

 

97

Other

23

Light pole or other

 

 

8 Work zone

31

Mailbox

object

45 Fire/explosion

 

99

Unknown

 

post/support

 

 

 

 

maintenance

24

Guardrail

 

 

 

 

 

46 Immersion

 

 

 

 

equipment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B24. Was your

 

 

Vehicle Towed

Yes

No

from the Scene

 

 

Due to Damage?

 

 

B25. Vehicle Damaged Area (check up to three)

2

3

4

 

 

 

0 None

97 Other

1

9

5

10 Undercarriage

99 Unknown

 

 

 

11 Totaled

 

8

7

6

 

 

CRASH102_1119

C. You and Your Passengers

Please provide the full name, address, and DOB or Age for all passengers in your vehicle. Then write the

corresponding code in each of the boxes for each occupant of the vehicle (yourself and all passengers). A

 

list of the possible codes is provided at the bottom of this section.

C1. Passenger 1 (Last, First, Middle)

C2. Address

City

 

State

Zip Code

C3. DOB

C4. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C5. Passenger 2 (Last, First, Middle)

C6. Address

City

 

State

Zip Code

C7. DOB

C8. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C9. Passenger 3 (Last, First, Middle)

C10. Address

City

 

State

Zip Code

C11. DOB

C12. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seating

Safety

Air Bag

 

Ejected

 

 

 

 

Transported

Name of Medical

 

System

 

From

 

 

 

 

for Medical

 

Position

Used

Status

 

Vehicle?

Trapped?

 

Injured?

Care?

 

Facility

 

Driver

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seating Position

 

 

1

Front seat - left side (or

8

Third row - middle

 

motorcycle driver)

9

Third row - right side

2

Front seat - middle

10

Sleeper section of cab

3

Front seat - right side

11

Enclosed passenger area

4

Second seat - left side (or

12

Unenclosed passenger area

 

motorcycle passenger)

5

Second seat - middle

13

Trailing unit

14

Riding on vehicle exterior

6

Second seat - right side

97

Other

7

Third row - left side (or

Safety System Used

0None used

1Shoulder and lap belt

2Lap belt only

3Shoulder belt only

4Child safety seat

5Helmet

97Unknown

Air Bag Status

1Deployed-front

2Deployed-side

3Deployed both front and side

4Not deployed

5Not applicable

97Unknown

 

motorcycle passenger)

 

99 Unknown

 

 

Ejected From Vehicle?

 

Trapped?

 

 

0

Not ejected

3

Not

0

Not trapped

2

Freed by

1

Totally ejected

 

applicable

1

Freed by

 

non-mechanical

97

 

 

means

2

Partially ejected

Unknown

 

mechanical

 

 

97

Unknown

 

 

 

 

 

means

Injured?

Transported for Medical Care?

1

Fatal

1

Not transported

3

Police

7

Suspected serious injury

2

EMS

97

Other

8

Suspected minor injury

 

(emergency

99

Unknown

9

Possible Injury

 

service)

10

No apparent injury

 

 

 

 

D. Other Vehicle(s) Involved in the Crash

 

D1. Number of occupants

 

D2. Number of

 

 

 

 

D3. Was Vehicle

Yes

No

 

D4. Moped?

 

D5. Hit and Run?

 

in the Vehicle:

 

 

injured occupants

 

 

 

Damage above $1000?

 

Yes

 

No

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D6. Driver’s License Number

 

 

D7. License State

D8. DOB

 

D9. Age

D10. Sex

M

X

D11. License Class

D

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

U

 

Unknown

 

C

B

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D12. Commercial Driver’s License Endorsements

P (Passenger transport)

 

T (Doubles/Triples)

 

D13. Vehicle Travel Direction

 

 

 

H (Hazardous)

X (Tank and Hazardous)

N (Tank vehicles)

 

 

 

S School Bus

 

 

 

N

S

 

E

W

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D14. Name of Vehicle Driver (Last, First, Middle)

 

 

 

D15. Street Address

 

City

 

 

State

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D16. Insurance Company

 

D17. Vehicle Registration #

 

D18. Reg. Type

D19. Reg. State

D20. Vehicle Year

 

D21. Vehicle Make

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D22. Indicate your type of vehicle

4 Bus (16 or more passengers)

 

 

9 Truck tractor (bobtail)

14 Motor home/

 

 

17 All terrain

 

1 Passenger car

 

 

5 Bus (9-15 passengers)

 

 

10 Tractor/semi-trailer

recreational vehicle

vehicle( ATV)

 

2 Light truck (van, mini-van,

 

 

15 Moped

 

 

 

 

18 Snowmobile

 

6 Single-unit truck (2 axles)

 

 

11 Tractor/doubles

 

 

 

 

 

 

pick-up, sport utility)

 

 

 

 

16 Low Speed

 

 

 

 

97 Other

 

 

7 Single-unit truck (3 or more axles)

 

 

12 Tractor/triples

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 Motorcycle

 

 

 

 

 

 

Vehicle

 

 

 

 

99 Unknown

 

 

 

8 Truck/trailer

 

 

 

 

 

 

 

 

13 Unknown heavy truck

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D23. Full Name of Vehicle Owner (Last, First, Middle)

 

 

D24. Street Address

 

City

 

 

State

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D25. What Was Your Vehicle Doing Prior to the Crash?

 

 

 

 

 

 

 

 

D26. Vehicle Damaged Area (check up to three)

0 None

 

 

 

1 Travelling straight

 

5 Changing lanes

 

9 Overtaking/passing

 

2

 

 

3

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 Undercarriage

 

ahead

 

6 Entering traffic lane

 

10 Backing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 Slowing or stopped

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11 Totaled

 

 

 

7 Leaving traffic lane

 

11 Parked

 

 

 

1

 

 

9

 

5

 

 

 

 

 

 

 

3 Turning right

 

 

 

 

 

 

 

 

 

 

 

 

97 Other

 

 

 

 

8 Making U-turn

 

97 Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 Turning left

 

 

 

 

 

8

 

 

7

 

6

 

 

 

 

99 Unknown

 

 

 

 

 

 

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CRASH102_1119

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Non-Motorist(s) Involved in the Crash

 

E1. Indicate the type of non-motorist involved

1 Pedestrian

2 Cyclist

 

3 Skater

 

97 Other

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

E2. What was the non-motorist doing prior to the crash?

E3. Where was the non-motorist prior to the crash?

 

 

 

 

 

1 Entering or crossing

4

Pushing vehicle

 

97 Other

1 Marked crosswalk

4

In roadway

 

8

Shoulder

 

location

5

Approaching or

 

99 Unknown

 

at intersection

 

5

Not in roadway

 

9

Sidewalk

 

2 Walking, running, or

 

2 At intersection but

 

 

 

leaving vehicle

 

 

 

6

Median (but not on

10

Shared-use

 

cycling

6

Working on vehicle

 

no crosswalk

 

 

 

 

 

shoulder)

 

 

path or trails

 

3 Working

3 Non-intersection

 

 

 

 

 

7 Standing

 

 

 

 

7

Island

 

99

Unknown

 

 

 

 

 

 

crosswalk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E4. Full Name of Non-Motorist (Last, First, Middle)

 

 

E5. Street Address

City

 

 

State Zip Code

 

E6. DOB

 

E7. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E8. Safety Equipment?

8

Reflective clothing

 

E9. Injured?

8

Suspected

 

10 No

 

E10. Transported for Medical Care?

 

0 None used

9

Lighting

 

1 Fatal

 

 

1 Not transported

3

Police

 

6 Helmet

 

7 Suspected

 

minor injury

 

apparent

2 EMS (emergency

97 Other

 

10

Other

 

9

Possible

 

 

injury

 

 

7 Protective pads

 

 

serious

 

 

 

service)

 

 

99 Unknown

 

99

Unknown

 

 

injury

 

Injury

 

 

 

 

 

 

 

 

 

(elbows, knees, etc.)

 

E11. If transported, please indicate Hospital/Medical Facility:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F. Crash Conditions

F1. Light Conditions

97Other

1 Daylight

2 Dawn

99Unknown

3 Dusk

 

4 Dark - lighted

 

roadway

 

5 Dark - roadway not lighted

6 Dark - unknown roadway lighting

F2. Weather Conditions (up to two)

1 Clear

7 Severe

2 Cloudy

crosswinds

8 Blowing

3 Rain

sand, snow

4 Snow

97 Other

5 Sleet, hail,

99 Unknown

freezing

 

rain

 

6 Fog, smog,

 

smoke

 

F3. Traffic Control Device

1 No controls

2 Stop signs

3 Traffic control signal

4 Flashing traffic control signal

5 Yield signs

6 School zone signs

7 Warning signs

8 Railroad crossing device

99 Unknown

F4. Road Surface

1 Dry

2 Wet

3 Snow

4 Ice

5 Sand, mud, dirt, oil, gravel

6 Water (standing, moving)

7 Slush

97 Other

99 Unknown

F5. Trafficway Description

 

 

F6. Manner of Collision

 

 

6 Head on

F7. Roadway Intersection Type

 

 

 

1 Two-way, not divided

 

 

1 Single vehicle crash

 

1 Not at intersection

 

7 Traffic circle

 

 

2 Two-way, divided, unprotected median

 

2 Rear-end

7 Rear to rear

 

2 Four-way intersection

 

8 Five-point or more

 

3 Two-way, divided, protected median

 

3 Angle

 

 

 

 

 

99 Unknown

 

3 T-intersection

 

9 Driveway

 

 

4 One-way, not divided

 

 

4 Sideswipe, same

 

 

 

 

4 Y-intersection

 

10 Railway grade

 

99 Unknown

 

 

direction

 

 

 

 

5 On ramp

 

crossing

 

 

 

5 Sideswipe, opposite

 

 

 

 

 

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6 Off ramp

 

 

 

 

 

 

 

 

 

 

 

direction

 

 

 

 

 

 

 

 

F8. Was the traffic control device

Yes

No

 

F9. School Bus Related?

Yes

No

F10. Work Zone Related?

Yes

No

functioning at the time of the crash?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. Crash Diagram

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Indicate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

North by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Arrow

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please draw a diagram of the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

roadway or streets where the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

crash occurred, indicating the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

vehicles involved and direction of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

travel using the following symbols:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Direction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= Vehicle 1 (Your Vehicle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= Vehicle 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= Pedestrian/Non-motorist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= North

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select one of the following if the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

crash did not occur on a public

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

way:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Off-street parking lot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Garage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mall/shopping center

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other private way

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CRASH102_1119

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H. Witness Information

H1. Witness Name (Last, First, Middle)

H2. Street Address

City

State

Zip Code

H3. Phone

H4. Witness Name (Last, First, Middle)

H5. Street Address

City

State

Zip Code

H6. Phone

I. Property Damage Information (Other than Vehicles)

I1.

Owner Name (Last, First, Middle)

I2. Street Address

I3. Phone

I4.

Property and Damage Description

 

 

 

 

 

 

 

 

I5.

Owner Name (Last, First, Middle)

I6. Street Address

I7. Phone

I8.

Property and Damage Description

 

 

 

 

 

 

 

J.

Description of What Happened

 

 

 

 

 

 

 

 

 

 

 

K. Signature

“Signed under Pains and Penalties of Perjury”

 

Print

 

Date

 

 

 

 

 

 

 

CRASH102_1119

Form Characteristics

Fact Name Details
Legal Requirement Massachusetts law, specifically M.G.L. Chapter 90, Section 26, mandates the completion of a Crash Report if there are injuries or damages exceeding $1,000.
Filing Deadline Individuals must file the Crash Operator Report within five days of the accident, unless physically incapacitated.
Police Department Notification A copy of the report must also be sent to the local police department where the crash occurred.
Owner Responsibility If the operator is incapacitated, the vehicle owner is obligated to file the report based on their knowledge of the crash.
Supplementary Reports The Registrar may request further information from the owner or operator, and failure to comply can result in license suspension.
Witness Information Individuals are encouraged to provide details about witnesses to the crash who were not involved.
Diagram Submission A diagram illustrating how the crash occurred is a crucial component of the report, clearly indicating the involved vehicles and their directions.

Guidelines on Utilizing Ma Vehicle Accident Report

If you've been involved in a motor vehicle crash in Massachusetts, it's important to complete the Vehicle Accident Report form accurately and submit it on time. This form captures the details of the incident, which may be necessary for legal, insurance, and safety purposes. Following the steps below will ensure that you provide the necessary information clearly and correctly.

  1. Section A: Crash Location Provide the city or town where the crash occurred, the date and the time. Also, state the number of vehicles involved. Complete either A1 or A2 to describe the exact location, using official names and providing as many details as you can.
  2. Section B: Vehicle You Were Driving Fill in your driver's license number, state, date of birth, age, and sex. Indicate the number of passengers in your vehicle and check if the damage exceeded $1,000.
  3. Section C: You and Your Passengers List your passengers, including their names, addresses, dates of birth, and gender. Use the provided codes to indicate their status during the crash.
  4. Section D: Other Vehicles Involved in the Crash Provide information for each other vehicle and driver involved in the crash. If multiple vehicles are involved, you may need to fill out an additional form.
  5. Section E: Non-Motorist(s) Involved If there were pedestrians, cyclists, or other non-motorists involved, record their details and actions prior to the crash.
  6. Section F: Crash Conditions Use the codes to mark the environmental conditions at the time of the crash, such as weather or lighting.
  7. Section G: Crash Diagram Create a simple sketch of the accident scene with an arrow indicating north. Show the involved vehicles and their directions.
  8. Section H: Witness Information List any witnesses who observed the crash. Include their names, addresses, and phone numbers.
  9. Section I: Property Damage Information Describe any non-vehicle property that was damaged during the crash. List the property owner's name and contact information.
  10. Section J: Description of What Happened Provide a detailed account of the crash, including what led up to the incident.
  11. Section K: Signature Finally, sign your name, print it clearly, and record the date you completed the form.

Once you have filled out the form, make sure to keep copies for your records. Submit one copy to the local police department, another to your insurance company, and a final copy to the Registry of Motor Vehicles at the specified address. Doing so will help ensure that all necessary parties are informed and can act accordingly.

What You Should Know About This Form

1. When should I complete a Crash Report?

According to Massachusetts law, you must complete a Crash Report when you operate a vehicle involved in a crash that results in any injuries or fatalities, or causes damage that exceeds $1,000 to any vehicle or property. You are required to file the report with the Registrar within five days of the incident. If you were incapable of filing due to physical limitations, the vehicle owner must take responsibility to complete and submit the report based on knowledge of the incident.

2. What specific information is needed for the Crash Location section?

In the Crash Location section, you must provide precise details about where the crash took place. This includes the city or town, the exact date and time of the accident, and the total number of vehicles involved. Use official names for streets and landmarks, and include route numbers if applicable. Aim to provide enough detail to locate the crash on a map accurately, going beyond just naming a street.

3. How do I describe the events leading up to the crash?

In Section J, you should provide a detailed narrative of what occurred during the crash. This description should cover events leading up to the collision for all vehicles involved. Summarize actions and movements before the incident, using clear language to help clarify the sequence of events. It's important to be thorough yet concise to ensure accurate reporting.

4. What should I do if I witness the crash but I'm not involved?

If you are a witness to the crash but not an involved party, you can still provide crucial information by completing the Witness Information section of the report. Include the names, addresses, and contact details of all individuals who saw the crash. This can help in corroborating accounts and clarifying the circumstances of the accident.

5. Where do I send the completed Vehicle Accident Report?

After you complete the Vehicle Accident Report, you need to send copies to several locations. First, mail or deliver one copy to the local police department or state police where the crash occurred. Additionally, send another copy to your insurance company. Finally, mail one copy to the Registry of Motor Vehicles (RMV) at the specified address in the instructions to ensure all necessary parties are informed.

6. What happens if I fail to file the Crash Report?

Failing to file the Crash Report as required can result in serious consequences. The Registrar may take action by revoking or suspending your driver’s license if you violate the filing requirements. It is essential to adhere to this legal obligation to avoid penalties and ensure proper documentation of the accident.

Common mistakes

Completing the Massachusetts Vehicle Accident Report form is crucial, but many people make mistakes that can complicate the process. One common mistake is failing to provide detailed crash location information. It's important to give the exact city or town, date, and time of the crash. Using vague descriptions like "on Main Street" instead of a specific intersection can lead to confusion. Always include all relevant details to pinpoint the crash accurately.

Another frequent error involves the vehicle information section. Operators often neglect to verify their license details or provide incorrect codes for the cause of the crash. This can result in further inquiries and delays. Be meticulous here; double-check everything. Make sure your vehicle registration number and description match the actual details of your vehicle.

Many also overlook the section regarding passengers. Providing incomplete information about passengers can lead to issues later on, especially if there are injuries involved. It’s not just about you—the details about everyone in the vehicle matter. Take the time to list everyone accurately with their corresponding information.

Not completing the witness information can also be a pitfall. Witnesses play a significant role in corroborating details of the crash. By omitting this section or providing insufficient information, it can weaken your case. Make sure to collect and record witness names and contact information, as they can offer valuable insights later.

In the crash conditions section, many people fail to note all appropriate details. Indicating the weather conditions, light conditions, and traffic controls at the time of the crash can make a big difference in understanding the scenario. A simple “clear” for weather can change perceptions entirely if it was foggy or raining at the time of the accident.

Some individuals complete the crash diagram section incorrectly or leave it blank. This is a visual representation of the crash and is essential. It guides investigators on how the accident unfolded. Take the time to draw this accurately; even small errors can lead to misunderstandings about the scene.

Finally, signing and dating the report often gets missed. Some people assume this step is obvious, but not providing your signature can render the report incomplete. Remember, your signature affirms the accuracy of the information provided, so don’t forget this important step.

Documents used along the form

When you fill out the Massachusetts Vehicle Accident Report form, a few other documents may also be necessary. These papers help provide clarity and support your report to the authorities, insurance companies, and any legal representatives involved. Here's a list of common forms you might encounter alongside the accident report:

  • Police Report: This document is created by the police at the scene of the accident. It includes details about the crash, involved parties, and any citations issued. This official record can be essential for insurance claims and legal matters.
  • Insurance Claim Form: After an accident, you’ll need to file a claim with your insurance company. This form outlines the damages and injuries sustained, and helps them assess how to proceed with your claim.
  • Medical Reports: If any injuries occurred, medical documentation from hospitals or clinics is crucial. These records detail treatment, diagnosis, and prognosis, providing solid evidence for claims and legal cases.
  • Witness Statements: Statements from people who witnessed the accident can support your account of events. Collecting these statements promptly ensures accuracy and enhances credibility in your report.
  • Damage Estimates: If you're filing a claim, you'll likely need an estimate of repairs for vehicle or property damage. This document helps establish the cost of damages and assists in the claims process.
  • Photos of the Scene: Making a record of the accident scene through photographs can provide visual context. They may depict damage, road conditions, and positioning of vehicles, which can be valuable for investigations.
  • Medical Release Authorization: This allows your insurance company or legal team to access your medical records related to the accident. It ensures them transparency in understanding the injuries claimed.

Each of these documents plays a vital role in ensuring that everything related to the accident is thoroughly documented. Having them organized and ready can make the process smoother and ensures that you are well-prepared for any upcoming procedures.

Similar forms

  • Police Report: Much like the MA Vehicle Accident Report, a police report documents the details of a car accident, including witness statements and police observations. It serves as an official record of the incident.
  • Insurance Claim Form: This form outlines the details of the accident in order to process an insurance claim. Similar to the accident report, it requires detailed information regarding the crash and any damages incurred.
  • Department of Motor Vehicles (DMV) Report: A DMV report also documents accidents involving vehicles, focusing on drivers' information and vehicle particulars. It helps maintain a history of incidents that may affect a driver's record.
  • Medical Report: Medical reports provide documentation of injuries sustained in an accident. They are similar in that they include details necessary for understanding the implications of the crash on health and well-being.
  • Witness Statement Form: This document captures firsthand accounts from individuals who observed the accident. Like the MA Vehicle Accident Report, it seeks to establish facts surrounding the event from various perspectives.
  • Property Damage Assessment Form: This form evaluates the extent of damage caused to property, akin to the property damage information section of the accident report. It details damage assessment necessary for resolving liability issues.

Dos and Don'ts

When filling out the Massachusetts Vehicle Accident Report form, it is crucial to adhere to certain guidelines for the submission to be valid and accurate. Here are five key things to do and avoid during the process:

  • Do: Fill out all applicable sections carefully. Ensure that all information is legible and accurate, as unclear submissions may be rejected.
  • Do: Provide specific details about the crash location, including the city or town, street names, and landmarks to help identify the exact scene of the incident.
  • Do: Include all occupants' information in your vehicle, ensuring their names, addresses, and relevant details are accurately reported.
  • Do: Describe the crash in detail, including events leading up to the incident, and indicate any damage to non-vehicular property involved.
  • Do: Sign and date the form before submission to validate the report and confirm the information provided.
  • Don't: Ignore any sections of the form that apply to your situation. Omitting information may lead to delays or issues with your report.
  • Don't: Use vague terms to describe locations or crash details. Precision is essential for accurate incident analysis and resolution.
  • Don't: Submit the report late. Timeliness is critical, and the form must be filed within five days of the crash.
  • Don't: Forget to retain copies of the completed report for your records. You will need to send copies to the local police, your insurance company, and the RMV.
  • Don't: Assume someone else will fill out the form for you. If you were involved in the crash, you are responsible for completing the report.

Misconceptions

Misconceptions can lead to confusion when it comes to the Massachusetts Vehicle Accident Report form. Here are ten common misconceptions, clarified:

  1. Only serious accidents require a report. In Massachusetts, a report is necessary even for minor accidents if the property damage exceeds $1,000.
  2. Only the driver must complete the form. If the driver is incapacitated, the vehicle owner is obligated to file the report based on their knowledge.
  3. A report is optional if no one is injured. Reports are mandatory if there is property damage exceeding $1,000, regardless of injuries.
  4. Illegible forms will be accepted. Incomplete or unclear forms will be returned for corrections. Clarity is essential.
  5. The police must file the report for you. Although you should notify the police, it is the responsibility of the involved parties to complete and submit the report.
  6. The form does not need to be submitted if the police arrive. Even if police take a statement on scene, a formal report must still be filed.
  7. Only accidents involving other vehicles require a report. Any accident involving property damage, including non-motorist incidents, mandates completion of the report.
  8. There is no deadline for submitting the report. The form must be filed within five days of the accident.
  9. A report can be submitted online. Currently, reports must be physically mailed or delivered to the appropriate authorities.
  10. All sections of the form must be filled out. Only the sections applicable to your accident need completion; unnecessary sections can be left blank.

Understanding these misconceptions ensures compliance and helps navigate the process following a vehicle accident effectively.

Key takeaways

Filling out the Massachusetts Vehicle Accident Report form is a crucial step after a motor vehicle crash. Understanding the requirements and ensuring all necessary sections are completed can simplify the process and avoid potential legal complications.

  • Timeliness is Essential: If you were involved in an accident resulting in injury, fatality, or property damage exceeding $1,000, it is mandatory to file the report within five days. Failure to do so may lead to penalties, including the suspension of your license.
  • Accuracy is Key: Make sure to fill out each section carefully. Providing specific details about the crash location, vehicles involved, and any witnesses will enhance the report’s clarity. Illegible or incomplete reports may be returned.
  • Document Everything: Include descriptions of what happened leading up to and during the crash. The form allows you to provide a detailed narrative that can be vital for insurance claims and potential legal issues.
  • Share Information Promptly: After completing the report, promptly send copies to the local police and your insurance company. It's also advisable to keep one for your records. This will ensure all parties have the necessary documentation.