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Understanding the complexities of a motor vehicle crash and the essential documentation that follows can be overwhelming. In Massachusetts, individuals involved in a motor vehicle crash must navigate these complexities through the completion and submission of the Commonwealth of Massachusetts Motor Vehicle Crash Operator Report. This mandatory form is a critical document required by M.G.L. Chapter 90, Section 26, to be completed and filed by operators involved in accidents resulting in personal injury, fatality, or property damage exceeding $1,000. It serves not only as a detailed account of the event but also as a vital tool for legal and insurance proceedings. Operators or vehicle owners must ensure the report is filed with the Registrar within five days, despite any incapacitating conditions preventing immediate action. The form is designed to capture every aspect of the crash from location, vehicle information, individuals involved, to the conditions that may have contributed to the incident. Through clear instructions and the requirement for precise details, such as the crash diagram and witness information, the form aims to provide a comprehensive framework for accurately documenting the incident. Moreover, failure to adhere to these requirements may lead to legal repercussions, including license suspension. Hence, completing this form accurately is not only a legal obligation but a crucial step in the post-accident process, ensuring all involved parties have the necessary information to proceed.

Ma Vehicle Accident Report Sample

Commonwealth of Massachusetts

Motor Vehicle Crash Operator Report

When should I complete a Crash Report?

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

How To Complete This Form

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

Section A: Crash Location

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

Complete section A1 or A2.

Use official names of all locations, streets and landmarks.

Use street name and route #, if applicable.

Be as precise as possible when describing the location.

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

Section B: Vehicle Yon Were Driving

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

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

Section C: You and Your Passengers

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

Use the codes provided to indicate occupant information.

Section D: Other Vehicles Involved in the Crash

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

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

Section E: Non-Motorist(s) Involved

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

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

Section F: Crash Conditions

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

Section G: Crash Diagram

Draw a diagram of how the crash occurred.

On the diagram, Vehicle 1 represents your vehicle.

Section H: Witness Information

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

Section I: Property Damage Information

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

Section J: Description of What Happened

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

Section K: Signature

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

Where to send completed reports:

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

Mail one copy to your Insurance Company.

Mail one copy to the RMV at the following address:

Registry of Motor Vehicles Crash Records

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

CRASH102_1119

A. Crash Location

A1. City/Town Where Crash Occurred

 

A2. Date of Crash

 

 

 

 

A3. Time of Crash

 

 

AM

A4. # Vehicles Involved:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

A5. Did the crash occur at an

 

Yes

No

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

intersection of two or more streets?

 

 

 

 

 

 

 

If Yes.

Step 1. Please indicate the route or roadway where

If No.

 

Step 1. Please

indicate the route, roadway and address where the

 

you were travelling when the crash occurred:

 

crash occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

at Street or Address Number:

 

 

 

 

 

 

 

 

 

 

 

 

The crash occurred on Route #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

on the Street/Roadway known as

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

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

 

 

 

 

 

 

 

 

The crash occurred

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

(estimate number of feet)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of:

a) Mile Marker number

 

 

 

 

 

 

 

 

 

 

OR: b) Exit Number

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR: c) Intersecting

 

 

 

 

 

 

 

Route# Name of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/Roadway

 

 

 

 

 

 

 

Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

OR: d) Landmark

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Vehicle You Were Driving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

B2. Was vehicle damage above $1000?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B3. Driver’s License Number

B4. License State

B5. DOB

 

B6. Age

B7. Sex

 

 

M

 

X

B8. License Class

D

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

 

U

 

Unknown

C

B

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B9. Commercial Driver’s License Endorsements

P (Passenger transport)

T (Doubles/Triples)

H (Hazardous)

X (Tank and Hazardous)

N (Tank vehicles)

S School Bus

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

B12. Street Address

City

B10. Vehicle Travel Direction

N

S

E

W

State

 

 

Zip Code

B13. Insurance Company

B14. Vehicle Registration #

B15. Reg. Type

B16. Reg. State

B17. Vehicle Year

B18. Vehicle Make

B19. Indicate your type of vehicle

4

Bus (16 or more passengers)

9 Truck tractor (bobtail)

1

Passenger car

5

Bus (9-15 passengers)

 

10 Tractor/semi-trailer

2

Light truck (van, mini-van,

 

6

Single-unit truck (2 axles)

11 Tractor/doubles

 

pick-up, sport utility)

 

7

Single-unit truck (3 or more axles)

12 Tractor/triples

 

3

Motorcycle

 

8 Truck/trailer

 

13 Unknown heavy truck

 

 

 

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

 

 

B21. Street Address

City

 

 

 

 

 

 

 

 

 

 

14 Motor home/ recreational vehicle

15 Moped

16 Low Speed

Vehicle

State

17 All terrain vehicle( ATV)

18Snowmobile

97Other

99Unknown

Zip Code

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

5 Changing lanes

8

Making U-turn

11 Parked

1 Travelling straight ahead

3

Turning right

6

Entering traffic lane

9

Overtaking/passing

97 Other

2 Slowing or stopped

4

Turning left

7

Leaving traffic lane

10 Backing

 

99 Unknown

 

 

 

 

 

 

 

 

 

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

What happened first?

Second?

Third?

Fourth?

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Collision with

9

Railway vehicle

25

Median barrier

32 Crash cushion/

1 Motor vehicle in traffic

jh

(train, engine)

26

Ditch

jh Impact attenuator

2 Parked motor vehicle

10

Other movable object

33 Bridge

27

Embankment/

3 Pedestrian

11

Unknown movable

jh

Sloping shoulder

34 Bridge overhead

4 Cyclist

jh

object

28

Highway traffic

jh structure

20

Curb

35 Other fixed

5 Animal- deer

jh signpost

21

Tree

29

Overhead sign

jh object (wall,

6 Animal- other

jh building, tunnel)

22

Utility pole

jh

support

7 Moped

30

Fence

36 Unknown fixed

23

Light pole or other

8 Work zone

31

Mailbox

object

jh

post/support

 

maintenance

24

Guardrail

 

 

 

equipment

 

 

 

Non-Collision

40 Ran off road right

41 Ran off road left

42 Cross median/ jh centerline

43Overturn/rollover

44Equipment failure jh (blown tire, brakes, jh etc)

45Fire/explosion

46Immersion

47Jackknife

48Cargo/equipment loss jh or shift

49Separation of units

50Downhill runaway

51Other non-collision

52Unknown non-collision

97Other

99Unknown

B24. Was your

 

 

Vehicle Towed

Yes

No

from the Scene

 

 

Due to Damage?

 

 

B25. Vehicle Damaged Area (check up to three)

2

3

4

 

 

 

0 None

97 Other

1

9

5

10 Undercarriage

99 Unknown

 

 

 

11 Totaled

 

8

7

6

 

 

CRASH102_1119

C. You and Your Passengers

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

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

 

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

C1. Passenger 1 (Last, First, Middle)

C2. Address

City

 

State

Zip Code

C3. DOB

C4. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C5. Passenger 2 (Last, First, Middle)

C6. Address

City

 

State

Zip Code

C7. DOB

C8. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C9. Passenger 3 (Last, First, Middle)

C10. Address

City

 

State

Zip Code

C11. DOB

C12. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seating

Safety

Air Bag

 

Ejected

 

 

 

 

Transported

Name of Medical

 

System

 

From

 

 

 

 

for Medical

 

Position

Used

Status

 

Vehicle?

Trapped?

 

Injured?

Care?

 

Facility

 

Driver

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Seating Position

 

 

1

Front seat - left side (or

8

Third row - middle

 

motorcycle driver)

9

Third row - right side

2

Front seat - middle

10

Sleeper section of cab

3

Front seat - right side

11

Enclosed passenger area

4

Second seat - left side (or

12

Unenclosed passenger area

 

motorcycle passenger)

5

Second seat - middle

13

Trailing unit

14

Riding on vehicle exterior

6

Second seat - right side

97

Other

7

Third row - left side (or

Safety System Used

0None used

1Shoulder and lap belt

2Lap belt only

3Shoulder belt only

4Child safety seat

5Helmet

97Unknown

Air Bag Status

1Deployed-front

2Deployed-side

3Deployed both front and side

4Not deployed

5Not applicable

97Unknown

 

motorcycle passenger)

 

99 Unknown

 

Ejected From Vehicle?

 

Trapped?

 

0

Not ejected

3

Not

0

Not trapped

2 Freed by

1

Totally ejected

k applicable

1

Freed by

k non-mechanical

97

 

d means

2

Partially ejected

Unknown

 

mechanical

 

97 Unknown

 

 

 

 

 

means

Injured?

Transported for Medical Care?

1

Fatal

1

Not transported

3

Police

7

Suspected serious injury

2

EMS

97

Other

8

Suspected minor injury

 

(emergency

99

Unknown

9

Possible Injury

 

service)

10

No apparent injury

 

 

 

 

D. Other Vehicle(s) Involved in the Crash

 

D1. Number of occupants

 

D2. Number of

 

 

 

 

D3. Was Vehicle

Yes

No

 

D4. Moped?

 

D5. Hit and Run?

 

in the Vehicle:

 

 

injured occupants

 

 

 

Damage above $1000?

 

Yes

 

No

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D6. Driver’s License Number

 

 

D7. License State

D8. DOB

 

D9. Age

D10. Sex

M

X

D11. License Class

D

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

U

 

Unknown

 

C

B

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D12. Commercial Driver’s License Endorsements

P (Passenger transport)

 

T (Doubles/Triples)

 

D13. Vehicle Travel Direction

 

 

 

H (Hazardous)

X (Tank and Hazardous)

N (Tank vehicles)

 

 

 

S School Bus

 

 

 

N

S

 

E

W

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

D15. Street Address

 

City

 

 

State

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D16. Insurance Company

 

D17. Vehicle Registration #

 

D18. Reg. Type

D19. Reg. State

D20. Vehicle Year

 

D21. Vehicle Make

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D22. Indicate your type of vehicle

4 Bus (16 or more passengers)

 

 

9 Truck tractor (bobtail)

14 Motor home/

 

 

17 All terrain

 

1 Passenger car

 

 

5 Bus (9-15 passengers)

 

 

10 Tractor/semi-trailer

recreational vehicle

vehicle( ATV)

 

2 Light truck (van, mini-van,

 

 

15 Moped

 

 

 

 

18 Snowmobile

 

6 Single-unit truck (2 axles)

 

 

11 Tractor/doubles

 

 

 

 

 

 

pick-up, sport utility)

 

 

 

 

16 Low Speed

 

 

 

 

97 Other

 

 

7 Single-unit truck (3 or more axles)

 

 

12 Tractor/triples

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 Motorcycle

 

 

 

 

 

 

Vehicle

 

 

 

 

99 Unknown

 

 

 

8 Truck/trailer

 

 

 

 

 

 

 

 

13 Unknown heavy truck

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

D24. Street Address

 

City

 

 

State

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

D26. Vehicle Damaged Area (check up to three)

0 None

 

 

 

1 Travelling straight

 

5 Changing lanes

 

9 Overtaking/passing

 

2

 

 

3

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 Undercarriage

 

ahead

 

6 Entering traffic lane

 

10 Backing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 Slowing or stopped

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11 Totaled

 

 

 

7 Leaving traffic lane

 

11 Parked

 

 

 

1

 

 

9

 

5

 

 

 

 

 

 

 

3 Turning right

 

 

 

 

 

 

 

 

 

 

 

 

97 Other

 

 

 

 

8 Making U-turn

 

97 Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 Turning left

 

 

 

 

 

8

 

 

7

 

6

 

 

 

 

99 Unknown

 

 

 

 

 

 

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CRASH102_1119

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

E1. Indicate the type of non-motorist involved

1 Pedestrian

2 Cyclist

 

3 Skater

 

97 Other

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

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

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

 

 

 

 

 

1 Entering or crossing

4

Pushing vehicle

 

97 Other

1 Marked crosswalk

4

In roadway

 

8

Shoulder

 

location

5

Approaching or

 

99 Unknown

 

at intersection

 

5

Not in roadway

 

9

Sidewalk

 

2 Walking, running, or

 

2 At intersection but

 

 

 

leaving vehicle

 

 

 

6

Median (but not on

10

Shared-use

 

cycling

6

Working on vehicle

 

no crosswalk

 

 

 

 

 

shoulder)

 

 

path or trails

 

3 Working

3 Non-intersection

 

 

 

 

 

7 Standing

 

 

 

 

7

Island

 

99

Unknown

 

 

 

 

 

 

crosswalk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

E5. Street Address

City

 

 

State Zip Code

 

E6. DOB

 

E7. Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E8. Safety Equipment?

8

Reflective clothing

 

E9. Injured?

8

Suspected

 

10 No

 

E10. Transported for Medical Care?

 

0 None used

9

Lighting

 

1 Fatal

 

 

1 Not transported

3

Police

 

6 Helmet

 

7 Suspected

g

minor injury

 

apparent

2 EMS (emergency

97 Other

 

10

Other

 

9

Possible

 

 

injury

 

 

7 Protective pads

 

 

serious

 

 

 

service)

 

 

99 Unknown

 

99

Unknown

 

 

injury

 

Injury

 

 

 

 

 

 

 

 

 

(elbows, knees, etc.)

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F. Crash Conditions

F1. Light Conditions

97Other

1 Daylight

2 Dawn

99Unknown

3 Dusk

 

4 Dark - lighted

 

roadway

 

5 Dark - roadway not lighted

6 Dark - unknown roadway lighting

F2. Weather Conditions (up to two)

1 Clear

7 Severe

2 Cloudy

crosswinds

8 Blowing

3 Rain

sand, snow

4 Snow

97 Other

5 Sleet, hail,

99 Unknown

freezing

 

rain

 

6 Fog, smog,

 

smoke

 

F3. Traffic Control Device

1 No controls

2 Stop signs

3 Traffic control signal

4 Flashing traffic control signal

5 Yield signs

6 School zone signs

7 Warning signs

8 Railroad crossing device

99 Unknown

F4. Road Surface

1 Dry

2 Wet

3 Snow

4 Ice

5 Sand, mud, dirt, oil, gravel

6 Water (standing, moving)

7 Slush

97 Other

99 Unknown

F5. Trafficway Description

 

 

F6. Manner of Collision

 

 

6 Head on

F7. Roadway Intersection Type

 

 

 

1 Two-way, not divided

 

 

1 Single vehicle crash

 

1 Not at intersection

 

7 Traffic circle

 

 

2 Two-way, divided, unprotected median

 

2 Rear-end

7 Rear to rear

 

2 Four-way intersection

 

8 Five-point or more

 

3 Two-way, divided, protected median

 

3 Angle

 

 

 

 

 

99 Unknown

 

3 T-intersection

 

9 Driveway

 

 

4 One-way, not divided

 

 

4 Sideswipe, same

 

 

 

 

4 Y-intersection

 

10 Railway grade

 

99 Unknown

 

 

direction

 

 

 

 

5 On ramp

 

crossing

 

 

 

5 Sideswipe, opposite

 

 

 

 

 

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6 Off ramp

 

 

 

 

 

 

 

 

 

 

 

direction

 

 

 

 

 

 

 

 

F8. Was the traffic control device

Yes

No

 

F9. School Bus Related?

Yes

No

F10. Work Zone Related?

Yes

No

functioning at the time of the crash?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. Crash Diagram

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Indicate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

North by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Arrow

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please draw a diagram of the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

roadway or streets where the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

crash occurred, indicating the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

vehicles involved and direction of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

travel using the following symbols:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Direction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= Vehicle 1 (Your Vehicle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= Vehicle 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= Pedestrian/Non-motorist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

= North

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select one of the following if the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

crash did not occur on a public

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

way:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Off-street parking lot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Garage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mall/shopping center

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other private way

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CRASH102_1119

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H. Witness Information

H1. Witness Name (Last, First, Middle)

H2. Street Address

City

State

Zip Code

H3. Phone

H4. Witness Name (Last, First, Middle)

H5. Street Address

City

State

Zip Code

H6. Phone

I. Property Damage Information (Other than Vehicles)

I1.

Owner Name (Last, First, Middle)

I2. Street Address

I3. Phone

I4.

Property and Damage Description

 

 

 

 

 

 

 

 

I5.

Owner Name (Last, First, Middle)

I6. Street Address

I7. Phone

I8.

Property and Damage Description

 

 

 

 

 

 

 

J.

Description of What Happened

 

 

 

 

 

 

 

 

 

 

 

K. Signature

“Signed under Pains and Penalties of Perjury”

 

Print

 

Date

 

 

 

 

 

 

 

CRASH102_1119

Form Breakdown

Fact Detail
Governing Law M.G.L. Chapter 90, Section 26
Report Requirement Report must be filed if there is a death, injury, or property damage over $1,000.
Submission Deadline Within five days of the crash, unless incapacity prevents it.
Submission Entities Registrar, local police department, and insurance company.
Owner's Requirement If the operator is incapacitated and not the owner, the owner must file the report.
Penalties Licence revocation or suspension for non-compliance.
Additional Acceptance Police must accept reports for vehicle damage under $1,000 if another vehicle unlawfully left the scene.
Form Sections Includes sections for crash location, involved vehicles and occupants, non-motorists, crash conditions, and a crash diagram.

How to Write Ma Vehicle Accident Report

After experiencing a vehicular accident in the Commonwealth of Massachusetts, prompt and accurate completion of the Motor Vehicle Crash Operator Report is critical. This document is essential not only for legal and insurance purposes but also for ensuring that all involved parties are accounted for, and any necessary actions can be taken. Following these steps closely will ensure that the form is filled out correctly and comprehensively.

  1. Section A: Crash Location
    1. Specify the city or town where the crash occurred.
    2. Enter the date (A2) and time (A3 AM/PM) of the crash.
    3. Indicate the number of vehicles involved (A4).
    4. Answer if the crash occurred at an intersection (A5) and provide detailed location information based on your response.
  2. Section B: Vehicle You Were Driving
    1. Fill in details about the vehicle you were driving, including the number of occupants (B1) and if the vehicle damage was above $1000 (B2).
    2. Provide driver and vehicle specifics such as driver’s license number (B3), license state (B4), and vehicle registration details (B14 to B18).
    3. Specify the type of vehicle you were driving (B19) and the vehicle's owner information (B20, B21).
  3. Section C: You and Your Passengers
    1. List details of all passengers including their full name, address, date of birth or age, and seating information.
    2. Use the codes provided to indicate safety system used and injury details for each occupant.
  4. Section D: Other Vehicles Involved in the Crash
    1. For other vehicles involved, record the number of occupants, any injuries, and vehicle damage.
    2. Enter driver, vehicle, and insurance information for the other vehicles involved.
    3. If more than one vehicle is involved, use additional forms for each.
  5. Section E: Non-Motorist(s) Involved
    1. Provide information about any non-motorist involved in the accident, including their actions prior to and at the time of the crash.
    2. Include safety equipment used and injury details.
  6. Section F: Crash Conditions
    1. Describe the light and weather conditions, road surface, and trafficway description at the time of the crash.
    2. Specify the manner of collision and type of roadway intersection.
  7. Section G: Crash Diagram
    1. Draw a diagram indicating the crash location, direction of vehicles involved, and any relevant signs or signals.
  8. Section H: Witness Information
    1. List names and contact details of any witnesses to the crash.
  9. Section I: Property Damage Information
    1. Document any non-vehicular property damage resulting from the crash.
  10. Section J: Description of What Happened
    1. Provide a narrative description of the crash, detailing events leading up to, during, and following the incident.
  11. Section K: Signature
    1. Sign and print your name, then date the form, affirming the accuracy of the information under penalties of perjury.

Once the report is fully completed, mail or deliver copies as directed: one to the local police department or state police where the crash occurred, one to your insurance company, and one to the RMV at the specified address. Ensuring this form is filled out accurately and submitted promptly supports all involved parties and is a legal requirement in the aftermath of a vehicle accident in Massachusetts.

Discover More on Ma Vehicle Accident Report

When am I required to complete a Massachusetts Vehicle Accident Report form?

You must complete a Massachusetts Vehicle Accident Report form if you were involved in a vehicle crash within the state that resulted in (i) any fatality, (ii) an injury, or (iii) property damage exceeding $1,000 to any one vehicle or property. This form must be filed with the Registrar within five days of the crash, unless physical incapacity prevents you from doing so. Additionally, copies must be sent to the police department with jurisdiction over the area where the crash occurred and to your insurance company.

What should I do if I am unable to complete the report due to physical incapacity?

If you are physically unable to complete the report due to injuries from the crash, the vehicle owner or another individual may complete and file the report on your behalf within the five-day period. It is important to gather as much information about the crash as possible to ensure the report is filled out accurately.

Where do I send the completed Massachusetts Vehicle Accident Report form?

Three copies of the completed form should be distributed as follows: one copy should be mailed or delivered to the local police department or state police in the jurisdiction where the crash occurred, one copy should be sent to your insurance company, and one copy should be mailed to the Registry of Motor Vehicles, Crash Records, P.O. Box 55889, Boston, MA 02205-5889.

What information is required in the Crash Location section of the form?

In the Crash Location section, you need to provide the city or town where the crash occurred, the date and time of the crash, and the number of vehicles involved. You should specify whether the crash happened at an intersection and give detailed information, including official names of locations, streets, route numbers, and landmarks to accurately describe the location.

What if the crash involved damage to property other than vehicles?

If the crash resulted in damage to property other than vehicles, such as fences, buildings, or public infrastructure, details about this property and the extent of the damage should be included in Section I of the form. Remember, a police department must accept a report if another person unlawfully left the scene, even if the vehicle damage does not exceed $1,000.

How should I document the vehicles and passengers involved in the crash?

For each vehicle (including yours) involved in the crash, you need to provide detailed information such as license number, state, vehicle make and model, and the number of occupants at the time of the crash in Section B. For passengers, Section C requires full names, addresses, dates of birth or ages, and seating positions along with safety equipment used and any injuries sustained.

Is a diagram of the crash necessary?

Yes, Section G of the form requires a diagram of the crash. It should include the layout of the roadway or scene, the position and direction of travel of the vehicles involved, and any relevant traffic controls. This helps in visulizing the sequence of events leading to the crash.

What do I do if more than one non-motorist was involved in the crash?

If the crash involved more than one non-motorist, such as pedestrians, cyclists, or skaters, an additional form must be used for each non-motorist involved, completing Section E only. This helps in providing detailed information on each non-motorist's actions and location at the time of the crash.

How do I indicate the cause and conditions of the crash on the form?

The form includes specific codes to describe the cause of the crash, the actions of the drivers and non-motorists, and the conditions under which the crash occurred. These codes help standardize the reporting and ensure clarity when the reports are reviewed by the Registrar, the police, and insurance companies. Select the appropriate codes as instructed in Sections B, C, D, E, and F.

Common mistakes

Filling out the Massachusetts Vehicle Accident Report form is a crucial step following a motor vehicle crash. It's an opportunity to provide an accurate account of what happened, yet it is common for people to make mistakes during this process. Understanding these mistakes can help ensure your report is as accurate and helpful as possible.

  1. Not being precise about the crash location. It's essential to provide specific details about where the crash occurred. Ambiguities in describing the location can lead to confusion or incorrect filing. Remember to use the official names of locations, streets, and landmarks, and specify the route number if applicable.
  2. Omitting details about the vehicles involved. Each vehicle involved in the crash needs to be documented thoroughly in the report. This includes the license, registration details, and a description of the damage. Forgetting to include any of these details could complicate insurance claims or legal proceedings.
  3. Skipping information on passengers. Just as it's crucial to document details about the vehicles, it's equally important to provide information about all passengers in your vehicle at the time of the crash. This includes their full names, addresses, and any injuries they may have sustained.
  4. Incorrectly depicting the crash diagram. The crash diagram is a visual summary of how the collision occurred. An inaccurate or unclear diagram can misrepresent the events leading to the crash, affecting fault determination and insurance claims.
  5. Leaving out witness information. Witnesses can provide objective perspectives on the crash, making their information invaluable. Not including the contact details of witnesses or failing to list them altogether is a significant oversight.
  6. Incomplete description of the crash. The narrative portion of the report, where you describe what happened, is your chance to tell your side of the story. Being too vague or leaving out details can lead to misunderstandings about the crash dynamics.

In summary, when filling out the Massachusetts Vehicle Accident Report form, it's important to be thorough, precise, and clear. Attention to detail can significantly impact the outcome of any subsequent insurance claims or legal matters. Take your time with the form, review all sections before submitting, and ensure that your account of the incident is as complete and accurate as possible.

Documents used along the form

When involved in a vehicle accident in Massachusetts, submitting the Motor Vehicle Crash Operator Report is a crucial step. However, this form is often just the starting point in a series of documentation needed for insurance claims, legal processes, or personal records. Understanding other forms and documents that may accompany the Crash Operator Report can streamline the aftermath of an accident. Here is a list of additional forms and documents that are commonly used:

  • Insurance Claim Form: This document is used to file a claim with an insurance company, detailing the accident and requesting coverage for damages and injuries.
  • Medical Records: Documentation of any medical treatment received as a result of the accident. These records can include doctor's notes, hospital records, and bills, which are crucial for insurance claims and legal cases.
  • Police Report: An official report from the responding police department providing an objective overview of the accident, which can be vital for insurance and legal issues.
  • Witness Statements: Written accounts from individuals who saw the accident occur. These statements can provide additional perspectives on the event and can be critical for establishing fault.
  • Photographs of the Accident Scene: Pictures taken at the scene can document vehicle positions, road conditions, and property damage. These visual details can support your claim or account of the accident.
  • Repair Estimates: Quotes from auto repair shops detailing the expected cost of repairing vehicle damage. These estimates are necessary for insurance claims and negotiations.
  • Rental Car Receipts: If a rental car is used while a vehicle is being repaired, keeping these receipts is important for reimbursement from insurance companies.
  • Personal Injury Journal: A diary or journal detailing the recovery from any injuries. This record can document the impact of the injuries on daily life and can be useful during legal or insurance settlement processes.
  • Proof of Lost Wages: If the accident results in time off work, documentation from an employer detailing lost hours and wages can support claims for compensation.

Collectively, these documents complement the Motor Vehicle Crash Operator Report by providing a comprehensive overview of the accident, its aftermath, and the impacts on those involved. Keeping thorough and organized records ensures that individuals are prepared to navigate the processes of insurance claims and legal proceedings effectively. Remember, each situation is unique, and additional documentation may be necessary depending on the circumstances surrounding the accident.

Similar forms

The MA Vehicle Accident Report form is similar to other legal and administrative documents required in the aftermath of traffic incidents. These documents often share common features, including the collection of detailed information about the incident, participants, and conditions at the time of the event. Notably:

  • Insurance Claim Forms: Like the MA Vehicle Accident Report, insurance claim forms require detailed information about the crash, including the date, time, location, and a description of the incident. Both documents need specifics about the vehicles involved, such as make, model, year, and the extent of damage. This parallel ensures that insurers can assess claims accurately, based on the comprehensive data provided, similar to how traffic departments evaluate reports for legal reasons.
  • Police Reports: Police reports, created by officers responding to the scene of an accident, bear similarities to the MA Vehicle Accident Report in structure and purpose. Both documents record critical information about the incident, including personal details of those involved, descriptions of the event, diagrammatic representations of the crash site, and damage assessments. The primary difference lies in the author; while police reports are completed by law enforcement officials, the MA Vehicle Accident Report is filled out by the individuals involved in the crash. Despite this, both serve as official records that can be used for legal proceedings, insurance assessments, and statistical analyses by transportation departments.
  • Driver’s Accident Reporting Form (in other states): Many states have their own versions of an accident report form that drivers must complete after a vehicle crash, similar to the MA Vehicle Accident Report. These forms typically include sections for indicating the crash location, details of the vehicles and people involved, a narrative description of the accident, and sometimes a diagram. The consistency across these forms, regardless of the state, ensures that regardless of where an accident occurs, there is a formal mechanism for documenting the essential details, which can then be used for legal, insurance, or statistical purposes.

Dos and Don'ts

When completing the Massachusetts Vehicle Accident Report form, there are several guidelines you should follow to ensure the report is filled out correctly and efficiently. Paying attention to these dos and don'ts can aid in the accurate processing of your report.

Do:
  • Complete all sections that apply to your specific crash, providing as much detail as possible.
  • Use official names for locations, streets, and landmarks to describe the crash location accurately.
  • Circle the answer where a choice is given to ensure clarity in your response.
  • Draw a detailed diagram in Section G, indicating the direction of travel and position of vehicles involved.
  • Sign and date the form in Section K to certify the accuracy of the information provided.
  • Mail or deliver copies of the completed form to the local police department, your insurance company, and the RMV as specified.
Don't:
  • Leave any applicable sections incomplete; an incomplete form could delay processing and resolution of your report.
  • Guess on specifics; if you're unsure about certain details, it's better to indicate this than provide inaccurate information.
  • Use nicknames or unclear abbreviations when describing the crash location and involved parties.
  • Omit the witness information in Section H if there were individuals who saw the crash but were not involved.
  • Forget to check if your vehicle damage is above $1,000 in Section B, as this is crucial for the necessity of the report.
  • Submit the report without making a copy for your records; keeping a copy can be helpful for future reference.

Misconceptions

When dealing with the Massachusetts (MA) Vehicle Accident Report form, understanding the facts is crucial. Misunderstandings can lead to errors in filing and potential legal implications. Here are nine common misconceptions about the form and the clarifications you need:

  • Filing is optional if damages seem minor: Massachusetts General Laws (M.G.L.) Chapter 90, Section 26 mandates filing a report for any crash involving injury, death, or property damage over $1,000. It's not optional based on personal judgment of damage severity.
  • Only at-fault drivers must file: All operators involved in a crash that meets the filing criteria must file a report, regardless of fault.
  • Police filing on your behalf suffices: Even if police file a report, operators must independently file their own report with the Registrar and send copies to the local police department and their insurance company.
  • Any writing style is acceptable: The form must be filled out carefully and legibly. Illegible reports will be returned, delaying the process.
  • General location descriptions are enough: The report requires specific location information, including the city/town, streets involved, and exact location details to pinpoint the crash site.
  • Estimating damage under $1,000 avoids reporting: If there's any possibility that the total damage (to all vehicles or property) exceeds $1,000, a report should be filed. Underestimating can lead to legal issues.
  • All sections must be filled out: Only complete sections pertinent to your specific crash. For example, if no non-motorists were involved, Section E would not apply.
  • A diagram is optional: Including a crash diagram (Section G) is crucial for providing a visual representation of the crash, which can significantly aid in understanding the events.
  • The report impacts fault determination: While the report provides critical information, fault is determined by insurance companies based on a broader investigation, not solely on the report.

Becoming familiar with the requirements and common misconceptions of the MA Vehicle Accident Report form is the first step in ensuring that if you're ever involved in a vehicle crash in Massachusetts, your report will be accurate and compliant with state laws.

Key takeaways

When filling out the MA Vehicle Accident Report form, there are several key takeaways to understand:

  • M.G.L. Chapter 90, Section 26 mandates filing this report if a person was killed or injured, or if there was property damage in excess of $1,000 due to a vehicle crash.
  • Reports must be filed with the Registrar within five days of the crash, except if the individual is physically incapable of doing so.
  • A copy of the report also needs to be sent to the police department that has jurisdiction over the location of the crash.
  • If the driver is incapacitated and not the vehicle's owner, the vehicle's owner must file the report within five days, based on available information.
  • The Registrar can request a supplemental report and has the authority to revoke or suspend licenses for non-compliance.
  • Police departments must accept crash reports even for incidents where the damage does not exceed $1,000 if another vehicle unlawfully left the scene.
  • Illegible reports will be returned, so it's crucial to complete the form clearly and comprehensively.
  • Each section of the form serves to collect specific information about the crash, from the location (Section A) and details about the vehicles and individuals involved (Sections B through E), to the conditions under which the crash occurred (Section F), and a diagram of the crash (Section G).
  • Finally, accurate and thorough completion of the report is essential not only for compliance with state laws but also for insurance claims and legal matters that could arise from the crash.
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