GEORGIA MOTOR VEHICLE CRASH REPORT OVERLAY ALCOHOL AND/OR DRUG TEST GIVEN OPERATOR CONTRIBUTING FACTORS ROADWAY CONTRIBUTING FACTORS VEHICLE TYPE 1-Yes 1-No Contributing Factors 1-No Contributing Factors 1-Passenger Car 2-No 2-Under the Influence (U.I.) 2-Shoulder (none, low, soft, high) 2-Pickup Truck 3-Refused 3-Following Too Close 3-Ruts, Holes, Bumps 3-Truck Tractor (Bobtail) 4-Failed to Yield 4-Loose Material On Surface 4-Tractor/Trailer TEST TYPE 5-Exceeding Speed Limit 5-Water Standing 5-Tractor W/Twin Trailers 1-Blood 6-Disregard Stop Sign/Signal 6-Work Zone (construction/maintenance/utility) 6-Logging Truck 2-Breath 7-Wrong Side of Road 7-Running Water 7-Logging Tractor/Trailer 3-Urine 9-Improper Passing 8-Other 8-Single Unit Truck 4-Other 10-Driver Lost Control 9-Backup Due to Prior Crash/Secondary Crash 9-Panel Truck 11-Changed Lanes Improperly 10-Traffic Congestion 10-Van FIRST / MOST HARMFUL EVENT 12-Reaction to Object or Animal 11-Road Surface Condition (wet, icy, snow, slush, etc.) 11-Sports Utility Vehicle (SUV) Non Collision 13-Improper Turn 12-Obstruction in Roadway 12-Vehicle With Trailer 1-Overturn 14-Parked Improperly 13-Visual Obstruction(s) – Other Along Roadway 13-Bus 2-Fire/Explosion 17-Misjudged Clearance 14-Visual Obstruction(s) – Vegetation Along Roadway 14-Truck Towing House Trailer 3-Immersion 18-Improper Backing 15-Incident Response Scene 15-Ambulance 4-Jackknife 19-No Signal/Improper Signal 16-Motorized Recreational Vehicle 5-Other Non-Collision 20-Driver Condition DIRECTION OF TRAVEL 17-Motorcycle 35-Cargo/Equipment Loss or Shift 22-Too Fast for Conditions 1-North 18-Moded, Scooter, or Minibike Collision With Object Not Fixed 23-Improper Passing of School Bus 2-South 19-Pedalcycle or Bicycle 6-Pedestrian 24-Disregard Police – Traffic Control 3-East 20-Farm or Construction Equip. 7-Pedalcycle 26-Other 4-West 21-All Terrain Vehicle (ATV) 8-Railway Train/Street Car 28-Inattentive or Other Distraction (Distracted) 22-Other 9-Animal 29-Texting (Distracted) VEHICLE MANEUVER 23-Golf Cart or Go Cart 10-Parked Motor Vehicle 30-Talking on Hands-Free Device (Distracted) 1-Turning Left 11-Motor Vehicle in Motion 31-Talking on Hand-Held Device (Distracted) 2-Turning Right VISION OBSCURED BY 13-Other Object (Not Fixed) 32-Other Activity-Mobile Device (Distracted) 3-Making U-Turn 1-Not Obscured 14-Deer 33-Occupant Distraction (Distracted) 4-Stopped 2-Headlights 36-Work Zone/Maintenance Equipment 34-Other Interior Distraction (Distracted) 5-Straight 3-Sunlight/Glare Collision With Fixed Object 35-Other Exterior Distraction (Distracted) 6-Changing Lanes 4-Parked/Stopped Vehicle 15-Impact Attenuate 36-Disregard Other Traffic Control 7-Backing 5-Trees, Bushes 16-Bridge Pier/Abutment 37-Reckless Driving 8-Parked 6-Rain, Snow, Ice on Windshield 17-Bridge Parapet End 38-Aggressive Driving 9-Passing 7-Other 18-Bridge Rail 39-Racing 10-Negotiating a Curve 19-Guardrail Face 40-Disregard Police – Evasion 11-Entering/Leaving Parking AREA OF INITIAL CONTACT 20-Guardrail End 41-Not Visible (Object, Person, or Vehicle) 12-Entering/Leaving Driveway 00-Overturned 21-Median Barrier 42-Vision Obscured 13-PIT 13-Top 22-Highway Traffic Sign Post 14-Other 14-Undercarriage 23-Overhead Sign Support VEHICLE CONTRIBUTING FACTORS 15-Non-Contact Vehicle 24-Luminaire Light Support 1-No Contributing Factors NON-MOTORIST MANEUVER 16-Not Applicable – Pedestrian 25-Utility Pole 2-Tire Failure 1-Crossing, Not at Crosswalk 26-Other Post 3-Brake Failure 2-Crossing at Crosswalk 27-Culvert 4-Improper or Inoperative Lights/Signals 3-Moving With Traffic on Roadway 28-Curb 5-Steering Failure 4-Moving Against Traffic on Roadway 29-Ditch 6-Slick Tires 5-Pushing or Working on Vehicle 30-Embankment 7-Other 6-Other Working in Roadway 31-Fence 8-Mirrors 7-Playing in Roadway 32-Mailbox 9-Power Train 8-Standing in Roadway 33-Tree 10-Suspension 9-Off Roadway 34-Other-Fixed Object 11-Truck Coupling/Trailer Hitch/Safety Chains 10-Other 37-Bridge Overhead Structure 12-Windows/Windshield 11-Darting Into Traffic 38-Cable Barrier 13-Wipers 12-Entering/Exiting Bus 13-Entering/Exiting Parked or Standing Vehicle OPERATOR/PEDESTRIAN CONDITION 1-Not Drinking VEHICLE CLASS 2-Unknown 1-Privately Owned 4-U.I. Alcohol 2-Police 5-U.I. Drugs 3-Fire 6-U.I. Alcohol & Drugs 4-School 7-Physical Impairment 5-Other Govt. Owned 8-Suspected Fatigued or Asleep 6-Military 9-Emotional (depressed, angry, disturbed, etc.) 7-Commercial Motor Vehicle (CMV) 10-Suspected U.I. (Alcohol and/or Drugs) 8-Other 9-Non-Transport Emergency Services Vehicle/HERO GDOT-523 Overlay 10-Passenger Service Vehicle (Taxi) (07/17) DAMAGE TO VEHICLE VEHICLE CONFIGURATION LIGHT CONDITION EJECTION 1-No Damage 1-Bus (Seating for More Than 15 Passengers) 1-Daylight 1-Not Ejected 2-Minor Damage 2-Single Unit Truck: 2 Axles 2-Dusk 2-Trapped 3-Functional Damage 3-Single Unit Truck: 3 or More Axles 3-Dawn 3-Totally Ejected 4-Disabling Damage 4-Truck Trailer 4-Dark – Lighted 4-Partially Ejected 5-Truck Tractor (Bobtail) 5-Dark – Not Lighted 5-Not Applicable TRAFFIC-WAY FLOW 6-Tractor Trailer 1-Two-way Traffic-way With No Physical Separation 7-Tractor With Twin Trailers AGE EXTRICATION (Equipment Used) 2-Two-way Traffic-way With a Physical Separation 8-Unknown Heavy Truck (Cannot Classify) 00-Up to One Year 1-Yes 3-Two-way Traffic-way With a Physical Barrier 9-Bus/Large Van (seats for 9-15 occupants, including driver) 01 to 97-Actual Age 2-No 4-One-way Traffic-way 10-Vehicle 10,000 Pounds or Less Placarded for Hazardous Materials 98-Ninety-eight years old or Older 5-Continous Turning Lane 99-Unknown AIR BAG FUNCTION PAGE 2 ATTRIBUTES (SHADED) 0-No Air Bag in this Seat ROAD COMPOSITION MANNER OF COLLISION SEX 1-Deployed Air Bag 1-Concrete 1-Angle M-Male F-Female 2-Non-Deployed Air Bag 2-Black Top 2-Head On 3-Deployed Side 3-Tar and Gravel 3-Rear End SEATING POSITION 4-Deployed other Directions 4-Dirt 4-Sideswipe – Same Direction 1-Front Seat – Left Side (Operator) 5-Deployed Multiple Directions 5-Gravel 5-Sideswipe – Opposite Direction 2-Front Seat – Middle 6-Non-Deployed Front 6-Other 6-Not a Collision With a Motor Vehicle 3-Front Seat – Right Side 7-Non-Deployed Side 4-Rear Seat – Left Side 8-Non-Deployed Other Direction ROAD CHARACTER LOCATION AT AREA OF IMPACT 5-Rear Seat – Middle 9-Non-Deployed Multiple Directions 1-Straight and Level 1-On Roadway – Non-Intersection 6-Rear Seat – Right Side 10-Deployed Curtain 2-Straight on Grade 2-On Shoulder 7-Other Seat – Interior 3-Straight on Hillcrest 3-Off Roadway 8-Riding on Vehicle Exterior INJURY 4-Curve and Level 4-Median 9-Non-Motorist – Outside of a Vehicle 0-No Apparent Injury (O) 5-Curve on Grade 5-Entrance/Exit Ramp 1-Fatal Injury (K) 6-Curve on Hillcrest 6-Gore 2-Suspected Serious Injury (A) 7-On Roadway – Roadway Intersection 3-Suspected Minor or Visible Injury (B) WORK ZONE 8-On Roadway – Roundabout 4-Possible Injury or Complaint (C) 0-None 9-On Roadway – Driveway Intersection 1-Construction 10-On Roadway – Railroad Crossing TAKEN FOR TREATMENT 2-Maintenance 11-On Roadway – Managed Lane (HOV, HOT, Reversible) 1-Yes 3-Utility 12-On Roadway – Collector Distributor (CD) 2-No 4-Unknown Type 13-On Roadway – Bicycle Lane 14-On Roadway – In Crosswalk TRAFFIC CONTROL 15-Off Roadway – Sidewalk 0-Gate 16-Private Property 1-No Control Present 2-Traffic Signal WEATHER 3-RR Signal/Sign 1-Clear 4-Warning Sign 2-Cloudy 5-Stop Sign 3-Rain 6-No Passing Zone 4-Snow 7-Lanes 5-Sleet 8-Other 6-Fog 9-Flashing Lights 7-Other 10-Yield Sign 8-Severe Thunderstorm or Tornadic CARGO BODY TYPE SURFACE CONDITION 1-Van (Encl. Box) 1-Dry SAFETY EQUIPMENT 2-Auto Carrier or Tow Truck 2-Wet 0-None Used 3-Bus 3-Snow 1-Shoulder Belt Only Used 4-Dump 4-Ice/Frost 2-Lap Belt Only Used 5-Garbage/Refuse 5-Other 3-Lap and Shoulder Belt Used 6-Flatbed 6-Mud 4-Child Restraint System (Properly Used) 7-Cargo Tanker 7-Sand 5-Child Restraint System (Improperly Used) 8-Concrete Mixer 8-Slush 6-Motorcycle Helmet 9-Other 9-Oil 7-Bicycle Helmet 10-Hopper 10-Water (standing or moving) 8-Unknown 11-Intermodal Container Chassis 9-Booster Seat (Properly Used) 12-Pole-Trailer 10-Booster Seat (Improperly Used) 11-Non-Motorist Lighting 12-Reflective: Clothing/Backpack/Equipment GDOT-523 Overlay (07/17)