Alabama Uniform Traffic Crash Report Once the Traffic

Alabama Uniform Traffic Crash Report Once the Traffic Crash Report Form has been successfully completed, it can be entered in to this Accident Report Database. Simply copy all information as it is recorded on the Crash Report into the corresponding Titles and categories within this program. To Begin Click NEXT Page 1 The TAB key will cycle your cursor from one text field to the next, and the NEXT and BACK buttons will let you move freely both forward and backwards through the program.

Page 2 [Location and Time] Section 1 Check if Amendment: 1. 2. DPS Case #: Local Case #: 4. Date: Time: 5. M 3. Check if Error Correction: 10. On Street, Road, or Hwy? 11. At Intersection or Between? (node 2) 12. And (Node 2) am T W R pm F 13. (On) Street/Road/Hwy Code: (Check Day of Week) 14. Node Code (1) Node Code (2) 1. 2. 3. 4. County: City: Local Zone: Hwy Class: 15. Feet/Miles From Node (1)

Page 3 [Location and Time] Section 1 o Continue Filling in all applicable information. 16. Mile Post: 21. 1 st Harmful Event: 26. Manner of Crash: 17. Control Access Hwy Loc: 22. 1 st Harmful Event Loc: 27. Lat. Coordinates: 18. Primary Contrib. Circums: 23. Most Harmful Event: 28. Long Coordinates: 19. Primary Contrib. Unit No: 24. Clearance to Fixed Object: 29. Primary Contrib. Unit No: (feet) 20. Manner of Crash: 25. Roadway Junction Feature 30. Highway Side: Proceed to Section 2 (Driver / Vehicle Info) upon completion of this page

Page 4 Section 2 [Driver / Vehicle] o. The Driver/Vehicle details found here in Section 2 directly correspond to the 2 nd section of the Alabama Uniform Traffic Crash Report Driver’s Information o o o o Driver’s License Information o o o Driver’s License No: DL Status: List Endorsements: o Driver Last Name: Driver First Name: Street Address: City: State: Zip: Telephone: DOB: Race: Sex: DL State: DL Class: List Restrictions: Less Than 25 Miles: Yes No CDL Status:

Page 5 Section 2 [Driver / Vehicle] Additional Details on Driver Information Ø Ø Ø Ø Ø Place of Employment: Liability Insur Comp: Social Security No: Driver Condition: Sobriety/Officer Opinion: Alcohol: Drugs: Type of Test Given: Add’tl Tests: Travel Road Name: Road Code: Travel Direction: Other Contrib. Circum: Sequence of Events 1. Event 1 2. Event 2 3. Event 3 4. Event 4 5. First Harmful Event Location When Complete, Continue on to Vehicle Information.

Page 6 [Driver / Vehicle] Section 2 Details of Vehicle Involved in Accident Vehicle Information v Vehicle Yr: Make: v Model: Body: Additional Vehicle Info v Haz. Cargo Released? v VIN Number: v Attachment: v Owner’s Name: v Oversized Load (Req’ Permit? ) Yes No v License Tag No: v If Yes, Did Owner Have Permit? Yes No v State: Year: v Street or RFD: v Contrib Defect: Speed Limit: v Est Speed Limit: Citation: v City: State: v Damage Severity: v Zip: Type: v Under/Over: v Usage: Emergency St: v Placard Req’d: Towed? v Vehicle Towed by Whom? v To Where? v Hazard Cargo: Proceed to Section 3 once this section has been successfully completed.

Page 7 Section 3 [Driver / Vehicle] o. The Driver/Vehicle details found here in Section 2 directly correspond to the 2 nd section of the Alabama Uniform Traffic Crash Report Driver’s Information o o o o Driver’s License Information o o o Driver’s License No: DL Status: List Endorsements: o Driver Last Name: Driver First Name: Street Address: City: State: Zip: Telephone: DOB: Race: Sex: DL State: DL Class: List Restrictions: Less Than 25 Miles: Yes No CDL Status:

Page 8 Section 3 [Driver / Vehicle] Additional Details on Driver Information Ø Ø Ø Ø Ø Place of Employment: Liability Insur. Comp: Social Security No: Driver Condition: Sobriety/Officer Opinion: Alcohol: Drugs: Type of Test Given: Add’tl Tests: Travel Road Name: Road Code: Travel Direction: Other Contrib. Circum: Sequence of Events 1. Event 1 2. Event 2 3. Event 3 4. Event 4 5. First Harmful Event Location When Complete, Continue on to Vehicle Information.

Page 9 [Driver / Vehicle] Section 3 Details of Vehicle Involved in Accident Vehicle Information v Vehicle Yr: Make: v Model: Body: Additional Vehicle Info v Haz. Cargo Released? v VIN Number: v Attachment: v Owner’s Name: v Oversized Load (Req’ Permit? ) Yes No v License Tag No: v If Yes, Did Owner Have Permit? Yes No v State: Year: v Street or RFD: v Contrib Defect: Speed Limit: v Est Speed Limit: Citation: v City: State: v Damage Severity: v Zip: Type: v Under/Over: v Usage: Emergency St: v Placard Req’d: Towed? v Vehicle Towed by Whom? v To Where? v Hazard Cargo: Proceed to Section 3 once this section has been successfully completed.