Free Oregon Dmv Accident Report Form
Content Overview
In the aftermath of a car accident, navigating the complexities of reporting can feel overwhelming. The Oregon DMV Accident Report form, officially known as the Oregon Traffic Crash and Insurance Report, is a crucial document for drivers involved in certain types of crashes. If your vehicle has sustained damage exceeding $2,500, or if any person's property has incurred similar damages, it's essential to file this report. Even minor injuries or fatalities necessitate the completion of this form. Oregon law mandates that you submit your report within 72 hours of the incident, emphasizing the urgency of timely compliance. Failure to do so may lead to suspension of your driving privileges. It's important to note that even if law enforcement files a police report, you still need to complete your own report with the DMV. This form requires detailed information, including the date, location, and time of the crash, as well as insurance details and descriptions of the events leading up to the accident. For commercial vehicle operators, additional reporting requirements apply. Understanding the requirements and ensuring accurate completion of the form can significantly impact your legal standing and insurance claims, making it essential to act promptly and diligently.
Similar forms
Police Report: Similar to the Oregon DMV Accident Report, a police report is filed after a traffic incident, documenting the details of the crash. Both require comprehensive information about the involved parties, vehicles, and circumstances surrounding the accident. However, while the police report is generated by law enforcement, the DMV report is the responsibility of the drivers involved.
Insurance Claim Form: An insurance claim form is used to report damages and injuries to an insurance company, much like the DMV report serves to inform the state about the accident. Both documents require specific details about the incident, including the extent of damage and involved parties, but the insurance claim focuses on recovery of costs rather than legal reporting.
- Employee Handbook Form: To effectively structure your workplace policies, consider our thorough Employee Handbook guidelines for comprehensive compliance and clarity.
Incident Report: An incident report, often used in workplace or organizational contexts, shares similarities with the DMV Accident Report in terms of documenting what occurred during an event. Both reports aim to provide a clear account of the facts, but the incident report may also include internal procedures and follow-up actions that the DMV report does not address.
Traffic Collision Report: This document is similar in purpose to the Oregon DMV Accident Report, as it records the specifics of a traffic collision. Like the DMV report, it includes details such as time, location, and parties involved. However, a traffic collision report is typically prepared by law enforcement, focusing more on the legal aspects of the incident.
Preview - Oregon Dmv Accident Report Form
OREGON TRAFFIC C
2//,6,21
AND INSURANCE REPORT
Tear this sheet off your report, read and carefully follow the directions.
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If you are not able to file D UHSRUW within 72 hours RI WKH FROOLVLRQ, submit RQH as soon as possible. If you GR QRW ILOH D
UHSRUWZKHQUHTXLUHG 2UHJRQ ODZ UHTXLUHV '09 WR VXVSHQG \RXU driving privileges. <RX VWLOO QHHG WR ILOH D UHSRUW ZLWK
'09HYHQ LI ODZ HQIRUFHPHQW ILOHV D SROLFH UHSRUW When required to report, \RX PXVW ILOH D UHSRUW HYHQ LI
\RX DUHOLFHQVHG LQDQRWKHU VWDWH RU \RX DUH QRW DQ 2UHJRQ UHVLGHQW DMV does not determine fault in a cROOLVLRQ,
but ZH DUH UHTXLUHG E\ ODZ WR post the cROOLVLRQ to the driving record of drivers required to report If you have
questions, please call WKH DMV Crash Reporting Unit at (503) 945-5098.
INSTRUCTIONS
PRINT OR TYPE ALL INFORMATION. (Use black or dark blue ink and press firmly.)
• Complete both sides of the form.
• If additional vehicles were involved in the cROOLVLRQ, complete the attached Supplemental Report (Form 735-32B)
Or, on a blank piece of paper, write all the information as requested in Section 4 — the “Other Vehicle” Section.
• DMV will verify the insurance information \RXsubmit. '09PD\VXVSHQG\RXUGULYLQJSULYLOHJHVLI\RXGRQRWFRPSOHWH
WKHLQVXUDQFHVHFWLRQ
SECTION 1
DATE, LOCATION AND TIME — Clearly identify the date, location and time of the cROOLVLRQ. ThLV LQIRUPDWLRQ LV FULWLFDOIRU
processing your report. If you GRQWNQRZthe county, contact any local law enforcement agency for KHOS
SECTION 2
Your vehicle is Vehicle #1. Complete ALL fields. :ULWH \RXU Lnsurance company name (not agent), policy
number, and Yehicle identification number (VIN). '09 PD\ VXVSHQG \RXU GULYLQJ SULYLOHJHV LI \RX IDLO WR JLYH FRPSOHWH
LQVXUDQFHDQGYHKLFOHLQIRUPDWLRQ
SECTION 3
&KHFNDOOVWDWHPHQWVWKDWDSSO\ PrincipDl purpose of driving and being paid to drive does not LQFOXGH driving to a destination to
perform a service. PropertyLncludes, but is not limited to, fixed or real property, landscaping, signs, parked vehicles, and
animals.
COMMERCIAL MOTOR VEHICLE OPERATORS: In addition to this report, Oregon Administrative Rule requires that Form
735-9229, Motor Carrier CROOLVLRQ Report
,
MUST be filed within 30 days of a commercial motor vehicle cROOLVLRQ when there is
a FATALITY, INJURY (requiring treatment away from the scene), or when a vehicle is TOWED from the scene because of
disabling damage. Form 735-9229 (attached on back) MUST be submitted with Oregon Traffic CROOLVLRQ and Insurance Report
(Form 735-32) to DMV.
You may file the Motor Carrier CROOLVLRQ Report RQOLQHat: www.oregontruckingonline.com/cf/MCAD/pubMetaEntry/accidentRpt/
SECTION 4
OTHER VEHICLE (# 2) — Completion of this information will help DMV match all drivers¶ cROOLVLRQ reports more
efficiently. If additional vehicles were involved in the cROOLVLRQ, complete attached Supplemental Report (Form 735-32B).
SECTION 5
DESCRIPTION AND SIGNATURE — Describe what happened. It is important for you to sign and date the form.
COMPLETING AND FILING REPORT
HOW TO SUBMIT A REPORT TO DMV:
• 2QOLQHDW'0982UHJRQJRYVFDQ45FRGHRQWKLVSDJH
• Fax to 503-945-5267
• Mail to DMV Crash Reporting Unit 1905 Lana Ave NE, Salem, Oregon 97314
• Deliver to a DMV ILHOGoffice
Keep a copy of the report and documentation that shows when you submitted your report to Oregon DMV. Under ORS
802.220(5), DMV is not authorized to provide you with a copy of the report that you file. If submitting by:
• Fax, many fax machines provide the option to generate a fax confirmation report. Save that report.
• DMV Iield Rffice, request and save that receipt.
PURSUANT TO OREGON INSURANCE LAW, AN INSURANCE COMPANY CANNOT REQUIRE REPAIRS BE MADE TO A
MOTOR VEHICLE BY A PARTICULAR PERSON OR REPAIR SHOP.
735-32 (-2)
STK# 300009
INSTRUCTIONS
TOTALED VEHICLE NOTICE
DEFINITIONS AND INSTRUCTIONS FOR TOTALED VEHICLES
IF YOUR C2//,6,21 HAS RESULTED IN A “TOTALED” VEHICLE, YOU ARE REQUIRED BY
LAW TO FOLLOW APPROPRIATE INSTRUCTIONS IN THIS NOTICE.
DEFINITION OF “TOTALED” VEHICLE
“Totaled Vehicle” or “Totaled” as defined in Oregon law (ORS 801.527) means:
• A vehicle that is declared a total loss by an insurer who is obligated to cover the loss or a vehicle that the insurer
takes possession of or title to.
• A vehicle that has sustained damage that is not covered by an insurer and the estimated cost to repair the vehicle
is equal to at least 80% of the retail market value prior to the damage. “Retail market value” is defined as the
amount shown in publications used by financial institutions (banks or lenders) in this state.
• A vehicle that is stolen, if it is not recovered within 30 days of theft and the loss is not covered by an insurer.
In this
situation, you must notify DMV within 60 days of the theft.
H
FOLLOW THESE INSTRUCTIONS IF YOUR VEHICLE IS TOTALED
H
If your vehicle is totaled, in addition to completing the cROOLVLRQ report, follow the instruction that is applicable to
your case. Either:
1. SURRENDER the title to the insurer if the damage is covered by an insurer who declares the vehicle to be a
“total loss,” and the insurer takes possession of the vehicle; or
2. SURRENDER the title to DMV and apply for salvage title if the damage is covered by an insurer who declares
the vehicle to be a “total loss,” but you keep possession of the vehicle; or
3. SURRENDER the title to DMV and apply for salvage title if the damage was not covered by an insurer and the
estimated cost of repair is at least 80% of the retail market value of the vehicle before the damage; or
4. NOTIFY DMV that your vehicle has been totaled if, for some reason, you are unable to obtain the title for
surrender. You must provide DMV with a signed statement which includes:
• A description of the vehicle which includes the year model, make, plate number and vehicle identification
number.
• A statement indicating the vehicle has been totaled.
• A statement that you are unable to obtain the title and why.
DO NOT SUBMIT THE TITLE WITH THE C2//,6,21 REPORT. You can obtain the Application
for Salvage Title )RUP from any DMV office, by calling (503) 945-5000, or
on-line at www.oregondmv.com. Application instructions and fee information are on the back of )orm
735-229.
NOTE: It is a Class A misdemeanor with a penalty of imprisonment and/or fine if you fail to comply with the above
requirements. (ORS 819.012)
1
OREGON TRAFFIC C
2//,6,21
AND INSURANCE REPORT
COMPLETE BOTH SIDES
Complete this form if the traffic cROOLVLRQ ZDVFDXVHGE\WKHPRWLRQRIDYHKLFOHRULWVORDGand meets at least one of the reporting
requirements RQWKHIURQWSDJHRIWKLVIRUP. '09PD\VXVSHQG\RXUGULYLQJSULYLOHJHVLI\RXIDLOWRUHSRUWZKHQUHTXLUHG. Call 503-945-5098
SECTION 1
DMV USE ONLY
TIME OF DAY
COUNTY
AM
PM
ALIR
INS CO
M T W TH F
S SN
DAY OF WEEK
:
LI\RXKDYHTXHVWLRQVRUQHHG KHOSZLWK completing the report.
C2//,6,21 DATE00''<<
MILE POST
ROAD ON WHICH C2//,6,21 OCCURRED (Name of street, road or route)
NAME OF NEAREST INTERSECTING ROAD
WITHIN FEET
NS E W
NEAR MILES
N S E W
NAME OF NEAREST CITY / TOWN
WITHIN FEET
N S E W
NEAR MILES
N S
E W
TYPE OF
&2//,6,21
-The cROOLVLRQ involved one or more of the following:
Mark all that apply)
Two vehicles ATV / Snowmobile Parked vehicle
More than two vehicles
Fatality
Motorcycle
Motor Home / RV
Motorized Scooter
Overturned vehicleUROORYHU
Animal
Bicycle
Pedestrian
Personal (assisted)
mobility device
Train
Fixed object / property
Other ____________________
SECTION 2
(YOUR INFORMATION)
Complete ALL fields. '09PD\VXVSHQG\RXUGULYLQJSULYLOHJHVLI\RXIDLOWRJLYHFRPSOHWHLQIRUPDWLRQ
DRIVER’S LAST NAME
FIRST NAME
MIDDLE NAME
DRIVER’S LICENSE NUMBER STATE DATE OF BIRTH00''<<<< GENDER
M F X
DRIVER’S RESIDENCE ADDRESS
CITY STATE ZIP CODE
CHECK BOX
IF ADDRESS
CHANGE
MAILING ADDRESS (IF DIFFERENT THAN RESIDENCE)
CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS
CITY STATE ZIP CODE
SAME
RENTAL?
CITY STATE ZIP CODE
STATE
VEHICLE PLATE NUMBER YEAR MAKE & MODEL
IF ADDITIONAL VEHICLES WERE INVOLVED IN THE C2//,6,21, USE ATTACHED SUPPLEMENTAL REPORT (Form 735-32B).
SECTION 3SECTION 4 (OTHER VEHICLE # 2)
Damage to your vehicle was more than $2500.
statements
Check all
Damage to SURSHUW\RWKHUWKDQDYHKLFOHLQYROYHGLQWKHFROOLVLRQLVRYHU$2500.
that apply:
Your vehicle was towed from the scene as a result of damages.
You or passengers in your vehicle were injuredQRPDWWHUKRZPLQRU .
<RXUYHKLFOHZDVSDUNHG
The cROOLVLRQoccurred while you were driving your employer’s vehicle.
You were driving on your job and being paid for the principal purpose of driving.
You were being paid to drive and/or deliver persons or property.
You were operating a governmentowned vehicle marked for transporting mail in accordance with government rules.
You were operating an authorized emergency vehicle.
The cROOLVLRQ occurred in a work or maintenance zone. ORS 811.230
A police officer came to the scene.
Name of police department: __________________________
City County State Police
You were operating a commercial motor vehicle requiring you to have a commercial driver license.
You were transporting hazardous materialV.
A citation was issued to you. The citation wasIRU: BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
DRIVER’S NAME (LAST, FIRST, MIDDLE)
DRIVER’S LICENSE NUMBER
STATE DATE OF BIRTH GENDER
M F
DRIVER’S ADDRESS CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS CITY STATE ZIP CODE
SAME
INSURANCE COMPANY NAME (NOT AGENT) AND ADDRESS
POLICY NUMBER VEHICLE IDENTIFICATION NUMBER STATE VEHICLE PLATE NUMBER YEAR MAKE & MODEL
SECTION 5
2
DESCRIBE WHAT HAPPENED: (IF MORE SPACE IS NEEDED, SUBMIT ADDITIONAL PAGE)
I certify all information given on this report is true and accurate to the best of my knowledge.
SIGNATURE OF PERSON MAKING REPORT
IF NOT DRIVER’S SIGNATURE, STATE RELATIONSHIP
PRINTED NAME OF PERSON MAKING REPORT DAYTIME PHONE # DATE SIGNED
( )
–
REASON DRIVER IS UNABLE TO SIGN REPORT &217$&7PHONE NUMBER
( )
–
735-32 (-2)
COMPLETE THE OTHER SIDE OF THIS PAGE
STK# 300009
DMV COPY
X
X
INSURANCE COMPANY NAME (NOT AGENT) AND ADDRESS
POLICY NUMBER
VEHICLE IDENTIFICATION NUMBER9,1
Reset Form
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If this cROOLVLRQ involved a pedestrian or
bicyclist, complete the following:
WITNESS INFORMATION:
PEDESTRIAN NAME BICYCLIST NAME
Pedestrian or bicyclist was going:
OCCUPANT INJURY AND SAFETY EQUIPMENT IN<2859(+,&/(
WRITE one of the codes (1–5) in column D
WRITE M, F or X in column A
INJURY CODE FOR OCCUPANTSSAFETY EQUIPMENT CODES
WRITE one of the codes (0–10) in column C
0
1
2
3
4
5
6
7
8
9
No seat belt available
Seat belt available but NOT used
Seat belt available and in use
Child restraint device available but NOT used
Child restraint device in use
Child restraint device not available
Helmet NOT in use
Helmet in use
Air bag deployed
Air bag available - NOT deployed
Air bag NOT available10
1
2
3
4
5
ALONG OR ACROSS:
(name of street, road or route)
6WDUWLQJIrom:
To:
EXAMPLE: (From: NE corner To: SE corner (or) From: East side To: West side, etc.)
GENDER CODE
Gender and age of pedestrian / bicyclist:
M F
X
Age: _____
SEAT
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Fatal
OCCUPANTS¶ NAMES
(your vehicle)
No apparent injury
POSITION
Suspected Serious
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(or none noted)
DRIVER
Pedestrian / bicyclist action: (mark one)
FRONT
CENTER
FRONT
RIGHT
MIDDLE
*
LEFT
MIDDLE
*
CENTER
MIDDLE
*
RIGHT
REAR
LEFT
REAR
CENTER
REAR
RIGHT
Use only for vehicles with middle row of seats (i.e., vans, SUVs, etc.)
*
Diagram
Number each vehicle:
(name of street,
road or route)
Show path by:
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Show pedestrian/bicyclist by:
Show railroad tracks by:
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OTHER DRIVER WAS HEADED
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North
South
East
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burns, unconsciousness, paralysis
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minor lacerations
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SUPPLEMENTAL REPORT
OREGON TRAFFIC
&2//,6,21
Supplemental for more than two drivers involved in the cROOLVLRQ.
Attach this form to your OREGON TRAFFIC C
2//,6,21
AND INSURANCE REPORT.
TIME OF DAY COUNTY
M T W F AM
S SN
DO NOT WRITE
PM
MILE POST
ROAD ON WHICH C2//,6,21 OCCURRED (Name of street, road or route)
IN THIS SPACE
INSURANCE COMPANY NAME (NOT AGEN7) POLICY NUMBER
VEHICLE
#3
VEHICLE IDENTIFICATION NUMBER9,1 VEHICLE PLATE NUMBER STATE YEAR MAKE & MODEL
OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE) DRIVER’S LICENSE NUMBER STATE DATE OF BIRTH GENDER
M F X
DRIVER’S ADDRESS CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS CITY STATE ZIP CODE
SAME
INSURANCE COMPANY NAME (NOT AGEN7) POLICY NUMBER
VEHICLE
#4
VEHICLE IDENTIFICATION NUMBER9,1 VEHICLE PLATE NUMBER STATE YEAR MAKE & MODEL
OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE) DRIVER’S LICENSE NUMBER STATE DATE OF BIRTH
GENDER
M F X
DRIVER’S ADDRESS CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS CITY STATE ZIP CODE
SAME
INSURANCE COMPANY NAME (NOT AGEN7) POLICY NUMBER
VEHICLE
#5
VEHICLE IDENTIFICATION NUMBER9,1 VEHICLE PLATE NUMBER STATE YEAR MAKE & MODEL
OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE) DRIVER’S LICENSE NUMBER STATE DATE OF BIRTH GENDER
M F X
DRIVER’S ADDRESS CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS CITY STATE ZIP CODE
SAME
INSURANCE COMPANY NAME (NOT AGEN7) POLICY NUMBER
VEHICLE
#6
VEHICLE IDENTIFICATION NUMBER9,1 VEHICLE PLATE NUMBER STATE YEAR MAKE & MODEL
OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE) DRIVER’S LICENSE NUMBER STATE DATE OF BIRTH GENDER
M F X
DRIVER’S ADDRESS CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS CITY STATE ZIP CODE
SAME
INSURANCE COMPANY NAME (NOT AGEN7) POLICY NUMBER
VEHICLE
#7
VEHICLE IDENTIFICATION NUMBER9,1 VEHICLE PLATE NUMBER STATE YEAR MAKE & MODEL
OTHER DRIVER’S FULL NAME (LAST, FIRST, MIDDLE) DRIVER’S LICENSE NUMBER STATE DATE OF BIRTH GENDER
M F X
DRIVER’S ADDRESS CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS CITY STATE ZIP CODE
SAME
C2//,6,21 DATE00''<<
'$<2):((.
TH
735-32B (-2)
SUPPLEMENTAL REPORT – USE IF MORE THAN TWO VEHICLES
CRASH ANALYSIS & REPORTING UNIT
MOTOR CARRIER C2//,6,21 REPORT
OREGON DEPARTMENT OF TRANSPORTATION
POLICY, DATA & ANALYSIS DIVISION
(For CMV Drivers Only)
55 &$3,72/67NE 06
SALEM OR 97301
(0$,/2'27&$5&09&UDVK6XSSRUW#RGRWRUHJRQJRY
TELEPHONE 503-986-3507
FAX 503-986-3592
INSTRUCTIONS: IF YOU CHECKED A BOX UNDER THE QUALIFYING VEHICLE COLUMN AND A BOX UNDER THE CRITERIA COLUMN, COMPLETE
THE MOTOR CARRIER C2//,6,21 REPORT SUBMIT TO THE ADDRESS SHOWN ABOVE25 86(7+( /,1.%(/2: 7268%0,7 21/,1(.
IF YOU HAVE ANY QUESTIONS REGARDING FILLING OUT THE MOTOR CARRIER C2//,6,21 REPORT, PLEASE CALL (503) 986-3507.
www.oregontruckingonline.com/cf/MCAD/pubMetaEntry/accidentRpt/
QUALIFYING VEHICLE
COMMERCIAL TRUCK (GVWR OVER 10,000 LBS OR ACTUAL WT AT
TIME OF C2//,6,21 EVEN IF GVWR IS SET UNDER 10,000 LBS)
HAZARDOUS MATERIAL PLACARD
COMMERCIAL BUS (DESIGNED FOR 8 OR MORE PASSENGERS)
FARM TRUCK INTERSTATE (OVER 10,000 LBS.)
FARM TRUCK FOR-HIRE (4 OR MORE AXLES)
FARM TRUCK TOWING TRIPLE TRAILERS
FARM TRUCK (OVER 80,000 LBS.)
CRITERIA
ANY PERSON SUSTAINING A FATALITY (WITHIN 30 DAYS OF THE
C2//,6,21)
ANY PERSON SUSTAINING INJURIES REQUIRING TREATMENT AWAY
FROM THE SCENE
ANY VEHICLE INCURRING DISABLING DAMAGE REQUIRING
REMOVAL FROM THE SCENE BY A TOW TRUCK OR ANOTHER
MOTOR VEHICLE
MOTOR CARRIER NAME
US DOT NUMBER
AUTHORITY/FILE NUMBER
ADDRESS CITY STATE ZIP CODE
DRIVER INFORMATION
DRIVER NAME (LAST, FIRST, MIDDLE) DATE OF BIRTH
CDL / DL NUMBER STATE EXPIRATION DATE OF MEDICAL CERTIFICATELICENSE CLASS
LENGTH OF EMPLOYMENT
YEARS MONTHS
MDA B C
COMPLETE THE FOLLOWING TWO QUESTIONS AS IF DOING A RECAP OF HOURS IN TIME DOCUMENTS AT TIME OF THE C2//,6,21.
AT TIME OF THE C2//,6,21 TOTAL
HOURS DRIVING SINCE LAST OFF-DUTY
PERIOD.
TOTAL HOURS ON DUTY DURING THE PREVIOUS
(FILL OUT ONE ONLY, BASED ON TIME DOCUMENTS)
7 CONSECUTIVE DAYS ____________
8 CONSECUTIVE DAYS ____________
DOES YOUR DRIVER HAVE A MEDICAL WAIVER
YES NO
TYPE OF WAIVER (SIGHT, DIABETES, AMPUTEE, ETC.)
DRIVER INJURY INFORMATION
RELIEF DRIVER INJUREDRELIEF DRIVER KILLED TOTAL NUMBER OF PASSENGERSYOUR DRIVER INJURED
_____KILLED _____ INJURED
YOUR DRIVER KILLED
YES
NO
YES NO YES NO YES NO
OTHER DRIVER INJURY INFORMATION
TOTAL NUMBER OF PEDESTRIANS
_____KILLED _____ INJURED
TOTAL NUMBER OF BICYCLISTS
_____KILLED _____ INJURED
OTHER MOTOR CARRIER INFORMATION
(IF 2 OR MORE MOTOR CARRIERS WERE INVOLVED)
MOTOR CARRIER NAME
VEHICLE LICENSE # AND STATE
DRIVER¶S NAME
DRIVER¶S LICENSE # AND STATE
MOTOR CARRIER VEHICLE INFORMATION
YEAR MAKE UNIT NUMBER LICENSE PLATE # & STATE - TRUCK/TRACTOR/BUS TOTAL NO. OF AXLES
INCLUDING TRAILERS
TRACTOR TYPE (SELECT APPROPRIATE TYPE)
1
Triples (tractor with 3 trailers
5
2
Triples (truck with 2 trailers)
6
3
7
Straight truck-full trailer
4
8
Doubles (any)
Standard
9
Tractor/Semi Trailer
Straight Truck
10
7UDFWRU2QO\
11
Saddlemount
Heavy Haul
Bus/Van (8 or more
passenger capacity)
Auto/Pickup
TOTAL NUMBER OF OTHER DRIVERS
_____KILLED _____ INJURED
TOTAL NUMBER OF OTHER PASSENGERS
_____KILLED _____ INJURED
735-9229 (-2)
COMPLETE REVERSE SIDE
SUPPLEMENTAL – MOTOR CARRIER C2//,6,21 REPORT
TRAILER TYPE (CHECK ONE)
VAN FLATBED TANKER CONTAINER POLE/LOG DUMP BELLY-DUMP CAR CARRIER LIVESTOCK
MOBILE HOME TOTER PASSENGER DROP-BOX GARBAGE BULK-HOPPER
MIXER
6$''/(02817
WRECKER FIXED LOAD HEAVY HAUL UTILITY
COMMODITY INFORMATION
COMMODITY BEING TRANSPORTED AT TIME OF C2//,6,21
WAS A HAZARDOUS COMMODITY BEING HAULED
YES NO
WAS HAZARDOUS MATERIAL RELEASED FROM
THE VEHICLE CARGO(NOT A FUEL RELEASE)
YES NO
HAZARD CLASS
C2//,6,21 INFORMATION
LOCATION OF C2//,6,21 (NEAREST CITY OR TOWN) HIGHWAY AND MILEPOINT/STREET/COUNTY ROAD DIRECTION OF YOUR VEHICLE (CHECK)
N S E W
DATE OF C2//,6,21
TIME
AM
PM
DAY OF THE WEEK (CHECK ONE)
MON TUES WED THU FRI SAT SUN
CONDITIONS AT TIME OF C2//,6,21
WEATHER
(CHECK ONE)
1. CLEAR 2. RAIN 3. SNOW
4. CLOUDY 5. SLEET 6. FOG 7. OTHER
ROAD SURFACE
(CHECK ONE)
1. DRY 2. WET 3.SNOW
4.IC( 5. OTHER
LIGHT CONDITION
(CHECK ONE)
1. DAY 2. DAWN 3. DUSK
4. ARTIFICIAL LIGHTS
5. DARK 6. OTHER
DESCRIBE WHAT HAPPENED BY CHECKING ALL BOXES THAT APPLY. YOUR VEHICLE IS ALWAYS NO.1. IF OTHER VEHICLES WERE INVOLVED, COMPLETE
COLUMNS 2 & 3 TO CORRESPOND TO THE ACTIONS OF THE SAME NUMBERED VEHICLES LISTED ABOVE UNDER "OTHER DRIVER INFORMATION".
VEHICLES
1 2 3
ACTION VEHICLES
1 2 3
ACTION VEHICLES
1 2 3
ACTION
SLOWING - STOPPING
STOPPED
REAR-END
BACKING
MAKING RIGHT TURN
MAKING LEFT TURN
MAKING U TURN
PROCEEDING STRAIGHT
INTERSECTION
ENTERING TRAFFIC
(FROM SHOULDER,
MEDIAN, PARKING STRIP OR PRIVATE DRIVE)
PASSING
CHANGING LANES
SIDESWIPE
HEAD-ON
SKIDDING
VEHICLE OUT OF CONTROL
ROLL-AWAY
CONTROLLED RR CROSSING
UNCONTROLLED RR CROSSING
RAN OFF ROAD
JACKKNIFE
OVERTURN
SEPARATION OF UNITS
FIRE
EXPLOSION
CARGO SHIFT
CARGO SPILL (HAZARDOUS)
CARGO SPILL (NON-HAZARDOUS)
OTHER (DEER, GUARDRAIL, ETC)
DID YOUR VEHICLE STRIKE A PARKED VEHICLE WAS YOUR PARKED VEHICLE STRUCK BY ANOTHER VEHICLE
YES NO YES NO
DESCRIPTION OF C2//,6,21 (BY CARRIER OR DRIVER)
NAME AND TITLE OF PERSON SIGNING REPORT TELEPHONE NUMBER(S)
SIGNATURE I CERTIFY THE INFORMATION PROVIDED IS TRUE AND ACCURATE
X
DATE
Key takeaways
Here are key takeaways regarding the Oregon DMV Accident Report form:
- Filing Requirement: Drivers involved in a crash with damages over $2,500, injuries, or fatalities must file a report.
- Deadline: Reports must be submitted within 72 hours of the accident.
- Consequences of Non-Reporting: Failing to report may lead to suspension of driving privileges.
- Police Reports: Even if a police report is filed, you are still required to submit your own report.
- Insurance Information: Complete the insurance section accurately to avoid potential suspension.
- Commercial Vehicles: Additional forms are required for commercial motor vehicle crashes.
- Signature Requirement: Only the driver or an authorized family member can sign the report.
- Submission Methods: Reports can be submitted via email, fax, mail, or in person at a DMV office.
- Keep Documentation: Retain a copy of your report and any submission confirmations for your records.
Find Other Templates
Oregin - Complete every section of the application form to ensure full consideration.
Food Stamp Contact Number - Submitting your changes efficiently ensures the continued support of your household's nutritional needs.
To properly establish your business in Maryland, you will need the correct legal documentation. For this purpose, consider utilizing the streamlined Articles of Incorporation form, a vital step in your entrepreneurial journey, by visiting this page: necessary Articles of Incorporation template.
Oregon Department of Revenue - Employers must keep a record of the application as part of their employment documentation.
File Details
| Fact Name | Details |
|---|---|
| Filing Requirement | Drivers involved in crashes resulting in damages over $2,500, injuries, or fatalities must file a report. |
| Filing Deadline | Reports must be submitted within 72 hours of the crash. Delays should be avoided. |
| Consequences of Non-Compliance | Failure to file can lead to suspension of driving privileges, as per ORS 802.220(5). |
| Insurance Information | Complete insurance details are mandatory. Incomplete information may trigger a Notice of Suspension. |
| Commercial Vehicle Requirement | Commercial motor vehicle operators must also file Form 735-9229 within 30 days for serious incidents. |
Documents used along the form
The Oregon DMV Accident Report form is an essential document for drivers involved in a traffic crash. However, several other forms and documents are often required or helpful in conjunction with this report. Below is a list of these documents, along with a brief description of each.
- Supplemental Report (Form 735-32B): This form is used when more than two vehicles are involved in a crash. It allows drivers to provide additional information about other parties involved.
- Motor Carrier Crash Report (Form 735-9229): Required for commercial motor vehicle operators, this report must be filed within 30 days of an accident involving a fatality, injury, or a vehicle towed due to disabling damage.
- Application for Salvage Title (Form 735-229): If a vehicle is deemed totaled, this form is necessary to apply for a salvage title, allowing the owner to retain possession of the vehicle.
- Insurance Claim Form: This document is submitted to an insurance company to initiate a claim for damages or injuries resulting from the accident.
- Police Report: If law enforcement responds to the accident, a police report may be generated. This report can provide an official account of the incident and is often required by insurance companies.
- Witness Statements: Collecting statements from individuals who witnessed the accident can provide additional context and support for claims made in the accident report.
- Medical Records: If injuries occurred, medical records may be necessary to document treatment and support any claims for medical expenses.
- Power of Attorney for a Child form - This legal document allows a parent or guardian to grant another adult the authority to make decisions on behalf of their child. For more information, visit Forms Georgia.
- Vehicle Repair Estimates: These estimates detail the costs associated with repairing the vehicle, which can be important for insurance claims.
- Driver's License Copies: Providing copies of all drivers' licenses involved in the accident can help verify identity and insurance coverage.
- Photographs of the Scene: Visual documentation of the accident scene can be valuable for understanding the circumstances and assessing liability.
Each of these documents plays a crucial role in ensuring that all aspects of the accident are properly reported and addressed. Having them ready can facilitate smoother communication with insurance companies and legal entities involved in the aftermath of a crash.