Homepage Fill Out Your Minnesota Accident Report Form
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Completing the Minnesota Accident Report form is essential for drivers involved in motor vehicle accidents. This form, known as PS 32001, is required for any crash that results in at least $1,000 worth of property damage, or involves injuries or fatalities. All drivers involved must fill out and submit the report to Driver and Vehicle Services within 10 days of the accident. Failure to do so can lead to misdemeanor charges under Minnesota Statute 169.09, subdivision 7. The report gathers important information regarding the time and location of the accident, driver and vehicle details, and insurance information. In addition, it collects descriptions of the type of incident, including collision details and environmental conditions at the time. Passengers’ information and a detailed narrative of the accident are also included to ensure a complete account of what occurred. Each section must be filled accurately to provide a clear picture of the incident and its aftermath. Remember, the information within this document is critical for road safety, and maintaining accurate records helps in analyzing traffic patterns and improving Minnesota's road infrastructure.

Minnesota Accident Report Example

MINNESOTA MOTOR VEHICLE ACCIDENT REPORT

PS 32001 - 08

The information on this report is used to help build safer roads.

Every driver in a crash involving $1,000 or more in property damage, or injury or death, MUST COMPLETE this form and send it to Driver and Vehicle Services within 10 days.

Failure to provide this information is a misdemeanor under Minnesota Statute 169.09, subdivision 7. See reverse side for address and for data privacy information.

A

B

C

DRIVER’S TRAFFIC ACCIDENT REPORT

E-form available at www.mndriveinfo.org

 

 

 

DO NOT DETACH

 

 

DATE OF

MONTH

DAY

YEAR

DAY OF WEEK

TIME

 

 

TOTAL # OF

 

COUNTY

 

 

NAME OF CITY OR TOWNSHIP

 

 

 

 

T

 

ACCIDENT

 

 

 

 

 

 

 

 

 

 

AM

VEHICLES

 

 

 

 

 

CITY

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

PM

INVOLVED

 

 

 

 

 

TWP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

ACCIDENT OCCURRED

LOCATION OF ACCIDENT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

(Choose only one box below

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and proceed to the right)

ON:

 

 

 

 

 

 

 

 

 

 

 

 

 

AT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AT INTERSECTION

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P

 

 

 

 

 

LOCATION OF ACCIDENT:

 

 

 

 

DISTANCE

 

 

DIRECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MILES

N

E

 

 

 

 

 

 

 

A

 

 

NOT AT INTERSECTION

ON:

 

 

 

 

 

 

 

 

 

 

FEET

S

W FROM:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

(Number)

 

 

 

 

 

(Street Name or Road Number)

 

 

 

 

 

 

IN PARKING LOT

DESCRIBE LOCATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D DRIVER’S FULL NAME

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

 

INJURY

M

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CODE*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LICENSE NUMBER

 

 

 

 

 

 

 

 

CLASS

 

 

STATE OF ISSUE

 

DATE OF BIRTH

 

SEX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VE

E R

H

V

 

OWNER’S FULL NAME

 

 

ADDRESS

 

CITY

 

STATE

ZIP CODE

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

E

 

 

 

 

 

 

 

 

 

 

 

 

H

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE PLATE NUMBER

YEAR

STATE OF ISSUE

PARTS OF VEHICLE DAMAGED

 

 

 

ESTIMATE COST TO REPAIR

E

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

$

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE (CAR, PICKUP, VAN, SUV, MOTORCYCLE, TRUCK, ETC.)

MAKE

 

MODEL

YEAR

 

COLOR

 

# OF OCCUPANTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IGIVE FULL LIABILITY INSURANCE INFORMATION OR IT WILL BE ASSUMED YOU DID NOT HAVE INSURANCE

N

SPLEASE NAME OF INSURANCE COMPANY (NOT AGENCY)

 

 

U

COPY

Automobile Insurance

 

 

 

 

 

 

 

 

 

 

 

 

MONTH

 

DAY

 

YEAR

 

 

 

MONTH

 

DAY

 

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POLICY NUMBER

 

 

 

 

 

 

 

 

Policy Period: from

 

 

 

 

 

 

 

 

to

 

 

 

 

 

 

 

 

 

 

A

POLICY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

Name of Policy Holder

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Signature X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

OTHER

FULL NAME

 

 

 

ADDRESS

 

 

 

 

 

CITY

 

 

 

 

STATE

ZIP CODE

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CODE*

O

 

R

DRIVER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

DRIVER’S LICENSE NUMBER

 

 

 

 

 

 

CLASS

 

STATE OF ISSUE

 

 

 

DATE OF BIRTH

 

 

 

 

SEX

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

V

OTHER FULL NAME

 

 

 

ADDRESS

 

 

 

 

 

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

HE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

OWNER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE PLATE NUMBER

 

YEAR

STATE OF ISSUE

 

PARTS OF VEHICLE DAMAGED

 

 

 

 

 

 

 

 

ESTIMATE COST TO REPAIR

I

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

C

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE (CAR, PICKUP, VAN, SUV, MOTORCYCLE, TRUCK, ETC.)

MAKE

 

 

MODEL

 

 

 

 

YEAR

 

 

COLOR

 

 

# OF OCCUPANTS

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF MORE THAN TWO VEHICLES - FILL IN SECTION “C” ON SEPARATE FORM AND ATTACH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*SEE CODES ON REVERSE SIDE*

ENTER NUMBER FOR CORRECT RESPONSE IN EACH BOX BELOW

 

 

 

 

TYPE ACCIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLLISION WITH A(N)

 

 

 

 

COLLISION WITH FIXED OBJECT

 

 

 

NON-COLLISION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- MOTOR VEHICLE

 

 

8- DEER

 

21- CONSTRUCTION EQUIPMENT

29- HYDRANT

 

37- EMBANKMENT/DITCH/CURB

51- OVERTURN/ROLLOVER

 

 

 

 

2- PARKED MOTOR VEHICLE

 

9- OTHER ANIMAL

 

22- TRAFFIC SIGNAL

30- TREE/SHRUBBERY

 

38- BUILDING/WALL

52- SUBMERSION

 

 

 

 

3- ROADWAY EQUIPMENT - SNOWPLOW

 

 

 

23- RR CROSSING DEVICE

31- BRIDGE PIERS

 

39- ROCK OUTCROPS

53- FIRE/EXPLOSION

 

 

 

 

4- ROADWAY EQUIPMENT - OTHER

 

12- COLLISION WITH OTHER

 

24- LIGHT POLE

 

32- MEDIAN SAFETY BARRIER

40- PARKING METER

54- JACKKNIFE

 

 

 

 

5- TRAIN

 

 

TYPE OF NON-FIXED OBJECT

 

25- UTILITY POLE

33- CRASH CUSHION

 

41- OTHER FIXED OBJECT

55- LOSS/SPILLAGE NON-HAZ MAT

 

 

 

 

6- PEDALCYCLE, BIKE, ETC.

 

13- OTHER COLLISION TYPE

 

26- SIGN STRUCTURE

34- GUARDRAIL

 

42- UNKNOWN FIXED OBJECT

56- LOSS/SPILLAGE HAZ MAT

 

 

 

 

7- PEDESTRIAN

 

 

 

 

27- MAILBOXES

 

35- FENCE (NON-MEDIAN BARRIER)

 

64- NON-COLLISION OF OTHER TYPE

 

 

 

 

 

 

 

 

 

28- OTHER POLES

36- CULVERT/HEADWALL

 

65- NON-COLLISION OF UNKNOWN TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WORK ZONE (CIRCLE CORRECT RESPONSE)

 

 

 

 

SPEED LIMIT ENTER POSTED SPEED LIMIT ( NOT YOUR TRAVEL SPEED)

 

YES

NO

 

 

 

 

 

 

 

 

DID THE CRASH OCCUR IN A WORK ZONE?

 

 

 

 

 

 

 

 

 

YES

NO

IF YES, WERE WORKERS PRESENT?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEATHER / ATMOSPHERE

5- SLEET/HAIL/FREEZING RAIN

8- SEVERE CROSSWINDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- CLEAR

3- RAIN

6- FOG/SMOG/SMOKE

90- OTHER

 

 

 

 

ROAD SURFACE

 

 

 

 

 

 

2- CLOUDY

4- SNOW

7- BLOWING SAND/DUST/SNOW

 

 

 

 

 

1- DRY

3- SNOW

5- ICE PACKED SNOW

7- MUDDY

9- OILY

 

 

 

 

 

 

 

 

2- WET

4-SLUSH

6- WATER (STANDING/MOVING)

8- DEBRIS

90- OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIGHT CONDITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- DAY LIGHT

 

4- DARK (STREET LIGHTS ON)

7- DARK (UNKNOWN LIGHTING)

 

 

 

 

TRAFFIC CONTROL DEVICE

 

 

 

 

 

2- BEFORE SUNRISE (DAWN)

5- DARK (STREET LIGHTS OFF)

90- OTHER

 

 

 

 

1- TRAFFIC SIGNAL

 

 

7- SCHOOL BUS STOP ARM

 

13- RR OVERHEAD FLASHERS

3- AFTER SUNSET (DUSK)

6- DARK (NO STREET LIGHTS)

 

 

 

 

 

2- OVERHEAD FLASHERS

 

8- SCHOOL ZONE SIGN

 

14- RR OVERHEAD FLASHERS/GATE

 

 

 

 

 

 

 

 

3- STOP SIGN - ALL APPROACHES

 

9- NO PASSING ZONE

 

15- RR SIGN ONLY

 

 

 

 

 

 

 

 

 

4- STOP SIGN - NOT ALL APPROACHES

 

10- RR CROSSING GATE

 

(NO LIGHTS, GATES OR STOP SIGN)

MANNER OF COLLISION

4- RAN OFF ROAD - LEFT SIDE

8- HEAD ON

 

 

 

 

5- YIELD SIGN

 

 

11- RR CROSSING -FLASHING LIGHTS

 

1- REAR END

 

5- RIGHT ANGLE (”T-BONE”)

9- SIDE SWIPE - OPPOSING DIRECTION

 

 

 

 

 

 

 

 

 

 

 

 

6- OFFICER/FLAG PERSON/SCHOOL PATROL

12- RR CROSSING - STOP SIGN

 

90- OTHER

 

2- SIDESWIPE - SAME DIRECTION

6- RIGHT TURN

90- OTHER

 

 

 

 

 

 

 

 

 

98- NOT APPLICABLE

3- LEFT TURN

 

7- RAN OFF ROAD - RIGHT SIDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MY

VEHICLE

OTHER

VEHICLE

ACTIONS / MANEUVERS PRIOR TO ACCIDENT

BY VEHICLE

PARKED VEHICLES

1- GOING STRAIGHT AHEAD

21- PARKED LEGALLY

FOLLOWING ROADWAY

22- PARKED ILLEGALLY

2- WRONG WAY INTO

23- VEHICLE STOPPED

OPPOSING TRAFFIC

OFF ROADWAY

3- RIGHT TURN ON RED

 

4- LEFT TURN ON RED

 

5- MAKING RIGHT TURN

 

6- MAKING LEFT TURN

 

7- MAKING U-TURN

 

8- STARTING FROM PARKED POSITION

 

9- STARTING IN TRAFFIC

 

10- SLOWING IN TRAFFIC

 

11- STOPPED IN TRAFFIC

 

12- ENTERING PARKED POSITION

 

13- AVOID UNIT/OBJECT IN ROAD

 

14- CHANGING LANES

 

15- OVERTAKING/PASSING

 

16- MERGING

 

17- BACKING

 

18- STALLED ON ROADWAY

 

 

 

 

 

 

 

 

 

 

DIRECTION OF TRAVEL PRIOR TO ACCIDENT

BY PEDESTRIAN

 

 

 

 

BY BICYCLIST

1- NORTHBOUND

 

 

 

 

 

 

 

31- CROSSING WITH SIGNAL

 

40- WALKING/RUNNING IN ROAD

51- RIDING WITH TRAFFIC

2- NORTH EASTBOUND

 

 

 

 

 

 

 

32- CROSSING AGAINST SIGNAL

 

AGAINST TRAFFIC

 

52- RIDING AGAINST TRAFFIC

3- EASTBOUND

 

 

 

 

 

 

 

33- DARTING INTO TRAFFIC

 

41- STANDING/LYING IN ROAD

53- MAKING RIGHT TURN

4- SOUTH EASTBOUND

 

 

 

 

 

 

 

34- OTHER IMPROPER CROSSING

 

42- EMERGING FROM BEHIND

54- MAKING LEFT TURN

5- SOUTHBOUND

 

 

 

 

 

 

 

35- CROSSING IN A MARKED CROSSWALK

PARKED VEHICLE

 

55- MAKING U-TURN

6- SOUTH WESTBOUND

 

 

 

 

 

 

 

36- CROSSING (NO SIGNAL OR CROSSWALK)

43- CHILD GETTING ON/OFF SCHOOL BUS

56- RIDING ACROSS ROAD

7- WESTBOUND

 

 

N

 

 

 

37- FAIL TO YIELD RIGHT OF WAY TO TRAFFIC

44- PERSON GETTING ON/OFF VEHICLE

57- SLOWING/STOPPING/STARTING

8- NORTH WESTBOUND

 

 

 

 

 

38- INATTENTION/DISTRACTION

 

45- PUSHING/WORKING ON VEHICLE

 

 

 

 

 

 

 

 

 

 

 

 

8

1

2

 

 

39- WALKING/RUNNING IN ROAD WITH TRAFFIC

46- WORKING IN ROADWAY

90- OTHER

 

 

 

 

 

 

 

 

W

 

7

 

 

3

 

E

 

 

 

47- PLAYING IN ROADWAY

 

 

 

 

 

 

 

 

 

6

 

 

4

 

 

 

 

48- NOT IN ROADWAY

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

 

 

 

 

 

CONTINUE

 

WAS THERE A POLICE

 

IF YES, WHAT DEPARTMENT (NAME OF CITY, COUNTY OR STATE PATROL)

 

 

 

 

 

 

 

OFFICER AT THE

 

 

 

 

 

 

 

 

 

 

 

REPORT ON

 

 

 

 

 

 

 

 

 

 

 

 

 

SCENE?

 

 

 

 

 

 

 

 

 

 

 

 

OTHER SIDE

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE

MY

VEHICLE

OTHER

As required by Minnesota Data Privacy Act you are hereby informed that the information requested on this form is collected pursuant to statute to provide statistical data on traffic accidents. The time and place of the accident, names of parties involved and insurance information may be disclosed to any person involved in the accident or to others persons as specified by law. This written report cannot be used against you as evidence in any civil or criminal matter and your version of how the accident happened is confidential.

SEAT

TYPE

USE

AIR BAG

EJECT

INJURY

OCCUPANT SEAT POSITION CODES

SAFETY EQUIPMENT TYPE

RESTRAINT DEVICE USED

SAFETY EQUIPMENT USED

EJECTION CODES

INJURY CODES

 

CODES

CODES

CODES

 

 

1- DRIVER

 

 

 

1- TRAPPED, EXTRICATED

K- KILLED

(INCLUDE MOTORCYCLE DRIVER)

1- NO SAFETY EQUIP IN PLACE

1- BELTS NOT USED

1- DEPLOYED-FRONT

(BY MECHANICAL MEANS)

A- INCAPACITATING INJURY

2- FRONT CENTER

 

2- LAP BELT ONLY USED

2- DEPLOYED-SIDE

2- TRAPPED, FREED BY

B- NON-INCAPACITATING INJURY

3- FRONT RIGHT

2- LAP BELT

3- SHOULDER BELT ONLY USED

3- DEPLOYED-FRONT AND SIDE

NON-MECHANICAL MEANS

C- POSSIBLE INJURY

4- SECOND ROW SEAT LEFT

3- SHOULDER BELT

4- LAP AND SHOULDER BELT USED

4- NOT DEPLOYED-SWITCH ON

3- PARTIALLY EJECTED

N- NO APPARENT INJURY

5- SECOND ROW SEAT CENTER

4- LAP & SHOULDER BELT

 

5- NOT DEPLOYED-SWITCH OFF

4- EJECTED

 

6- SECOND ROW SEAT RIGHT

5- CHILD SAFETY SEAT

5- CHILD SEAT NOT USED

6- NOT DEPLOYED- UNKNOWN

 

 

7- THIRD ROW SEAT LEFT

6- CHILD BOOSTER SEAT

6- CHILD SEAT USED IMPROPERLY

IF SWITCH ON OR OFF

5- NOT EJECTED OR TRAPPED

 

8- THIRD ROW SEAT CENTER

 

7- CHILD SEAT USED PROPERLY

 

 

 

9- THIRD ROW SEAT RIGHT

98- NOT APPLICABLE

8- BOOSTER SEAT NOT USED

90- OTHER DEPLOYMENTS

 

 

10- OUTSIDE OF VEHICLE

(MOTORCYCLE,

9- BOOSTER SEAT USED IMPROPERLY

98- NOT APPLICABLE

 

 

11- TRAILING UNIT

SNOWMOBILE, ECT.)

10- BOOSTER SEAT USED PROPERLY

(MOTORCYCLE,

 

 

12- PICKUP TRUCK BED

 

 

SNOWMOBILE, ECT.)

 

 

13- TRUCK CAB SLEEPER SECTION

 

11- HELMET NOT USED

 

 

 

14- PASSENGER IN OTHER POSITION

 

12- HELMET USED

 

 

 

(INCLUDE MOTORCYCLE PASSENGER)

 

 

 

 

 

15- PASSENGER IN UNKNOWN POSITION

 

 

 

 

 

16- FRONT LEFT (NON-DRIVER)

 

 

 

 

 

MY VEHICLE: DRIVER AND PASSENGERS INFORMATION:

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER >>>>>>>>>>>>>>>>>>

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PASSENGER NAME

CITY

STATE

 

DATE OF BIRTH (OR AGE)

SEX

SEAT

TYPE

USE

AIR BAG

EJECT

 

 

INJURY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE ACCIDENT IN SUFFICIENT DETAIL BELOW TO DISCLOSE CAUSES.

 

 

 

 

 

 

INDICATE

 

 

 

 

 

 

 

NORTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE WHAT HAPPENED:

 

 

DIAGRAM WHAT HAPPENED:

 

 

 

 

 

BY ARROW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAMAGE TO PROPERTY OTHER THAN VEHICLES: (MAILBOX, FENCE, SIGNPOST, GUARDRAIL, ETC.)

DESCRIBE

NAME OF

PROPERTY

PROPERTY

DAMAGED:

OWNER:

 

 

ESTIMATE COST OF REPAIR

$

SIGN HERE X

SIGNATURE OF PERSON SUBMITTING REPORT IS REQUIRED

ADDRESS

DATE OF REPORT

MAIL THIS REPORT TO:

DVS / ACCIDENT RECORDS

445 MINNESOTA STREET, SUITE 181

ST. PAUL, MN 55101-5181

Form Characteristics

Fact Description
Governing Law This form is regulated under Minnesota Statute 169.09, subdivision 7.
Property Damage Threshold The form must be completed for accidents involving $1,000 or more in property damage.
Deadline for Submission Accident reports must be submitted within 10 days of the accident.
Misdemeanor Penalty Failure to submit the report is considered a misdemeanor.
Purpose of Information The data collected helps build safer roads by providing traffic accident statistics.
Access to Information Accident details may be disclosed to persons involved or as required by law.
Validity of Report This report cannot be used against the individual in civil or criminal matters.

Guidelines on Utilizing Minnesota Accident Report

Filling out the Minnesota Accident Report form takes careful attention to detail. It is important to provide accurate information to ensure compliance with state regulations. This form must be completed if an accident involves significant property damage or injuries. Here are clear steps to guide you through the process.

  1. Begin by entering the date of the accident, specifying the month, day, and year.
  2. Indicate the day of the week and the time the accident occurred.
  3. Specify the total number of vehicles involved in the accident.
  4. Provide the county name and the name of the city or township where the accident occurred.
  5. Detail the location of the accident, selecting whether it was on a street, at an intersection, or in a parking lot. Fill in the required additional information based on your selection.
  6. Fill in your full name, address, city, state, and ZIP code.
  7. Complete the section regarding your driver's license number, class, state of issue, date of birth, and sex.
  8. Next, fill in the vehicle owner’s full name, address, city, state, and ZIP code.
  9. Provide the license plate number, year, and state of issue for the vehicle involved.
  10. List the parts of your vehicle damaged and the estimated cost to repair them.
  11. Select the type of vehicle you were driving and provide details about its make, model, year, and color.
  12. Indicate the number of occupants in your vehicle.
  13. Provide your full liability insurance information, including the name of the insurance company, policy number, and policy period. Be sure to include the name and address of the policyholder.
  14. If applicable, fill in the details for other drivers involved in the accident using their full names, addresses, and information regarding their vehicles.
  15. Answer the questions regarding the type of accident and choose the corresponding codes. Ensure to indicate if there were any injuries and detail the circumstances to the best of your ability.
  16. Indicate the weather conditions and any traffic control devices present at the time of the accident.
  17. Describe the accident in a detailed manner. Include a diagram if necessary to explain the incident clearly.
  18. Lastly, sign the form and include the date of your report.
  19. Mail the completed form to DVS / Accident Records at the provided address.

Once you have thoroughly completed the form, it's critical to submit it within the 10-day deadline to avoid potential penalties. Proper completion ensures that the information you provide will assist in future road safety measures.

What You Should Know About This Form

What is the Minnesota Accident Report form?

The Minnesota Accident Report form is a document used to report any motor vehicle accident involving $1,000 or more in property damage, or injury or death. It helps authorities gather the necessary information to improve road safety and determine liability in accidents.

Who is required to complete this form?

All drivers involved in a crash that meets the specified damage or injury thresholds must complete the form. This is mandatory under Minnesota law, and failure to do so can result in misdemeanor charges.

When must the form be submitted?

The completed Minnesota Accident Report form must be submitted within 10 days of the accident. Delays can lead to legal consequences, so it is important to act quickly.

Where do I send the completed form?

Submit the completed form to the Driver and Vehicle Services at the following address: DVS / Accident Records, 445 Minnesota Street, Suite 181, St. Paul, MN 55101-5181.

How can I access the form?

The Minnesota Accident Report form can be obtained online at www.mndriveinfo.org. You may also physically obtain it from your local Driver and Vehicle Services office.

What information do I need to provide on the form?

The form requires details such as the date and time of the accident, location, vehicle information, driver information, insurance details, and descriptions of the events leading up to the accident. Be thorough and accurate to ensure proper processing.

What happens if I don’t have insurance?

If insurance information is not provided on the form, it will be assumed that you did not have insurance at the time of

Common mistakes

Completing the Minnesota Accident Report form can be a straightforward process, but many individuals make mistakes that can complicate matters. One common error is neglecting to submit the report within the mandated timeframe. According to the instructions, this form must be sent to Driver and Vehicle Services within **10 days** of the accident. Failing to do so can lead to legal consequences. Ensure that you keep track of the timeline to avoid this mistake.

Another frequent issue is incorrect or incomplete information. Filling out the form requires specific details about the accident location, the vehicles involved, and the parties' information. Leaving out critical elements, such as the **license plate numbers** or the **insurance information**, can hinder the processing of the report. Every section needs attention to detail, so double-check to ensure all necessary data is present and accurate.

People often forget to sign the form before submission, which can lead to delays in processing. Your signature is not just a formality; it’s a confirmation of the information provided. Without it, the report may be considered invalid. Always remember to sign and date the form before you mail it.

Many accidents involve multiple vehicles, yet individuals sometimes fail to report all parties involved. If you're in a multi-vehicle crash, it is essential to include every driver's information and the relevant insurance details. Omitting a driver or vehicle from the report could complicate matters and potentially lead to disputes over liability.

Providing vague descriptions of the incident can also be a pitfall. The section that requires a description of the accident must be filled with sufficient detail about what transpired. Using specific language and mentioning actions taken prior to the accident will provide a clearer picture and support any claims. Avoid ambiguity and focus on factual statements.

Lastly, confusion over terminology or codes can lead to mistakes in choosing options on the form. For example, selecting the wrong type of accident or misunderstanding the various classifications can distort the report’s accuracy. Familiarizing yourself with the terms used can help avoid this common error, ensuring that you select the appropriate responses for your situation.

Documents used along the form

When involved in an accident in Minnesota, completing the Minnesota Accident Report form is just one step in addressing the incident. There are several other documents and forms that may be needed to ensure a comprehensive approach to managing the aftermath of the accident. Below is a list of commonly associated forms.

  • Insurance Claim Form: This document is submitted to your insurance company to seek compensation for damages or injuries sustained during the accident.
  • Police Report: A report generated by law enforcement detailing the accident scene, contributing factors, and parties involved. It can be crucial for insurance claims.
  • Medical Records: Documentation of diagnoses, treatments, and costs associated with any injuries suffered in the accident. These records help substantiate claims for medical expenses.
  • Witness Statements: Written accounts from individuals who saw the accident can provide critical evidence. These statements can clarify the circumstances surrounding the accident.
  • Release of Liability Form: This form is often used to relinquish the right to claim further damages after an agreement has been reached, particularly in cases of settlements.
  • Vehicle Repair Estimates: Quotes or assessments from auto repair shops detailing the costs to fix damage to the vehicle involved in the accident, important for insurance processes.
  • Release of Medical Information Form: This form allows insurance companies or other involved parties to obtain your medical records related to the accident, ensuring transparency in claims.

Proper handling of these documents can significantly influence the outcome of claims and legal matters following an accident. Always keep copies for your records and provide any required information promptly.

Similar forms

  • Florida Traffic Crash Report - Similar to the Minnesota Accident Report, this document must be completed after vehicle crashes resulting in damage or injury. It gathers essential details about the accident and involved parties, helping authorities assess the situation effectively.

  • California Accident Report - This form requires drivers involved in accidents to provide comprehensive information. Like the Minnesota form, it focuses on determining the circumstances surrounding the accident for better road safety and enforcement.

  • Texas Motor Vehicle Accident Report - This Texas report serves a similar purpose as its Minnesota counterpart. It collects information post-accident, emphasizing accountability from drivers involved in collisions.

  • Illinois Crash Report - Comparable to Minnesota’s document, the Illinois Crash Report captures crucial data about traffic accidents to support law enforcement in evaluating causes and responsibilities.

  • New York State Motor Vehicle Accident Report - This report requires submission by drivers involved in specific accidents. It shares similarities with the Minnesota form in its emphasis on reporting and documenting incidents for regulatory compliance.

  • Ohio Motor Vehicle Accident Report - Ohio's report is designed for collecting detailed information about accidents and aligning with similar objectives of determining liability, much like the Minnesota Accident Report.

  • Pennsylvania Accident Report - Similar to the Minnesota form, this Pennsylvania document plays a critical role in accident documentation, requiring driver input for effective assessment and follow-up by authorities.

  • Michigan Traffic Crash Report - This report collects vital information about accidents, aiming to inform state authorities and improve roadway conditions, mirroring the goals of Minnesota’s report.

  • Georgia Uniform Motor Vehicle Accident Report - Like the Minnesota form, this document must be completed for vehicle crashes resulting in certain damage or injuries. It assists in understanding traffic incidents thoroughly.

  • Virginia Crash Report - This form serves a similar purpose of gathering information about traffic collisions. It aids law enforcement and insurance companies alike, just as the Minnesota Accident Report does.

Dos and Don'ts

  • Do ensure that you fill out the form accurately and completely. Mistakes or omissions could lead to complications.
  • Don't delay in submitting the report. You must send it within 10 days of the accident to avoid penalties.
  • Do provide all necessary personal information, including names, addresses, and insurance details of all parties involved.
  • Don't forget to include the location details of the accident. Specify the exact place where the incident occurred.
  • Do describe the accident thoroughly—details can aid in understanding what happened and determining liability.
  • Don't make any assumptions or place blame when describing the accident; stick to the facts.
  • Do keep a copy of the completed report for your own records after mailing it.
  • Don't forget to sign the report. An unsigned report may be considered invalid.

Misconceptions

Understanding the Minnesota Accident Report form can be challenging due to various misconceptions. Here are some common myths and the truths behind them:

  • Only serious accidents require a report. This is false. Any crash with over $1,000 in damages, or any injury or death, must be reported.
  • The form can be submitted anytime. You must submit the form within 10 days following the accident.
  • Filing the report is optional. It is mandatory. Failure to do so can lead to misdemeanor charges.
  • Only police can fill out the form. Any driver involved in the accident can complete the report.
  • The information is public and can be accessed by anyone. Certain details, like your exact fault in the accident, are kept confidential.
  • You can ignore the insurance requirement on the form. Providing insurance details is necessary; otherwise, it will be assumed you have no coverage.
  • The form is for police use only. This form is for the Minnesota Department of Driver and Vehicle Services and helps with road safety statistics.
  • Once submitted, you cannot make changes. If you notice a mistake after sending the form, you can submit a corrected version.
  • You need to get a police report to complete the form. While helpful, a police report is not a requirement to submit the accident report.
  • The accident report is used against you in court. Your version of the accident is confidential and cannot be used as evidence.

By understanding these misconceptions, you can navigate the Minnesota Accident Report form more confidently.

Key takeaways

Filing a Minnesota Accident Report is crucial following a motor vehicle crash. Here are nine key takeaways to consider:

  1. Mandatory Submission: The report must be completed if the accident involves $1,000 or more in property damage, or if there are injuries or fatalities.
  2. Time Limit: The form must be submitted to Driver and Vehicle Services within 10 days of the accident.
  3. Legal Consequences: Failing to submit the report is classified as a misdemeanor under Minnesota law.
  4. Complete Accuracy: Ensure all information is accurate and complete, including personal details, location, and circumstances of the accident.
  5. Insurance Details: Include full liability insurance information; otherwise, it may be assumed no insurance was held.
  6. Information Privacy: The report is confidential and cannot be used against you in civil or criminal matters.
  7. Accident Description: Provide a clear and detailed description of the accident to aid in understanding the causes.
  8. Diagram Use: Utilize diagrams to illustrate the accident scene, highlighting all relevant details and directions.
  9. Mailing Instructions: Send the completed report to the specified address: DVS/Accident Records, 445 Minnesota Street, Suite 181, St. Paul, MN 55101-5181.

Understanding these key aspects can help ensure compliance and provide clarity in the aftermath of an accident.