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Fillable Form Minnesota Accident Report Form

This form is used to report a motor vehicle crash in the state of Minnesota.

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What is the Minnesota Vehicle Crash Report Form?

It is the government’s responsibility to provide basic social services to its people. One of these services includes transportation infrastructure that would provide convenience to citizens. In building infrastructure, the government must ensure that their project is compliant with safety standards, so that the citizens could enjoy hassle-free travel.

However, safety is not always ensured. This may be due to the infrastructure itself, or this may arise from problems other than the infrastructure itself. Whatever the cause may be, the government must be informed about these, so that they can further improve the infrastructure and provide solutions to the other external factors.

One way they could gather information about the causes of motor vehicle crashes is from the reports of the citizens themselves. If you have been involved in a car crash, it is mandatory that you submit a Minnesota Vehicle Crash Report Form (Form PS 32001-10).

Who is mandated to fill out Minnesota Vehicle Crash Report form?

You must fill out this form if you have been involved in a car crash that had caused damage to $1000 worth of property, or if the crash had caused injury or death. Complete this form in 10 days after the crash incident. Non-submission of this form is a criminal offense.

Is the Motor Vehicle Crash Report Form different from a police report?

This motor vehicle crash report is different from the actual police report. This form is filed by the citizens themselves who were involved in the crash incident, and is filed for the purpose of data gathering for future references. The police report, on the other hand, is filed by the police department, and is filed for the purpose of recording the traffic violations and criminal offenses made by the citizens.

How to fill out the Minnesota Motor Vehicle Crash Report?

The form is two pages long, and you are required to answer all the items (unless it’s not applicable). Non-disclosure of information is a criminal offense and may get you fined, jailed, or both.

Please use black ink and CAPITAL LETTERS in answering all questions on the form. Make sure to read through the form first, so that you avoid making mistakes while writing on the form.

SECTION A (Driver’s Traffic Crash Report)
In this section you are going to provide information about the crash incident:

  • Date of Crash (including day of the week)
  • Time of Crash
  • Total number of vehicles involved
  • Location of Crash

SECTION B (My Vehicle Information)
In this section, you are to provide information about the vehicle that you were using during the crash incident.

Driver Information

  • Full Name
  • Address
  • License Number
  • License Class
  • License State of Issue
  • Date of Birth
  • Sex
  • Injury Code

Vehicle Information

  • Owner’s Full Name
  • Address
  • License Plate Number
  • License Year of Issue
  • License State of Issue
  • Parts of Vehicle Damaged
  • Estimated Repair Cost
  • Car Type
  • Car Make
  • Car Model
  • Car Year of Purchase
  • Car Color
  • Number of Occupants

Insurance

  • Name of Insurance Company
  • Policy Number
  • Policy Period
  • Name of Policy holder
  • Address

Section C - Other Driver’s Information
In this section, you are to provide information about the other driver and the vehicle that he or she was using. If there are more than two vehicles involved in the crash, fill out only section C on a separate form and attach it to this form when submitting.

  • Owner’s Full Name
  • Address
  • License Plate Number
  • License Year of Issue
  • License State of Issue
  • Parts of Vehicle Damaged
  • Estimated Repair Cost
  • Car Type
  • Car Make
  • Car Model
  • Car Year of Purchase
  • Car Color
  • Number of Occupants

Crash Description
In this section, you are to provide information about the crash incident. You are presented with codes, which you will use as reference in describing what happened in the crash incident. Write the code corresponsing to your response on the boxes provided.

You will be asked about the following, and your responses should be the codes listed in each of the subsections.

  • Type of Crash (Collision with vehicle or living object, collision with fixed object, or non-collision)
  • Work Zone
  • Road Surface
  • Traffic Control Device
  • Speed Limit
  • Weather/Atmosphere
  • Light Condition
  • Manner of Collision
  • Actions/Maneuvers prior to crash
  • Direction of Travel Prior to crash

Presence of Police Officer at the scene
You are asked if there is a police officer present at the scene during the crash. If you answered “Yes”, please provide the police officer’s department.

Passenger Information
In this section, you are asked if you have a passenger with you during the crash incident. If applicable, please write the following information of your passenger:

  • Full Name
  • Address
  • Date of Birth
  • Sex
  • Seat Position
  • Safety Equipment Type
  • Restrained Device Used
  • Safety Equipment Used
  • Ejection
  • Injury

Accident Description
In this section, you are asked to describe the scene during the crash incident. Unlike the prior section, you are going to provide a detailed description of the crash scene.

  • On the left side of this section, you are asked to write a detailed narration of the crash incident. It would be preferred that you write down the chronological order of events--what led to the crash, what happened during the crash, what properties were found damaged, any significant events that happened after the crash, etc.
  • On the right side, you are asked to create a diagram or a simple sketch of what happened during the crash. This is to further visualize the crash so that authorities could get a clearer picture of the problem.

Damage to Property other than Vehicles
In this section, you are asked if there are any other properties that were damaged during the crash. Perhaps the persons involved in the crash may have caused damage to a nearby fence, mailbox, or any other property. If this is applicable, please provide information on the following:

  • Describe property damage
  • Name of property owner
  • Estimated cost of repair

Signature
To finish the report, sign the form on the space provided. Also write your address and the date you signed the form.

How do I submit my accomplished Minnesota Motor Vehicle Crash Report Form?

You can submit the report in person in the Department of Vehicle Safety Office, or you may mail your report to the following address:

DVS / CRASH RECORDS
445 MINNESOTA STREET, SUITE 181
ST. PAUL, MN
55101-5181

For more information about what to do during car crash incidents, please approach the police department as they can assist you with this matter.

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