The Minnesota Accident Report form is a crucial document that records details of motor vehicle accidents in the state. Required for any crash involving property damage exceeding $1,000 or resulting in injury or death, this form must be completed and submitted to Driver and Vehicle Services within ten days. Compliance with this requirement is essential, as failure to do so may result in legal penalties.
To ensure accurate reporting, please fill out the form by clicking the button below.
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The Missouri Compromise was a crucial step in addressing the escalating tensions surrounding slavery in America. By allowing Missouri to join the Union as a slave state and Maine as a free state, it aimed to preserve the delicate balance of power between differing factions. For those looking to gain a deeper understanding of the intricacies of this agreement, the Missouri PDF Forms provide valuable resources and information.
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When dealing with a motor vehicle accident in Minnesota, several forms and documents may accompany the Minnesota Accident Report form. Each of these documents serves a specific purpose and can help streamline the process of reporting and managing the aftermath of an accident.
Gathering these documents can help ensure a smoother process following an accident. Each piece of information contributes to a clearer understanding of the event and can assist in resolving any related claims or disputes.
What is the purpose of the Minnesota Accident Report form?
The Minnesota Accident Report form is designed to collect important information about motor vehicle accidents. This data helps improve road safety by allowing authorities to analyze accident trends and causes. If your accident involved $1,000 or more in property damage, or resulted in injury or death, completing this form is mandatory.
Who is required to complete the Minnesota Accident Report form?
Every driver involved in a crash that meets the specified criteria must complete the form. This includes accidents with property damage exceeding $1,000, as well as any accidents that result in injury or death. It is crucial to submit the report to Driver and Vehicle Services within 10 days of the accident to comply with Minnesota law.
What happens if I fail to submit the form?
Failure to submit the Minnesota Accident Report form within the required timeframe is considered a misdemeanor under Minnesota Statute 169.09, subdivision 7. This means you could face legal consequences. It is essential to complete and send the form promptly to avoid any penalties.
Where do I send the completed Minnesota Accident Report form?
Once you have completed the Minnesota Accident Report form, mail it to the following address: DVS / Accident Records, 445 Minnesota Street, Suite 181, St. Paul, MN 55101-5181. Ensure that you keep a copy for your records before sending it off.
Filling out the Minnesota Accident Report form can be a daunting task, especially during a stressful time following an accident. However, making mistakes on this form can lead to complications, so it’s essential to be thorough and accurate. Here are eight common mistakes people often make when completing this form.
One frequent error is not including all required information. The form asks for specific details about the accident, including the names and addresses of all parties involved. Omitting any of this information can result in delays or even legal repercussions. Ensure that every section is filled out completely, as incomplete forms may be considered invalid.
Another common mistake is failing to report the accident within the required timeframe. Minnesota law mandates that the report must be submitted within 10 days of the accident. Missing this deadline can lead to penalties. Set a reminder to ensure the form is sent on time, as timely reporting is crucial.
People also often misidentify the location of the accident. It’s important to provide precise details about where the incident occurred. Whether it’s an intersection or a specific street, clear descriptions help authorities understand the context of the accident. Double-check the information before submission to avoid confusion.
Many individuals overlook the importance of providing accurate insurance information. The form requires details about your insurance policy, including the name of the insurance company and the policy number. If this information is missing or incorrect, it may be assumed that you do not have insurance, which can lead to significant consequences.
Another mistake is not documenting the accident's circumstances thoroughly. The section asking for a description of the accident should be filled out with as much detail as possible. Vague descriptions can lead to misunderstandings about what happened. Be clear and concise in your explanation to help clarify the situation.
Some people fail to sign the form before submission. A signature is essential as it verifies that the information provided is accurate to the best of your knowledge. Without a signature, the report may be considered incomplete, which can delay processing.
Additionally, not keeping a copy of the completed report for personal records is a common oversight. Having a copy can be beneficial for future reference, especially if disputes arise regarding the accident. It’s wise to maintain your own records to support your account of events.
Lastly, many individuals neglect to review the form for errors before submitting it. Simple mistakes, such as typos or incorrect dates, can have significant implications. Take a moment to proofread the completed form to ensure that all information is accurate and complete.
By being mindful of these common mistakes, you can ensure that your Minnesota Accident Report is filled out correctly, helping to facilitate a smoother process in the aftermath of an accident.
The Minnesota Accident Report form shares similarities with the police accident report. Both documents serve to document the details of a vehicle accident, including information about the parties involved, the circumstances of the crash, and any damages incurred. Police reports are typically filled out by law enforcement officers at the scene and may include additional investigative details that can aid in legal proceedings. Like the Minnesota form, police reports are essential for insurance claims and can be used to establish fault in accidents.
Another comparable document is the insurance claim form. This form is used by individuals to report an accident to their insurance company and request compensation for damages or injuries. Similar to the Minnesota Accident Report, the insurance claim form requires detailed information about the accident, including the parties involved, the extent of damages, and any injuries sustained. Both documents are critical in processing claims and determining liability, ensuring that all relevant information is documented for review.
For landlords and tenants alike, understanding the important aspects of the Notice to Quit process is crucial. This form provides a formal means for landlords to communicate lease violations and may help in resolving disputes efficiently before escalating to eviction proceedings.
The motor vehicle registration form also resembles the Minnesota Accident Report in that it collects essential information about vehicle ownership and details. While the registration form is primarily used for legal identification of vehicles, it shares the common goal of maintaining accurate records related to vehicle operation. Both documents help authorities track vehicles involved in accidents and ensure compliance with state regulations.
Lastly, the driver’s license application form bears similarities to the Minnesota Accident Report as it gathers personal information about the driver. This includes details such as name, address, and date of birth. Both documents emphasize the importance of accurate identification and accountability on the road. While the application form focuses on granting driving privileges, it indirectly relates to accident reporting by ensuring that only qualified individuals operate vehicles.
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)
P
DISTANCE
DIRECTION
L
MILES
N
NOT AT INTERSECTION
FEET
S
W FROM:
(Number)
IN PARKING LOT
DESCRIBE LOCATION:
D DRIVER’S FULL NAME
ADDRESS
STATE
ZIP CODE
INJURY
R
CODE*
Y
V
DRIVER’S LICENSE NUMBER
CLASS
STATE OF ISSUE
DATE OF BIRTH
SEX
VE
E R
H
OWNER’S FULL NAME
LICENSE PLATE NUMBER
PARTS OF VEHICLE DAMAGED
ESTIMATE COST TO REPAIR
$
TYPE (CAR, PICKUP, VAN, SUV, MOTORCYCLE, TRUCK, ETC.)
MAKE
MODEL
COLOR
# OF OCCUPANTS
IGIVE FULL LIABILITY INSURANCE INFORMATION OR IT WILL BE ASSUMED YOU DID NOT HAVE INSURANCE
SPLEASE NAME OF INSURANCE COMPANY (NOT AGENCY)
U
COPY
Automobile Insurance
FROM
POLICY NUMBER
Policy Period: from
to
POLICY
Name of Policy Holder
Address
Your Signature X
D
OTHER
FULL NAME
O
DRIVER
OTHER FULL NAME
HE
OWNER
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?
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
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)
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
2- SIDESWIPE - SAME DIRECTION
6- RIGHT TURN
98- NOT APPLICABLE
3- LEFT TURN
7- RAN OFF ROAD - RIGHT SIDE
MY
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
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
W
7
3
47- PLAYING IN ROADWAY
6
4
48- NOT IN ROADWAY
5
CONTINUE
WAS THERE A POLICE
IF YES, WHAT DEPARTMENT (NAME OF CITY, COUNTY OR STATE PATROL)
OFFICER AT THE
REPORT ON
SCENE?
OTHER SIDE
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
OCCUPANT SEAT POSITION CODES
SAFETY EQUIPMENT TYPE
RESTRAINT DEVICE USED
SAFETY EQUIPMENT USED
EJECTION CODES
INJURY 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
8- BOOSTER SEAT NOT USED
90- OTHER DEPLOYMENTS
10- OUTSIDE OF VEHICLE
(MOTORCYCLE,
9- BOOSTER SEAT USED IMPROPERLY
11- TRAILING UNIT
SNOWMOBILE, ECT.)
10- BOOSTER SEAT USED PROPERLY
12- PICKUP TRUCK BED
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)
PASSENGER NAME
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
DAMAGED:
OWNER:
ESTIMATE COST OF REPAIR
SIGN HERE X
SIGNATURE OF PERSON SUBMITTING REPORT IS REQUIRED
DATE OF REPORT
MAIL THIS REPORT TO:
DVS / ACCIDENT RECORDS
445 MINNESOTA STREET, SUITE 181
ST. PAUL, MN 55101-5181