Blank Oregon Dmv Accident Report Form Open Editor Now

Blank Oregon Dmv Accident Report Form

The Oregon DMV Accident Report Form is a crucial document that drivers must complete following a traffic crash that meets specific criteria. This form is necessary when damages exceed $2,500, injuries occur, or a vehicle is towed from the scene. Timely submission of this report is mandated by law, with a 72-hour window for filing after the incident.

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The Oregon DMV Accident Report form is a crucial document for drivers involved in traffic crashes within the state. It is designed to ensure that all necessary information is collected promptly and accurately. If a crash results in damages exceeding $2,500 to any vehicle or property, or if there are injuries or fatalities, the involved drivers are legally required to file this report within 72 hours. The form includes several sections that guide users in detailing the specifics of the incident, such as the date, time, and location of the crash, as well as information about the vehicles and drivers involved. Additionally, it requires drivers to provide their insurance details, which the DMV will verify. Failing to submit the report can lead to suspension of driving privileges, making compliance essential. The form also emphasizes that even if a police report is filed, drivers must still complete their own report. For commercial motor vehicle operators, there are additional reporting requirements to fulfill. Understanding the importance of this form and the procedures for completing it can help drivers navigate the aftermath of an accident more effectively.

Form Example

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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• 'DPDJHWRDQ\RQHVSURSHUW\RWKHUWKDQDYHKLFOH
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LQYROYHGLQWKHFROOLVLRQLVRYHU
YHKLFOHLVWRZHGIURPWKHVFHQH
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
UHSRUWZKHQUHTXLUHG 2UHJRQ ODZ UHTXLUHV '09 WR VXVSHQG \RXU driving privileges. <RX VWLOO QHHG WR ILOH D UHSRUW ZLWK
'09HYHQ LI ODZ HQIRUFHPHQW ILOHV D SROLFH UHSRUW When required to report, \RX PXVW ILOH D UHSRUW HYHQ LI
\RX DUHOLFHQVHG LQDQRWKHU 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 \RXsubmit. '09PD\VXVSHQG\RXUGULYLQJSULYLOHJHVLI\RXGRQRWFRPSOHWH
WKHLQVXUDQFHVHFWLRQ
SECTION 1
DATE, LOCATION AND TIME — Clearly identify the date, location and time of the cROOLVLRQ. ThLV LQIRUPDWLRQ LV FULWLFDOIRU
processing your report. If you GRQWNQRZthe 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
LQVXUDQFHDQGYHKLFOHLQIRUPDWLRQ
SECTION 3
&KHFNDOOVWDWHPHQWVWKDWDSSO\ PrincipDl purpose of driving and being paid to drive does not LQFOXGH driving to a destination to
perform a service. PropertyLncludes, 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 RQOLQHat: 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:
• 2QOLQHDW'0982UHJRQJRYVFDQ45FRGHRQWKLVSDJH
• Fax to 503-945-5267
• Mail to DMV Crash Reporting Unit 1905 Lana Ave NE, Salem, Oregon 97314
• Deliver to a DMV ILHOGoffice
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 ZDVFDXVHGE\WKHPRWLRQRIDYHKLFOHRULWVORDGand meets at least one of the reporting
requirements RQWKHIURQWSDJHRIWKLVIRUP. '09PD\VXVSHQG\RXUGULYLQJSULYLOHJHVLI\RXIDLOWRUHSRUWZKHQUHTXLUHG. 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\RXKDYHTXHVWLRQVRUQHHG KHOSZLWK completing the report.
C2//,6,21 DATE00''<<
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 vehicleUROORYHU
Animal
Bicycle
Pedestrian
Personal (assisted)
mobility device
Train
Fixed object / property
Other ____________________
SECTION 2
(YOUR INFORMATION)
Complete ALL fields. '09PD\VXVSHQG\RXUGULYLQJSULYLOHJHVLI\RXIDLOWRJLYHFRPSOHWHLQIRUPDWLRQ
DRIVER’S LAST NAME
FIRST NAME
MIDDLE NAME
DRIVER’S LICENSE NUMBER STATE DATE OF BIRTH00''<<<< 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\RWKHUWKDQDYHKLFOHLQYROYHGLQWKHFROOLVLRQLVRYHU$2500.
that apply:
Your vehicle was towed from the scene as a result of damages.
You or passengers in your vehicle were injuredQRPDWWHUKRZPLQRU .
<RXUYHKLFOHZDVSDUNHG
The cROOLVLRQoccurred while you were driving your employer’s vehicle.
You were driving on your job and being paid for the principal purpose of driving.
You were being paid to drive and/or deliver persons or property.
You were operating a governmentowned vehicle marked for transporting mail in accordance with government rules.
You were operating an authorized emergency vehicle.
The cROOLVLRQ occurred in a work or maintenance zone. ORS 811.230
A police officer came to the scene.
Name of police department: __________________________
City County State Police
You were operating a commercial motor vehicle requiring you to have a commercial driver license.
You were transporting hazardous materialV.
A citation was issued to you. The citation wasIRU: BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
DRIVER’S NAME (LAST, FIRST, MIDDLE)
DRIVER’S LICENSE NUMBER
STATE DATE OF BIRTH GENDER
M F
DRIVER’S ADDRESS CITY STATE ZIP CODE
VEHICLE OWNER’S NAME AND ADDRESS CITY STATE ZIP CODE
SAME
INSURANCE COMPANY NAME (NOT AGENT) AND ADDRESS
POLICY NUMBER VEHICLE IDENTIFICATION NUMBER STATE VEHICLE PLATE NUMBER YEAR MAKE & MODEL
SECTION 5
2
DESCRIBE WHAT HAPPENED: (IF MORE SPACE IS NEEDED, SUBMIT ADDITIONAL PAGE)
I certify all information given on this report is true and accurate to the best of my knowledge.
SIGNATURE OF PERSON MAKING REPORT
IF NOT DRIVER’S SIGNATURE, STATE RELATIONSHIP
PRINTED NAME OF PERSON MAKING REPORT DAYTIME PHONE # DATE SIGNED
( )
–
REASON DRIVER IS UNABLE TO SIGN REPORT &217$&7PHONE 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 NUMBER9,1
Reset Form
'$7(2)%,57+
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<2859(+,&/(
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)
6WDUWLQJIrom:
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
3RVVLEOH
Fatal
OCCUPANTS NAMES
(your vehicle)
No apparent injury
POSITION
Suspected Serious
6XVSHFWHG0LQRU
(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:
X
Show pedestrian/bicyclist by:
Show railroad tracks by:
Show fixed object by:
X
YOU INTENDED TO...
YOUR VEHICLE7<3(
WEATHER CONDITIONS
6QRZ
'XVW
ROAD SURFACE
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LIGHT CONDITIONS
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YOUR RESIDENCE
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West
On: ____________________
(name of street, road or route)
OTHER DRIVER WAS HEADED
On: ____________________
(name of street, road or route)
Vehicle Damage,PSDFW3RLQWV
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9HKLFOHWRZHG
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(name of street,
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(name of street,
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South
East
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West
North
South
East
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1:
Fatal
Suspected Serious: severe laceration,broken
or distorted limb, crush injury, significant
burns, unconsciousness, paralysis
Suspected Minor: lump, abrasions, bruises,
minor lacerations
PossiblePRPHQWDU\ORVVRIFRQVFLRXVQHVV
FODLPRILQMXU\OLPSLQJFRPSODLQWRISDLQRU
QDXVHD
No apparent
Crossing at intersection or crosswalk
Crossing not at intersection or crosswalk
Walking RU riding in roadway with traffic
Walking RU riding in roadway against traffic
StandingRUO\LQJGRZQ in roadway
Pushing or working on vehicles in roadway
Other working in roadZD\
3OD\LQJLQURDG
Hitchhiking
Not in roadway
8VLQJSHUVRQDOPRELOLW\GHYLFHHJ
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Other
VSHFLI\_________________________
7RWDOHG
8QNQRZQ
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EQP BAG
A B C D
YOU WERE HEADED
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 NUMBER9,1 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 NUMBER9,1 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 NUMBER9,1 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 NUMBER9,1 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 NUMBER9,1 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 DATE00''<<
'$<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 &$3,72/67NE 06
SALEM OR 97301
(0$,/2'27&$5&09&UDVK6XSSRUW#RGRWRUHJRQJRY
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 ABOVE25 86(7+( /,1.%(/2: 7268%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
DRIVERS NAME
DRIVERS 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
7UDFWRU2QO\
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
↓ Oregon Dmv Accident Report PDF Form

Document Characteristics

Fact Name Details
Reporting Requirement Drivers must file a report if vehicle damage exceeds $2,500, property damage exceeds $2,500, or if there is any injury.
Filing Deadline Reports must be submitted within 72 hours of the accident.
Failure to Report Not reporting may lead to suspension of driving privileges.
Police Report If police file a report, drivers still need to file their own Crash and Insurance Report.
Non-Residents Even out-of-state drivers must file a report with the Oregon DMV if involved in a crash.
Fault Determination The DMV does not determine fault in accidents but will record the incident on driving records.
Commercial Vehicles Commercial drivers must also file the Motor Carrier Crash Report within 30 days for serious incidents.
Insurance Information Complete insurance details are necessary to avoid suspension of driving privileges.
Legal Reference ORS 802.220(5) outlines the requirement to file a report with the DMV.
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