INVESTIGATING OFFICER CRASH CIRCUMSTANCES AND … · 2020. 1. 28. · 108 Snow 980 Other 999...
Transcript of INVESTIGATING OFFICER CRASH CIRCUMSTANCES AND … · 2020. 1. 28. · 108 Snow 980 Other 999...
Weather Conditions
000 Clear100 Blowing sand, soil, dirt101 Blowing snow102 Cloudy103 Fog, smog, smoke104 Freezing rain or freezing drizzle105 Rain106 Severe crosswinds107 Sleet or hail108 Snow980 Other999 Unknown
Rank
Badge #
First Harmful Event
Intersection Approach
Intersection Geometry
Investigating Agency
MISSISSIPPI UNIFORM CRASH REPORTCRASH INFORMATION
Agency # Case #Rev. 2019-3 Page of
VehiclesInvolved
City Latitude LongitudeCounty
Police Notified Date/Time Police Arrived Date/Time Roadway Cleared Date/Time 10-24 Investigation Completed
Number ofMotorists
Number ofNon-Motorists
Non-Fatally InjuredPersons
Fatalities Injuries
Crash Date/Time
Secondary Crash
100 Cargo/equipment loss or shift101 Fell/jumped from motor vehicle102 Fire/explosion103 Immersion, full or partial104 Jackknife105 Overturn/rollover106 Thrown or falling object198 Other non-collision harmful event
No
n-C
ollisio
n C
ollisio
n w
ith N
on
-Fixed
Ob
ject
200 Collision with animal (live)201 Collision with motor vehicle in transport202 Collision with parked motor vehicle203 Collision with pedalcycle204 Collision with pedestrian205 Collision with railway vehicle (train, engine)206 Collision with object at rest from MV in transport207 Falling/shifting cargo or anything set in motion by MV208 Work zone/maintenance equipment297 Collision with other non-motorist298 Collision with other non-fixed object
Co
llision
with
Fixed
Ob
ject
300 Collision with bridge overhead structure301 Collision with bridge pier or support302 Collision with bridge rail303 Collision with cable barrier304 Collision with concrete traffic barrier305 Collision with culvert306 Collision with curb307 Collision with ditch308 Collision with embankment309 Collision with fence310 Collision with guardrail end terminal311 Collision with guardrail face312 Collision with impact attenuator/crash cushion313 Collision with mailbox314 Collision with traffic sign support315 Collision with traffic signal support316 Collision with tree (standing)317 Collision with utility pole/light support396 Collision with other post, pole, or support397 Collision with other traffic barrier398 Collision with other fixed object (wall, building, tunnel, etc.)399 Collision with unknown fixed object
Location of FirstHarmful Event100 Gore101 In parking lane or zone102 Median103 Off roadway, location unknown104 On roadway105 On shoulder, left side106 On shoulder, right side107 Outside road/right-of-way108 Roadside109 Separator/traffic island999 Unknown
100 Angled / skewed101 Roundabout / traffic circle102 Perpendicular970 Not applicable
Roadway SurfaceCondition000 Dry100 Ice/Frost101 Mud, dirt, gravel102 Oil103 Sand104 Slush105 Snow106 Water (standing,moving)107 Wet980 Other999 Unknown
Manner of Crash
000 Not a collision between two motor vehicles100 Angle101 Front to front102 Front to rear103 Rear to rear104 Rear to side105 Sideswipe, opposite direction106 Sideswipe, same direction980 Other999 Unknown
Relation to Junction
000100101102103104105106107980
999
Light Condition
101 Daylight201 Dawn/Dusk301 Dark - lighted302 Dark - not lighted399 Dark - unknown lighting980 Other999 Unknown
Environmental Conditions
Intersection TrafficControl000 No controls100 Signalized101 Stop -all way102 Stop -partial103 Yield970 Not applicable
School Bus Relation
000 No100 Yes, school bus directly involved101 Yes, school bus indirectly involved
NoneAnimal(s)DebrisGlareNon-highway workObstructed crosswalksObstruction in roadwayPrior crashPrior non-recurring incidentRegular congestionRelated to a bus stopRoad surface condition(wet, icy, snow, slush, etc.)Ruts, holes,bumpsShoulders (none, low, soft, high)Toll booth/plaza relatedTraffic control deviceTraffic incidentVisual obstructionWeather conditionsWork zone (construction/maintenance/utility)Worn,travel-polished surfaceOtherUnknown
CRASH REPORT - CRASH SUMMARY
1 Not an intersection2 Two3 Three4 Four5 Five or more
Traffic Flow Direction
N North
TrafficwayCharacteristics100 Trafficway, on road101 Trafficway, not on road102 Non-trafficway
Property Ownership
100 Public property101 Private property
Named road Numbered road
Road Classification
100 Interstate101 US highway102 State highway103 County road104 City street
Address Number Street Name Road Number Milepost
LOCATION INFORMATION
Intersection Road Name Intersection Road NumberCrash was at an intersection
CRASH CIRCUMSTANCES AND CONDITIONS
First Name Middle Name Last Name Suffix
Printed Name Signature
CRASH TIME INFORMATION
INVESTIGATING OFFICER
INTERSECTION INFORMATION
000100101102103104105106107108109110
111112113114115116117118
119980999
Not an interchange areaAcceleration or deceleration laneCrossover relatedDriveway access or relatedEntrance/exit ramp or relatedIntersection or relatedNon-junctionRailway grade crossingShared-use path or trailOther location within an interchangearea (median, shoulder, and roadside)Unknown
200
201202
Parking lot/private driveState parkOff road
Not applicable(not a divided highway)
X
S South
W West E East
SAMPLE
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
ConductorFirst Middle Last Suffix
Unknown
Unknown
DOT Crossing Number UnknownUnknown
Engineer ID Number Unknown
Unknown
Middle Last SuffixFirst
TRAIN #
MISSISSIPPI UNIFORM CRASH REPORTCRASH INFORMATION
Agency #Rev. 2019-3 Page ofCase #
CRASH REPORT - SUMMARY BACK
Work Zone Type Law Enforcement PresentWork Zone
WORK ZONE CRASH INFORMATION
000 No100 Yes999 Unknown
Location Relativeto Work Zone100 Before the first work zone warning sign101 Advance warning area102 Transition area103 Activity area104 Termination area999 Unknown
000 No law enforcement presence100 Officer present101 Law enforcement vehicle only present970 Not applicable999 Unknown
Worker(s) Present
000 No100 Yes970 Not applicable999 Unknown
100 Lane closure101 Lane shift or crossover102 Work on shoulder or median103 Intermittent or moving work980 Other999 Unknown
Photos Taken? Rank First Name Middle Name Last Name Suffix
PHOTOGRAPHER
REVIEWING OFFICER
First Name Middle Name Last Name SuffixRank
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
WITNESS #
State City
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last First Middle LastSuffix Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
WITNESS #
State City
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last First Middle LastSuffix Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
WITNESS #
State City
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last First Middle LastSuffix SuffixSAMPLE
DESCRIPTION AND INFORMATION
Page
MISSISSIPPI UNIFORM CRASH REPORTVEHICLE INFORMATION
Agency # Case # ofMotor Vehicle #
Rev. 2019-3
CRASH REPORT - MOTOR VEHICLE DESCRIPTION AND IDENTIFICATION
Tow Status
Insurance
ColorModelModel Year Make
Tow Authority
Initial Contact PointDamage Extent Damaged Areas
Hit and Run
000 No, did not leave the scene100 Yes, driver and vehicle left scene101 Yes, only driver left scene
Vehicle Body Type
100 Passenger car101 Passenger van (less than 9 seats)102 Sport utility vehicle
300 2-wheeled motorcycle301 3-wheeled motorcycle302 Moped or motorized bicycle303 All-terrain vehicle / all-terrain cycle (ATV / ATC)304 Golf Cart305 Snowmobile306 Low Speed Vehicle307 Recreational off-highway vehicles (ROV)308 Autocycle
Passenger Vehicles
Cycle / Low Speed
Towed By
100 Top
12345
6
1110987
12
000 Non-collision
100 Top
999 Unknown
113 Undercarriage
114 Cargo Loss
DAMAGE
000 None100 Minor damage101 Functional damage102 Disabling damage990 Vehicle not at scene
State Property Damaged
TOWING
License Plate
State
Missing
Unknown
Owner Name Same as driver Unknown
Owner Address Same as driver Unknown
City State Postal CodeStreet
Uninsured at time of crash
VIN
Check if this vehiclehad no driver
200 Construction equipment (backhoe, bulldozer,etc.)201 Farm equipment (tractor, combine,harvester, etc.)
Construction / Farm Equipment
Other
400 Single unit truck401 Truck tractor498 Other truck
505 School bus506 Transit bus507 Motorcoach598 Other bus / large passenger vehicle
Trucks
Large Passenger Vehicle
980 Other
Vehicle Type
100 Motor vehicle in transport101 Parked motor vehicle102 Working vehicle / equipment
Unknown
500 Motor home501 9 or 12 passenger van502 15-passenger van503 Large limo504 Mini-bus
1235
6
1110987
12
4
Unknown
001 Vehicle not at scene
001 Vehicle not at scene
103 Pickup104 Cargo van
Number YearUnknown Unknown
Unknown
Company Unknown
NAIC # Unknown
Policy # Unknown
113 Undercarriage
100 Owner101 Law enforcement970 Not applicable980 Other
000 None
100 Bridge overhead structure
101 Bridge pier or support
102 Bridge rail
200 Cable barrier
201 Concrete traffic barrier
202 Guardrail end terminal
203 Guardrail face
204 Impact attenuator/crash cushion
298 Other traffic barrier
300 Traffic sign support
301 Traffic signal support
302 Utility pole/light support
980 Other
000 Not towed100 Towed, but not due to disabling damage101 Towed due to disabling damage
Non-expiring
SAMPLE
MISSISSIPPI UNIFORM CRASH REPORTVEHICLE INFORMATION
Agency # Case #Motor Vehicle #
Rev. 2019-3 Page of
100 Cargo/equipment loss or shift101 Fell/jumped from motor vehicle102 Fire/explosion103 Immersion, full or partial104 Jackknife105 Overturn/rollover106 Thrown or falling object198 Other non-collision harmful event
200201202203204205206207
208298
300 Collision with bridge overhead structure301 Collision with bridge pier or support302 Collision with bridge rail303 Collision with cable barrier304 Collision with concrete traffic barrier305 Collision with culvert306 Collision with curb307 Collision with ditch308 Collision with embankment309 Collision with fence310 Collision with guardrail end terminal311 Collision with guardrail face312 Collision with impact attenuator/crash cushion313 Collision with mailbox314 Collision with traffic sign support315 Collision with traffic signal support316 Collision with tree (standing)317 Collision with utility pole/light support
396
397398
399
Non-Collision Events Collision with Person / Vehicle / Non-Fixed Object
Collision with Fixed Object
Sequence of Events 1 2 3 4 Most Harmful Event
MOTOR VEHICLE EVENTS
Vehicle Usage
000 No special function100 Bus - school (public or private)101 Bus - childcare / daycare102 Bus - transit / commuter103 Bus Charter / tour104 Bus - intercity105 Bus - shuttle198 Bus -other200 Farm vehicle201 Fire truck202 Highway / maintenance203 Mail carrier204 Military205 Ambulance206 Police
Vehicle Maneuver
100 Backing101 Changing lanes102 Entering traffic lane103 Leaving traffic lane104 Making U-turn105 Movement essentially straight ahead106 Negotiating a curve107 Overtaking/passing108 Parked109 Slowing110 Stopped in traffic111 Turning left112 Turning right980 Other999 Unknown
Roadway Grade
100 Level101 Uphill102 Hillcrest103 Downhill104 Sag (bottom)999 Unknown
RoadwayAlignment
100 Straight101 Curve left102 Curve right
Barrier Type
000 None100 Cable barrier101 Concrete barrier (e.g. Jersey barrier)102 Earth embankment103 Guardrail980 Other
Posted Speed Limit
# of Through Lanes
Trafficway Division
Emergency Vehicle Usage
100 Non-emergency, non-transport101 Non-emergency transport200 Emergency operation, emergency warning equipment not in use201 Emergency operation, emergency warning equipment in use970 Not applicable999 Unknown
Travel Direction
000 Not on roadway
CRASH REPORT - MOTOR VEHICLE CIRCUMSTANCES AND EVENTS
207208209210211212213214215
980999
MOTOR VEHICLE CIRCUMSTANCES
Permitted Travel
100 One-way200 Two way
# of Auxiliary Lanes
Vehicle Defects
000 None100 Brakes101 Exhaust system102 Body doors103 Steering104 Power train105 Suspension106 Tires107 Wheels108 Lights (head,signal,tail)109 Window / Windshield110 Mirrors111 Wipers112 Truck coupling /trailer /hitch /safety chains980 Other999 Unknown
Traffic Control Device Types and Statuses
Traffic Control Device Types
000 None
100 Person
200 Bicycle crossing sign201 "Curve Ahead" sign202 "Intersection Ahead"203 Pedestrian crossing sign204 Railroad crossing205 "Reduce Speed Ahead"206 School zone sign207 Stop sign208 Yield sign298 Other warning sign
980 Other999 Unknown
Devices Present
300 Flashing railroad crossing301 Flashing school zone302 Flashing traffic control303 Lane use control signal304 Ramp meter signal305 Traffic control signal398 Other signal
400 Bicycle crossing401 Pedestrian crossing402 Railroad crossing403 School zone498 Other pavement marking
Devices Inoperativeor Missing
1 1
2 2
3 3
4 4
Vehicle Automation Level
000 No automation100 Driver assistance101 Partial automation102 Conditional automation103 High automation
103 High automation104 Full automation199 Automation level unknown999 Unknown
Automation Levels Engaged at Time of Crash
600 Southwest
HOV Lane Presence
000 Not Present100 Separated barrier, flush (greater than 4 ft wide), raised or depressed median101 Not separated, painted pavement markings, post-mounted delineators
HOV Lane Relation
000 No100 Yes
Unknown
N/A
000 No automation100 Driver assistance101 Partial automation102 Conditional automation103 High automation
103 High automation104 Full automation199 Automation level unknown999 Unknown
000 Not divided001 Not divided, with a continuous left turn lane100 Divided, flush median (greater than 4 ft wide)101 Divided, raised median (curbed)102 Divided, depressed median999 Unknown
Public utilityNon-transport emergency services vehicleSafety service patrols - incident responseOther incident responseRental truckTowing - incident responseTruck acting as crash attenuatorTaxiVehicle used for electronic ride-hailing(transportation network company)
OtherUnknown
100 North
200 Northeast
300 East
400 Southeast
500 South
700 West
800 Northwest
999 Unknown
Collision with animal (live)Collision with motor vehicle in transportCollision with parked motor vehicleCollision with pedacycleCollision with pedestrianCollision with railway vehicle(train,engine)Collision with object at rest from MV in transportCollision with falling, shifting cargo, oranything set in motion by MVCollision with work zone/maintenance equipmentCollision with other non-fixed object
Collision with other post,pole,orsupportCollision with other traffic barrierCollision with other fixed object(wall, building, tunnel, etc.)Collision with unknown fixed object
Non-Harmful Events
000 Cross centerline001 Cross median002 End departure (T-intersection, dead-end, etc.)003 Downhill runaway004 Equipment failure (blown tire, brake failure, etc.)
005 Ran off roadway left006 Ran off roadway right007 Reentering roadway008 Separation of units098 Other non-harmful event
SAMPLE
COMMERCIAL MOTOR VEHICLE INFORMATION
Page
MISSISSIPPI UNIFORM CRASH REPORTVEHICLE INFORMATION
Agency # Case # ofMotor Vehicle #
Rev. 2019-3
CRASH REPORT - COMMERCIAL MOTOR VEHICLE DESCRIPTION AND IDENTIFICATION
Year Model
Special Sizing Motor Carrier Type
License Plate
Make
VIN
Motor Carrier Address
Vehicle Configuration
GVWR/GCWR
Motor Carrier Identification
100 USDOT number101 State number970 Not applicable999 Unknown/unable to determine
State
City State Postal CodeStreet
Unknown
Numberof Axles000 No special sizing
Motor Carrier ID Number
Hazardous Materials Placard
000 Did not carry hazardous materials100 Carried hazardous materials with placard200 Carried hazardous materials without placard
Hazardous Material ID
Hazardous Material Class
Hazardous Materials Releasedfrom Vehicle Cargo Compartment000 No, hazardous materials not released100 Yes, hazardous materials released970 Not applicable
100 Light (less than 10,000 lbs.GVWR/GCWR)101 Medium (10,001 - 26,000 lbs GVWR/GCWR)102 Heavy (greater than 26,000 lbs GVWR/GCWR)970 Not applicable999 Unknown
Commodity Hauled
Number of Axles
100 Vehicles 10,000 lbs or less placarded for hazardous materials
200 Bus/large van (seats 9-15 occupants, including driver)201 Bus (seats more than 15 occupants, including driver)
999 Unknown
Cargo Body Type
109 Log110 Pole trailer111 Van / enclosed box112 Vehicle towing another vehicle
999 Unknown
105 Flatbed106 Garbage / refuse107 Grain/chips/gravel108 Intermodal container chassis
980 Other
000 No cargo body
100 Bus101 Auto transporter102 Cargo tank103 Concrete mixer104 Dump
970 Not applicable
000 Not a motor carrier100 Interstate carrier101 Intrastate carrier102 Not in commerce - government980 Not in commerce - other truck
Motor Carrier Name Unknown
TRAILER INFORMATION TRAILER #
License Plate
VIN Number of Axles
TRAILER INFORMATION TRAILER #
License Plate
VIN Number of Axles
TRAILER INFORMATION TRAILER #
Year ModelMake
Year ModelMake
State Number
State Number
State Number
123456789
970999
100 Over-height
101 Over length
102 Over-weight
103 Over-width
Unknown Unknown
Unknown UnknownUnknown
Unknown Unknown
Missing
Unknown
Unknown
Missing
Unknown Unknown
Unknown
Unknown Unknown
UnknownUnknown
Missing
Unknown Unknown
Unknown UnknownUnknown
300 Single-unit truck (2-axle and GVWR > 10,000 lbs.)301 Single-unit truck (3 or more axles)302 Truck pulling trailer(s)303 Truck tractor (bobtail)304 Truck tractor/semi-trailer305 Truck tractor/double306 Truck tractor/triple307 Truck more than 10,000 lbs., cannot classify
ExplosivesGasFlammable liquidsOther flammable substancesOxidizing substances and organic peroxidesToxic (poisonous) and infectious substancesRadioactive materialCorrosivesMiscellaneous dangerous goodsNot applicableUnknown
Unknown
999 Unknown
999 Unknown
SAMPLE
Air Bags Deployed
Motor Vehicle #
Name
DRIVER INFORMATION
AddressFirst
Street
Seating Position
DRIVER SEATING AND SAFETY INFORMATION
MISSISSIPPI UNIFORM CRASH REPORTDRIVER INFORMATION
Agency # Case #Rev. 2019-3 Page of
Restraint Systems Used
100 None used - motor vehicle occupant101 Booster seat102 Child restraint system - forward facing103 Child restraint system - rear facing104 Child restraint - type unknown105 Lap belt only used106 Shoulder and lap belt used107 Shoulder belt only used108 Stretcher109 Wheelchair199 Restraint used - type unknown
Race
100
101102103980999
SexAge
Middle Last Suffix
City State Postal Code
Unknown
Unknown
Front
Row Left Middle Right
1
2
3
4
Oth
Unk
100
200
300
400
500
101
201
301
401
501
102
202
302
402
502
199
299
399
499
599
700 Unenclosed cargo area701 Riding on motor vehicle exterior (non-trailing unit)800 Trailing unit801 Sleeper section of cab (truck)898 Other enclosed cargo area970 Not applicable999 Unknown
Ejection
000 Not ejected100 Ejected, partially101 Ejected, totally970 Not applicable999 Unknown
200 No helmet201 DOT-compliant motorcycle helmet202 Non-DOT-compliant motorcycle helmet299 Unknown if DOT-compliant motorcycle helmet
Used Improperly?
Standard Vehicle Seats Other Seating Positions
Extrication
000 No100 Yes
Unk 600 601 602 699
Phone Number Unknown
Unknown
Ethnicity
100 Hispanic101 Other than Hispanic999 Unknown
Date of Birth
Endorsements on License
DRIVER LICENSE INFORMATIONLicense Status
100 Valid license000 Not licensed001 Canceled or denied002 Expired003 Revoked004 Suspended999 Unknown
Alcohol Interlock Presence
Restrictions on License
100 H - Hazardous materials
101 N - Tank vehicle
102 P - Passenger
103 S - School
104 T - Double/triple trailers
105 X - Combination of tank/HAZMAT
980 Other non-commercial license endorsements
999 Unknown
Endorsement Compliance
License Number
License State
License Class
Is Commercial DL?
Yes No
000 No100 Yes
000 None/not applicable
Commercial Driver License Status
100 Valid101 Learner's Permit
000 Canceled or denied001 Disqualified002 Expired003 Revoked004 Suspended098 Other (not valid)
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other (knee, air belt, etc.)
970 Not applicable
999 Deployment unknown
Incident Responder
CRASH REPORT - DRIVER INFORMATION
Unknown
000 No endorsements required for the vehicle100 Endorsements required, complied with101 Endorsements required, not complied with199 Endorsements required, compliance unknown999 Unknown if endorsements required
000 No100 EMS101 Fire
102 Police103 Tow operator104 Transportation (i.e. maintenance workers, safety service patrol operators, etc.)
980 Other999 Unknown
999 Unknown
970 Not applicable999 Unknown
100 Female101 Male999 Unknown
000 None100 Class A101 Class B102 Class C200 Light commercial/taxi/chauffeur (MS class D)300 Motorcycle only (class M, non-MS only)400 Regular driver license class (MS classes R, T, P, and Y)970 Not applicable
000 No100 Yes999 Unknown
970 Not applicable980 Other999 Unknown
American Indian/Alaska NativeAsian/Pacific IslanderBlackWhiteOtherUnknown
SAMPLE
Conditions at Time of Crash
Apparently normalAsleep or fatiguedEmotional (depressed, angry, disturbed, etc.)Ill (sick), faintedPhysically impairedUnder the influence of medications/drugs/alcoholNot applicableOtherUnknown
Avoidance ManeuverDriver Actions at Time of Crash
EMS Response Run #
Injury Status
MISSISSIPPI UNIFORM CRASH REPORTDRIVER INFORMATION
Agency # Case #Rev. 2019-3 Page of
Distraction SourceDistracted By
000100101
980999
Speeding Related
000 No100 Exceeded speed limit101 Racing102 Too fast for conditions999 Unknown
Type of Medical Transportation
000 Not transported100 EMS air101 EMS ground200 Law enforcement980 Other999 Unknown
EMS Response Agency
Facility Receiving Patient
100 Hands-free mobile phone101 Hand-held mobile phone102 Vehicle-integrated device198 Other electronic device200 Passenger or other non-motorist201 External to vehicle/non motorist area298 Other970 Not applicable999 Unknown
000 No contributing action
100 Disregard other road markings101 Disregard other traffic sigs102 Failed to keep in proper lane103 Failed to yield right-of-way104 Followed too closely105 Improper backing106 Improper passing107 Improper turn108 Operated motor vehicle in attentive, careless, negligent, or erratic manner109 Operated motor vehicle in reckless or aggressive manner110 Over-correcting or over-steering111 Ran off roadway112 Ran red light113 Ran stop sign114 Swerved or avoided due to wind,slippery surface,motor vehicle,object,non-motorist in roadway,etc.115 Wrong side or wrong way
980 Other contributing action999 Unknown
Motor Vehicle #
MEDICAL INFORMATION
DRIVER CONDITION AND CIRCUMSTANCES
100 (K) Fatal Injury101 (A) Suspected Serious Injury102 (B) Suspected Minor Injury103 (C) Possible Injury104 (O) No Apparent Injury
000100101102103104
970980999
CRASH REPORT - DRIVER CONDITION AND CIRCUMSTANCES
SuspectedDrugUsage
SuspectedAlcoholUsage
000 No100 Yes999 Unknown
Alcohol Test Results
Test Status Drug Test Results
000 Results pending001 Negative results with no actual value100 Results received101 Positive results with no actual value970 Not applicable999 Unknown
BAC
Drug Test Type
000 Test not given001 Test refused100 Test given999 Unknown if tested
000 No100 Yes999 Unknown
970 Not applicable999 Unknown
100 Blood101 Urine102 Both blood and urine103 Saliva198 Other
Alcohol Test Type
100 Blood101 Blood clot102 Blood plasma/serum
300 Urine301 Vitreous
Test Status
000 Test not given001 Test refused100 Test given999 Unknown if tested
DRIVER ACTIONS
000 No avoidance maneuver
100 Accelerating101 Accelerating and steering left102 Accelerating and steering right103 Braking and steering left104 Braking and steering right105 Braking (lockup)106 Braking (no lockup)107 Braking (lockup unknown)108 Releasing brakes109 Steering left110 Steering right
980 Other999 Unknown
Unknown
Not distractedTalking / listeningManually operating an electroniccommunication device (texting, typing,dialing, playing game, etc.)OtherUnknown
970 Not applicable980 Other
200 Breath201 Preliminary breath test (PBT)
CITATIONS
SAMPLE
MISSISSIPPI UNIFORM CRASH REPORTPASSENGER INFORMATIONTotal # of Passengers
PageAgency # Case # ofRev. 2019-3
PASSENGER INFORMATION
Ejection
000 Not ejected100 Ejected, partially101 Ejected, totally970 Not applicable999 Unknown
Extrication
000 Not extricated100 Extricated
Injury Status
100 (K) Fatal injury101 (A) Suspected serious injury102 (B) Suspected minor injury103 (C) Possible injury104 (O) No apparent injury
Race
100 American Indian or Alaska Native101 Asian/Pacific Islander102 Black103 White980 Other999 Unknown
Restraint Systems
100 None used - motor vehicle occupant101 Booster Seat102 Child restraint system - forward facing103 Child restraint system - rear facing104 Child restraint system - type unknown105 Lap belt only used106 Shoulder and lap belt used107 Shoulder belt only used108 Stretcher109 Wheelchair199 Restraint used - type unknown
Type of Medical Transportation
000 Not transported100 EMS air101 EMS ground200 Law enforcement980 Other999 Unknown
Seating Position
Front
Row Left Middle Right
1
2
3
4
Other
Unk
100
200
300
400
500
101
201
301
401
501
102
202
302
402
502
199
299
399
499
599
700 Unenclosed cargo area701 Riding on motor vehicle exterior (non-trailing unit)800 Trailing unit801 Sleeper section of cab (truck)898 Other enclosed cargo area970 Not applicable999 Unknown
PASSENGER CODES
Ethnicity
100 Hispanic101 Other than Hispanic999 Unknown
Unk 600 601 602 699
200 No helmet201 DOT-compliant motorcycle helmet202 Not DOT-compliant motorcycle helmet299 Unknown if DOT-compliant motorcycle helmet
970 Not applicable980 Other999 Unknown
Incident Responder
000 No100 EMS101 Fire102 Police103 Tow operator104 Transportation
980 Other999 Unknown
(i.e. maintenance workers, safety service patrol operators, etc.)
CRASH REPORT - PASSENGER INFORMATION
EMS Response Run #
Name
Address
PASSENGER #
Middle Last SuffixFirst
Date of Birth Sex
Phone Number Ethnicity
EMS Response Agency
Injury Status Seating PositionRestraint System Ejection Extrication
Type ofMedicalTransportation
Facility Receiving Patient
Street City State Postal Code
MOTOR VEHICLE # UNBORN CHILD OF
Air Bags Deployed
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other
970 Not applicable
Incident Responder
Race
999 Unknown
100 Female101 Male999 Unknown
Unknown
Used Improperly?
Unknown
Unknown
Age
EMS Response Run #
Name
AddressMiddle Last SuffixFirst
Phone Number Ethnicity
EMS Response Agency
Injury Status Seating PositionRestraint System Ejection Extrication
Type ofMedicalTransportation
Facility Receiving Patient
Street City State Postal Code
Air Bags Deployed
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other
970 Not applicable
Incident Responder
Race
999 Unknown
Unknown
Used Improperly?
Unknown
Unknown
Date of Birth Sex100 Female101 Male999 Unknown
Age
EMS Response Run #
Name
AddressMiddle Last SuffixFirst
Phone Number Ethnicity
EMS Response Agency
Injury Status Seating PositionRestraint System Ejection Extrication
Type ofMedicalTransportation
Facility Receiving Patient
Street City State Postal Code
Air Bags Deployed
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other
970 Not applicable
Incident Responder
Race
999 Unknown
Unknown
Used Improperly?
000 No100 Yes
Unknown
Unknown
Date of Birth Sex100 Female101 Male999 Unknown
Age
PASSENGER #MOTOR VEHICLE # UNBORN CHILD OF
PASSENGER #MOTOR VEHICLE # UNBORN CHILD OF
999 Unknown
000 No100 Yes 999 Unknown
000 No100 Yes 999 Unknown
SAMPLE
Non-Motorist #
Contributing Circumstances
Non-Motorist Type
100198200298
300
999Safety Equipment
000
100101
102103104
Location At Time of Crash
100 Intersection - marked crosswalk101 Intersection - unmarked crosswalk102 Intersection - other103 Median/crossing island104 Midblock - marked crosswalk105 Shoulder/roadside106 Travel lane - other location
Suspected Drug Usage
Conditions at the Time of the Crash
000
100101
102103
104
970980999
Origin/Destination
100 Going to or from school (K-12)101 Going to or from transit970 Not applicable999 Unknown
Suspected Alcohol Usage
000 No100 Yes999 Unknown
Alcohol Test Results
Test Status Drug Test Results
000001100101970999
BAC
Drug Test Type
000 Test not given001 Test refused100 Test given999 Unknown if tested
000 No100 Yes999 Unknown
InitialContact Point100 Front (12 o'clock)101 Right (3 o'clock)102 Rear (6 o'clock)106 Left (9 o'clock)999 Unknown
970 Not applicable999 Unknown
100 Blood101 Urine102 Both blood and urine103 Saliva198 Other
Alcohol Test Type
100 Blood101 Blood clot102 Blood plasma/serum200 Breath201 Preliminary breath test (PBT)
300 Urine301 Vitreous970 Not applicable980 Other
Test Status
000 Test not given001 Test refused100 Test given999 Unknown if tested
NON-MOTORIST INFORMATION
Page
MISSISSIPPI UNIFORM CRASH REPORTNON-MOTORIST INFORMATION
Agency # Case # ofRev. 2019-3
CRASH REPORT - NON-MOTORIST INFORMATION
BicyclistOther cyclistPedestrianOther pedestrian (wheelchair,person in a building, skater,personal conveyance, etc.)Occupant of a non-motor vehicletransportation deviceUnknown
Apparently normal
Asleep or fatiguedEmotional(depressed,angry,disturbed,etc.)Ill (sick), faintedPhysically impaired
Under the influence ofmedication drugs/alcohol
Not applicableOtherUnknown
Results pendingNegative results with no actual valueResults receivedPositive results with no actual valueNot applicableUnknown
Name
AddressFirst
Street
Race
100
101102103980999
SexAge
Middle Last Suffix
City State Postal Code
Unknown
Unknown Phone Number Unknown
Unknown
Ethnicity
100 Hispanic101 Other than Hispanic999 Unknown
Date of BirthIncident Responder Unknown
000 No100 EMS101 Fire
102 Police103 Tow operator104 Transportation (i.e. maintenance workers, safety service patrol operators, etc.)
980 Other999 Unknown
100 Female101 Male999 Unknown
American Indian/Alaska NativeAsian/Pacific IslanderBlackWhiteOtherUnknown
NON-MOTORIST CIRCUMSTANCES
200 Signed route (no pavement marking)201 Shared lane markings202 On-street bike lanes203 On-street buffered bike lanes204 Separated bike lanes205 Off-street trails/sidepaths
300 Driveway access301 Non-trafficway area302 Shared-use path or trail303 Sidewalk
980 Other999 Unknown
000 None 100 Helmet
101 Protective pads
102 Reflective wear
103 Lighting
104 Reflectors
980 Other
999 UnknownStruck by Vehicle #
Unborn Child of Non-Motorist #
Injury Status
100 (K)101 (A)102 (B)103 (C)104 (O)
Fatal InjurySuspected Serious InjurySuspected Minor InjuryPossible InjuryNo Apparent Injury
105106107108
109110
Type of Medical Transportation
000 Not transported100 EMS air101 EMS ground200 Law enforcement980 Other999 Unknown
EMS Response Run #EMS Response Agency
Facility Receiving Patient
Unknown
NON-MOTORIST MEDICAL INFORMATION
980 Other999 Unknown
NON-MOTORIST CONDITION
Distraction SourceDistracted By
000100101
980999
100 Hands-free mobile phone101 Hand-held mobile phone102 Vehicle-integrated device198 Other electronic device200 Passenger or other non-motorist201 External to vehicle/non motorist area298 Other970 Not applicable999 Unknown
Not distractedTalking / listeningManually operating an electroniccommunication device (texting, typing,dialing, playing game, etc.)OtherUnknown
None (no improper action)
Darted or dashedDisabled vehicle related(working on, pushing, leaving/approaching)Entering or exiting parked or standing vehicle103 Failed to obey traffic signs, signals, or officer104 Failed to yield right-of-way
Improper passingImproper turn or mergeInattentive (talking, eating, etc.)In roadway improperly(standing, lying, working, playing)Not visible (dark clothing, no lighting, etc.)Wrong-way riding or walking
Action Prior to Crash
000100101102103
104105106198999
NoneAdjacent to roadway (e.g.,shoulder,median)Crossing roadwayWaiting to cross roadwayWalking/cycling along roadway against traffic(in or adjacent to travel lane)Walking/cycling along roadway with trafficWalking/cycling on sidewalkWorking in trafficway (incident response)In roadway -otherUnknown
SAMPLE
MISSISSIPPI UNIFORM CRASH REPORTCRASH INFORMATION
Agency # Case #Rev. 2019-3 Page of
CRASH REPORT - TRAIN INFORMATION
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
ConductorFirst Middle Last Suffix
Unknown
Unknown
DOT Crossing Number UnknownUnknown
Engineer ID Number Unknown
Unknown
Middle Last SuffixFirst
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
ConductorFirst Middle Last Suffix
Unknown
Unknown
DOT Crossing Number UnknownUnknown
Engineer ID Number Unknown
Unknown
Middle Last SuffixFirst
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
ConductorFirst Middle Last Suffix
Unknown
Unknown
DOT Crossing Number UnknownUnknown
Engineer ID Number Unknown
Unknown
Middle Last SuffixFirst
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
ConductorFirst Middle Last Suffix
Unknown
Unknown
DOT Crossing Number UnknownUnknown
Engineer ID Number Unknown
Unknown
Middle Last SuffixFirst
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
ConductorFirst Middle Last Suffix
Unknown
Unknown
DOT Crossing Number UnknownUnknown
Engineer ID Number Unknown
Unknown
Middle Last SuffixFirst
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
ConductorFirst Middle Last Suffix
Unknown
Unknown
DOT Crossing Number UnknownUnknown
Engineer ID Number Unknown
Unknown
Middle Last SuffixFirst
TRAIN #
SAMPLE
WITNESSES
Page
MISSISSIPPI UNIFORM CRASH REPORTWITNESSES
Agency # Case # ofTotal # of Witnesses
Rev. 2019-3
CRASH REPORT - WITNESSES
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
State
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City
WITNESS #
Name
Address
Phone Number Age
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Sex
State
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City
WITNESS #
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Address
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Sex
State
First Middle Last Suffix
City
WITNESS #
Name
Address
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State
First Middle Last Suffix
City
WITNESS #
Name
Address
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State
First Middle Last Suffix
City
WITNESS #
Name
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Postal Code
Sex
State
First Middle Last Suffix
City
WITNESS #
Name
Address
Phone Number Age
Postal Code
Sex
State
First Middle Last Suffix
SAMPLE
CRASH REPORT - DIAGRAM
Scene #
MISSISSIPPI UNIFORM CRASH REPORTDIAGRAM
Agency # Case #Rev. 2019-3 Page of
CRASH DIAGRAM
SAMPLE
MISSISSIPPI UNIFORM CRASH REPORTNARRATIVE
Agency # Case #Rev. 2019-3 Page of
CRASH NARRATIVE
CRASH REPORT - NARRATIVE
SAMPLE
CRASH REPORT - PHOTOS
MISSISSIPPI UNIFORM CRASH REPORTPHOTOS
Agency # Case #Rev. 2019-3 Page of
PHOTOS
SAMPLE