ALCOHOL AND / OR DRUG TEST GIVEN 1 – Yes 2 – No 3 – Refused TYPE TEST 1 – Blood 2 – Breath 3 – Urine 4 – Other 1 – Not Drinking 2 – Not Known if U.I. 3 – Drinking Not Impaired 4 – U.I. Alcohol 5 – U.I. Drugs 6 – U.I.Alcohol &Drugs 7 – Physical Impairment 8 – Apparently Fell Asleep DIRECTION OF TRAVEL 1 – North 2 – South 3 – East 4 – West VISION OBSCURED BY 1 – Not Obscured 2 – Headlights 3 – Sunlight 4 – Parked Vehicle 5 – Trees, Bushes 6 – Rain, Snow, Ice on Windshield 7 – Other VEHICLE CONDITION 1 – No Known Defects 2 – Tire Failure 3 – Brake Failure 4 – Improper Lights 5 – Steering Failure 6 – Slick Tires 7 – Other VEHICLE MANEUVER 1 – Turning Left 2 – Turning Right 3 – Making U-turn 4 – Stopped 5 – Straight 6 – Changing Lanes 7 – Backing 8 – Parked 9 – Passing 10 – Negotiating A Curve 11 – Entering/Leaving Parking 12 – Entering/Leaving Driveway PEDESTRIAN MANEUVER 1 – Crossing, Not At Crosswalk 2 – Crossing at Crosswalk 3 – Walking with Traffic 4 – Walking Against Traffic 5 – Pushing Or Working on Vehicle 6 – Other Working in Road 7 – Playing Roadway 8 – Standing in Roadway 9 – Off Roadway 10 -Other 11 -Darting Into Traffic FIRST HARMFUL EVENT/MOST HARMFUL EVENT NON-COLLISION 1 – Overturn 2 – Fire/Explosion 3 – Immersion 4 – Jackknife 5 – Other Non-Collision COLLISION WITH OBJECT NOT FIXED 6 – Pedestrian 7 – Pedalcycle 8 – Railway Train 9 – Animal 10 – Parked Motor Vehicle 11 – Motor Vehicle In Motion 12 – Motor Vehicle In Motion In Other Roadway 13 – Other Object (Not Fixed) 14 – Deer COLLISION WITH FIXED OBJECT 15 – Impact Attenuate 16 – Bridge Pier/Abutment 17 – Bridge Parapet End 18 – Bridge Rail 19 – Guardrail Face 20 – Guardrail End 21 – Median Barrier 22 – Highway Traffic Sign Post 23 – Overhead Sign Support 24 – Luminaire light Support 25 – Utility Pole 26 – Other Post 27 – Culvert 28 – Curb 29 – Ditch 30 – Embankment 31 – Fence 32 – Mailbox 33 – Tree 34 – Other – Fixed Object CONTRIBUTING FACTORS 1 – No Contributing Factors 2 – D.U.I. 3 – Following Too Close 4 – Failed to Yield 5 – Exceeding Speed Limit 6 – Disregard Stop Sign/Signal 7 – Wrong Side Of Road 8 – Weather Conditions 9 – Improper Passing 10 – Driver Lost Control 11 – Changed Lanes Improperly 12 – Object Or Animal 13 – Improper Turn 14 – Parked Improperly 15 – Mechanical Or Vehicle Failure 16 – Surface Defects 17 – Misjudged Clearance 18 – Improper Backing 19 – No Signal/Improper Signal 20 – Driver Condition 21 – Driver’s Vehicle 22 – Too Fast For Conditions 23 – Improper Passing Of School Bus 24 – Disregard Police Officer 25 – Distracted 26 – Other 27 – Cell Phone 28 – Inattentive VEHICLE CLASS 1 – Privately Owned 2 – Police 3 – Fire 4 – School 5 – Other Govt. Owned 6 – Military 7 – Commercial Vehicle (For Acc. Reporting Purposes Only) 8 – Other VEHICLE TYPE 1 – Passenger Car 2 – Pickup Truck 3 – Truck Tractor (Bobtail) 4 – Tractor/Trailor 5 – Tractor W/Twin Trailers 6 – Logging Truck 7 – Logging Tractor/Trailer 8 – Single Unit Truck 9 – Panel Truck 10 – Van 11 – Utility Passenger Vehicle. 12 – Vehicle With Trailer 13 – Bus 14 – Truck Towing House Trailer 15 – Ambulance 16 – Motorized Recreational Vehicle 17 – Motorcycle, Scooter, Minibike 18 – Moped 19 – Pedalcycle, Bicycle 20 – Farm or Construction. Equip. 21 – All Terrain Vehicle 22 – Other 23 – Go cart TRAFFIC CONTROL 0 – Gates 1 – No Control Present 2 – Traffic Signal 3 – RR Signal/Sign 4 – Warning Sign 5 – Stop Or Yield Sign 6 – No Passing Zone 7 – Lanes 8 – Other 9 – Flashing Lights CARGO BODY TYPE 1 – Van (Encl. Box) 2 – Auto Carrier 3 – Bus 4 – Dump 5 – Garbage/Refuse 6 – Flatbed 7 – Cargo Tanker 8 – Concrete Mixer 9 – Other VEHICLE CONFIGURATION 1 – Bus (Seating for More Than 15 Passengers) 2 – Single Unit Truck: 2 Axles 3 – Single Unit Truck: 3 or More Axles 4 – Truck Trailer 5 – Truck Tractor (Bobtail) 6 – Tractor Tralier 7 – Tractor With Twin Trailers 8 – Unknown Heavy Truck (Cannot Classify) TRAFFIC-WAY FLOW 1 – Two-way Traffic-way With No Physical Separation 2 – Two-way Traffic-way With a Physical Separation 3 – Two-way Traffic-way With a Physical Barrier 4 – One-way Traffic-way 5 – Continuous Turning Lane WEATHER1 – Clear 2 – Cloudy 3 – Rain 4 – Snow 5 – Sleet 6 – Fog 7 – Other SURFACE CONDITION 1 – Dry 2 – Wet 3 – Snowy 4 – Icy 5 – Other 6 – Mud 7 – Sand 8 – Slush 9 – Oil LIGHT CONDITION 1 – Daylight 2 – Dusk 3 – Dawn 4 – Dark – Lighted 5 – Dark – Not Lighted MANNER OF COLLISION 1 – Angle 2 – Head On 3 – Rear End 4 – Sideswipe – Same Direction 5 – Sideswipe – Opposite Direction 6 – Not A Collision With a Motor Vehicle LOCATION AT AREA OF IMPACT 1 – On Roadway 2 – On Shoulder 3 – Off Roadway 4 – Median 5 – Ramp 6 – Gore ROAD COMPOSITION 1 – Concrete 2 – Black Top 3 – Tar And Gravel 4 – Dirt 5 – Gravel 6 – Other CONTRIBUTING ROAD DEFECTS 1- No Defects 2 – Defective Shoulders 3 – Holes, Deep Ruts, Bumps 4 – Loose Material On Surface 5 – Water Standing 6 – Road Under Construction 7 – Running Water 8 – Other DAMAGE TO VEHICLE 1 – None 2 – Slight 3 – Moderate 4 – Extensive 5 – Fire Present ROAD CHARACTER 1 – Straight And Level 2 – Straight On Grade 3 – Straight On Hillcrest 4 – Curve And Level 5 – Curve On Grade 6 – Curve On Hillcrest AGE 00 – Up To One Year 01 – 97 Actual Age 98 – Ninety-eight Or Older 99 – Unknown SEX M – Male F – Female TAKEN FOR TREATMENT 1 – Yes 2 – No 0 – Not injured 1 – Killed 2 – Serious SAFETY EQUIPMENT 0 – None Used6 – Motorcycle Helmet 1 – Shoulder Belt7 – Bicycle Helmet 2 – Lap Belt8 – Unknown 3 – Lap and Shoulder Belt 4 – Child Safety Seat (Property Used) 5 – Child Safety Seat (Improperly Used) EXTRICATION (Equipment Used) 1 – Yes 2 – No AIR BAG FUNCTION 0 – No Air Bag In This Seat 1 – Deployed Air Bag 2 – Non-Deployed Air Bag 3 – Deployed Side 4 – Deployed other Directions 5 – Deployed Multiple Directions 6 – Non-Deployed Front 7 – Non-Deployed Side 8 – Non-Deployed Other Direction 9 – Non-Deployed Multiple Direction 123 456 788 SEATING POSITION POINTS OF INITIAL CONTACT 00 – Overturned 13 – Top 14 – Undercarriage 15 – Non-Contact Vehicle
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