Printable Iowa Accident Report Form in PDF Modify Form Online

Printable Iowa Accident Report Form in PDF

The Iowa Accident Report form, designated as Form 433002, is a critical document required by any individual involved in an accident in the state of Iowa leading to death, personal injury, or total property damage of $1,500 or more. This document needs to be submitted within 72 hours to avoid the suspension of driving privileges, ensuring all pertinent details about the incident are captured accurately. For those navigating the aftermath of an accident, filling out this form attentively is essential. Click the button below to fill out the form accurately and comply with Iowa’s reporting requirements.

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When an accident occurs within the state of Iowa causing death, personal injury, or total property damage of $1,500.00 or more, it necessitates the completion and submission of the Iowa Accident Report Form, officially known as Form 433002 08-10. This comprehensive document serves to catalog the specifics of the accident, detailing everything from the date, time, and location of the incident, down to the minute details concerning the drivers, vehicles, and any property damage incurred. It's imperative for individuals involved in such accidents to swiftly fill out this report, as failing to submit it within a stipulated 72-hour timeframe could lead to the suspension of driving privileges. The form is designed for clarity and thoroughness, requiring information to be printed or typed in black or dark blue ink, with explicit instructions provided for each step. Crucial aspects such as accident codes, vehicle types, and an accident diagram enrich the report's accuracy, ensuring that all details pertinent to the incident are well-documented. This process not only aids in the legal and insurance proceedings that may follow but also contributes valuable data for traffic safety analysis, underscoring the importance of its meticulous completion and prompt submission.

Iowa Accident Report Preview

Form 433002 08-10

IOWA ACCIDENT REPORT FORM

An accident occurring anywhere within the State of Iowa causing death, personal injury, or total property damage of $1,500.00 or more must be reported on this accident report form. Failure to return this accident report form within 72 hours may result in suspension of your driving privilege. Caution: You must attempt to completely fill out this report.

Instructions

Please print or type all information. Use black or dark blue ink.

Step 1. Begin completing the "Report of Motor Vehicle Accident" form by entering accident date, day of week, time, number of vehicles, total number killed, number injured, and the total amount of damage to all vehicles and any property other than vehicles.

Step 2. Enter the information pertaining to all drivers and vehicles involved in the accident. Important: Be sure to include the driver's name, driver license number, and driver license state. Also include the vehicle owner's name, license plate number, and license plate state. If more than two drivers or two vehicles were involved, use an extra report form or sheet of paper making sure that the extra vehicles and drivers are numbered 3, 4, 5, etc.

If you were involved in an accident with a pedestrian, print PEDESTRIAN in the driver space provided for vehicle No. 2 and complete pedestrian information in Step 7. If you were involved in an accident with a pedalcyclist (bicycle, etc.) print 'Bike' in the driver space provided for Vehicle 2 and complete information for Non-Motorist in Step 7.

If one of the vehicles involved was parked at the time of the accident, print PARKED in the driver space and complete the vehicle owner information.

Step 3. Please use the following codes when completing the box marked "vehicle type code":

01

= Passenger Car

09

= Tractor/semi-trailer

17

= Small school bus (seats 9-15)

02

= Four-tire light truck (pick-up, panel)

10

= Tractor/doubles

18

= Other bus (seats > 15)

03

= Van or mini-van

11

= Tractor/triples

19

= Other small bus (seats 9-15)

04

= Sport utility vehicle

12

= Other heavy truck (cannot classify)

20

= Farm vehicle/equipment

05

= Single-unit truck (2-axle, 6-tire)

13

= Motor home/recreational vehicle

21

= Maintenance/construction vehicle

06

= Single-unit truck (> = 3 axles)

14

= Motorcycle

22

= Train

07

= Truck/trailer

15

= Moped/All-Terrain Vehicle

88

= Other (explain in narrative)

08

= Truck tractor (bobtail)

16

= School bus (seats > 15)

99

= Unknown

Step 4. The location of the accident is very important. Please be as specific as possible.

Step 5. To the best of your ability, complete the Accident Codes section for your own vehicle using codes provided on page 2 of this form.

Step 6. If there is damage to property other than the vehicles involved complete the property damage information.

Step 7. Injury information should be entered in the space provided. Make sure that the vehicle number in which the injured party was riding is complete, describe the nature of the injury, and check the box under the column most appropriate for the injury severity. NOTE: Include all drivers whether injured or not. The codes are:

Injury Status:

1 = Fatal

2 = Incapacitating

3 = Non-incapacitating

4 = Possible

5 = Uninjured

9 = Unknown

Occupant Protection:

Airbag Deployment:

Ejection:

Type Non-Motorist:

1

= None used

1

= Deployed front of person

1

= Not ejected

1

= Pedestrian

2

= Shoulder and lap belt used

2

= Deployed side of person

2

= Partially ejected

2

= Pedalcyclist (bicycle, tricycle,

3

= Lap belt only used

3

= Deployed both front/side

3

= Totally ejected

 

unicycle, pedal car)

4

= Shoulder belt only used

4

= Other deployment (explain

4

= Not applicable

3

= Skater

5

= Child safety seat used

 

in narrative

 

(motorcycle,

8

= Other (explain in narrative)

6

= Helmet used

5

= Not deployed

 

bicycle, etc.)

9

= Unknown

8

= Other (explain in narrative)

6

= Not applicable

9

= Unknown

 

 

9

= Unknown

9

= Unknown

 

 

 

 

Motorcycle Seating Position

Seating

01

- Motorcycle Driver

Position

04

- Motorcycle Passenger

 

 

 

88

- Other (explain in

01

02

03

 

narrative)

 

 

 

 

04

05

06

 

 

 

 

 

 

 

 

 

07

08

09

 

 

 

 

 

10 - Sleeper Section

11 - Enclosed Cargo Area

12 - Unenclosed Cargo Area

13 - Training Unit

14 - Exterior

15 - Pedestrian

16 - Pedalcyclist

17 - Pedalcyclist, passenger

88 - Other (explain in narrative)

99 - Unknown

(Instructions continued on page 2) Æ

-1-

(Instructions continued from page 1)

Step 8. To the best of your ability, complete the accident diagram and description as briefly as possible. Important: If you are vehicle No. 1 in Step 2, make sure that your vehicle is vehicle No. 1 in the description and diagram. Indicate if there has been a Peace Officer investigation.

Step 9. Complete the insurance information on the back of the report. Failure to complete insurance coverage information may result in a suspension of your driving and registration privileges.

Step 10. Sign the accident report and tear at the perforated line and return accident report to:

Iowa Department of Transportation

Office of Driver Services

P.O. Box 9235

Des Moines, IA 50306-9235

ACCIDENT CODES (See Step 5)

LOCATION OF ACCIDENT (Where did first damage or injury event occur)

1

= On Roadway

4

= Roadside (ditch)

6 = Outside Trafficway

2

= Shoulder

5

= Grassy Area between

9 = Unknown

3

= Median

 

 

exit ramp and roadway

 

 

 

 

MANNER OF CRASH/COLLISION

7 = Sideswipe,

 

 

 

 

1

= Non-collision

5

= Broadside

2

= Head-on

6

= Sideswipe,

 

opposite direction

3

= Rear-end

 

 

same direction

9 = Unknown

4

= Angle, oncoming

 

 

 

 

 

 

 

left turn

 

 

 

 

 

 

 

VEHICLE ACTION

 

 

 

 

 

 

 

 

 

 

 

 

01

= Movement essentially

06

= Changing lanes

11

= Stopped for

 

 

straight

07

= Entering traffic lane

 

stop sign/signal

02

= Turning left

 

 

(merging)

12

= Legally Parked

03

= Turning right

08

= Leaving traffic lane

13

= Illegally Parked /

WEATHER CONDITIONS (up to two)

01

= Clear

06

= Rain

02

= Partly cloudy

07

= Sleet, hail, freezing

03

= Cloudy

 

 

rain

04

= Fog, smoke

08

= Snow

05

= Mist

09

= Severe winds

 

 

SURFACE CONDITIONS

 

 

 

 

 

 

 

 

1

= Dry

5

= Slush

2

= Wet

6

= Sand, mud, dirt, oil,

3

= Ice

 

 

gravel

4

= Snow

7

= Water (standing,

 

 

 

 

 

moving)

VISION OBSCURED

10 = Blowing sand, soil, dirt, snow

88 = Other (explain in narrative)

99 = Unknown

8 = Other (explain in

narrative)

9 = Unknown

04

= Making U-turn

09

= Backing

 

Unattended

05

= Overtaking/passing

10

= Slowing/stopping

88

= Other (explain in

 

 

 

 

 

 

narrative

 

 

 

 

 

99

= Unknown

 

 

FIRST HARMFUL EVENT

 

 

 

 

Non-collision events:

24

= Railway vehicle/train

35

= Guardrail

11

= Overturn/rollover

25

= Animal

36

= Concrete barrier

12

= Jackknife

26

= Other non-fixed object

 

(median or right side)

13

= Other non-collision

 

(explain in narrative)

37

= Tree

 

 

(explain in narrative)

Collision with fixed object:

38

= Poles (utility, light,

Collision with:

30

= Bridge/bridge rail/

 

etc.)

20

= Non-motorist (see

 

overpass

39

= Sign post

 

 

non-motorist type)

31

= Underpass/structure

40

= Mailbox

21

= Vehicle in traffic

 

support

41

= Impact attenuator

22

= Vehicle in/from other

32

= Culvert

42

= Other fixed object

 

 

roadway

33

= Ditch/Embankment

 

(explain in narrative)

23

= Parked motor vehicle

34

= Curb/island/raised median

 

 

01

= Not obscured

08

= Moving vehicles

12

= Blowing snow

02

= Trees/crops

09

= Person/object in or

13

= Fog/smoke/dust

03

= Buildings

 

 

on vehicle

88

= Other (explain in

04

= Embankment

10

= Blinded by sun or

 

narrative)

05

= Sign/billboard

 

 

headlights

99

= Unknown

06

= Hillcrest

11

= Frosted windows/

 

 

07

= Parked vehicles

 

 

windshield

 

 

 

 

DRIVER CONDITION

 

 

 

 

 

 

 

 

 

 

 

 

1

= Apparently normal

4

= Illness

8 = Other (explain in

2

= Physical impairment

5

= Asleep, fainted,

 

narrative)

3

= Emotional (e.g.,

 

 

fatigued, etc.

9 = Unknown

 

 

depressed, angry,

6

= Under the influence of

 

 

 

 

disturbed)

 

 

alcohol/drugs/

 

 

 

 

 

 

 

medications

 

 

CONTRIBUTING CIRCUMSTANCES Driver (up to two)

 

 

TYPE OF ROADWAY JUNCTION/FEATURE

 

 

 

 

 

 

Non-intersection::

08

= Other non-intersection

16

= Intersection with ramp

01

= No special feature

 

(explain in narrative)

17

= On-ramp merge area

02

= Bridge/overpass/

Intersection:

18

= Off-ramp diverge area

 

 

underpass

11

= Four-way intersection

19

= On-ramp

03

= Railroad crossing

12

= T-intersection

20

= Off-ramp

04

= Business drive

13

= Y-intersection

21

= With bike/pedestrian

05

= Farm/residential drive

14

- Five-leg or more

 

path

06

= Alley intersection

15

- Offset four-way

22

= Other intersection

07

= Crossover in median

 

intersection

 

(explain in narrative)

 

 

 

 

 

99

= Unknown

 

 

TRAFFIC CONTROLS

 

 

 

 

 

 

 

 

 

 

01

= No controls present

06

= No Passing Zone

10

= Traffic director

02

= Traffic signals

 

(marked)

11

= Workzone signs

03

= Flashing traffic control

07

= Warning sign

88

= Other control (explain

 

 

signal

08

= School zone signs

 

in narrative)

04

= Stop signs

09

= Railway crossing

99

= Unknown

05

= Yield signs

 

device

 

 

 

 

LIGHT CONDITIONS

4 = Dark, roadway lighted

6 = Dark, unknown

 

 

1 = Daylight

2 = Dusk

5 = Dark, roadway not

 

roadway lighting

3 = Dawn

 

lighted

9 = Unknown

01 = Ran traffic signal

02 = Ran stop sign

03 = Exceeded authorized speed

04 = Driving too fast for conditions

05 = Made improper turn

06 = Traveling wrong way or on wrong side of road

07 = Crossed centerline

08 = Lost Control

09 = Followed too close

10 = Swerved to avoid; vehicle, object, non- motorist, or animal in roadway

11 = Over correcting/over steering

12 = Operating vehicle in erratic, reckless, careless, negligent, or aggressive manner

Failed to yield right-of-way: 13 = From stop sign

14 = From yield sign

15 = Making left turn

16 = Making right turn on red signal

17 = From driveway

18 = From parked position

19 = To pedestrian

20 = At uncontrolled intersection

21 = Other (explain in narrative)

Inattentive/distracted by: 22 = Passenger

23 = Use of phone or other device

24 = Fallen object

25 = Fatigued/asleep

Other

26 = Vision obstructed

27 = Other improper action

28 = No improper action

99 = Unknown

-2-

Form 433002

 

08-10

 

 

REPORT OF MOTOR VEHICLE ACCIDENT

Step 1.

See Instructions on completing (please print or type)

Did accident occur on

Yes

private property?

No

Accident Date (Mo/Day/Year)

Day of Week

Time

 

 

 

AM

Number of Vehicles

Total Killed

 

Total Injured

Total Estimated Damage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 2.

 

 

 

NO. 1 (YOUR VEHICLE)

 

 

 

 

 

 

 

 

 

 

NO. 2 (OTHER VEHICLE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth

Sex

Dr.Lic. State

Driver License No. as Printed on License

D

Date of Birth

 

Sex

Dr.Lic. State

Driver License No. as Printed on License

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name of Driver 1

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

Middle Initial

I

Last Name of Driver 2

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

Middle Initial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number and Street

 

 

 

 

City

 

 

 

 

 

State

 

 

 

Zip Code

E

Number and Street

 

 

 

City

 

 

 

 

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name of Owner 1

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

Middle Initial

----

Last Name of Owner 2

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

Middle Initial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

w

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number and Street

 

 

 

 

City

 

 

 

 

 

State

 

 

 

Zip Code

N

Number and Street

 

 

 

 

City

 

 

 

 

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

----

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No. of Occupants

 

Plate Number

 

 

 

State of Registration

Year

No. of Occupants

 

Plate Number

 

 

 

 

State of Registration

Year

 

 

 

 

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V.I.N.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Est. Cost of Repairs

H

V.I.N.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Est. Cost of Repairs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Year & Make

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 3.

Vehicle Type Code

L

Vehicle Year & Make

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 3.

Vehicle Type Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

----

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION OF ACCIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

Accident occurred within corporate limits of (city)

If accident occurred outside of

 

 

N NE E SE S SW W NW

city limits, describe distance to city

 

miles

of nearest city

 

 

 

 

 

 

Name of Road, Street or Highway

 

 

At Intersection with

Note: Unless accident occurred at an intersection which is completely described above, use the space below to give the exact location from a milepost or definable intersection, bridge or railroad crossing, using two distances and directions if necessary.

Feet Miles

or

N NE E SE S SW W NW

Feet

 

Miles

 

 

 

 

 

and

 

or

 

 

 

 

N NE E SE S SW W NW

of

Milepost Number

Definable Intersection, bridge, or railroad crossing

Or

Step 5. Accident Codes (on page 2) For your own vehicle

 

 

Location of Accident

 

 

 

Manner of Crash

 

 

 

 

 

Vehicle Action

 

 

Type of Roadway

 

 

 

 

Traffic Controls

 

 

 

 

 

Light Conditions

 

 

Junction/Feature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surface Conditions

 

 

 

Vision Obscured

 

 

 

 

 

Driver Condition

 

 

 

Identify Damaged Property Other Than Vehicles

 

Owner

Step 6.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 7. Injury Section: Fill Out Space Below For Every Person Injured Or Killed In The Accident (Attach additional sheets if necessary)

 

Vehiclen

 

Gender

 

Name & Address

I Number

Date of Birth

Describe Injuries

 

 

 

 

 

First Harmful Event

Weather Conditions

Contributing Circumstances

Amount of Damage

 

Insert Correct Code

 

 

 

(See Step 7 of Instructions)

 

InjuryStatus

Occupant Protection

Airbag Deployment

Ejection

Type Non-Motorist

Seating Position

Date of

 

 

 

 

 

 

 

 

 

 

 

 

Death

 

 

 

 

 

 

 

(Complete reverse side)´

-3-

Step 8.

Indicate On This Diagram What Happened

Use one of these outlines to sketch the scene of your accident, writing in street or highway names or numbers.

Initial Travel Direction

 

 

 

(prior to coded Vehicle Action)

 

N

 

1

- North

 

 

 

 

 

2

- East

W

E

3

- South

 

 

 

4

- West

 

S

9

- Unknown

 

 

 

 

INDICATE

NORTH

BY ARROW

Street or Highway

Original Direction of Travel: (Example: Vehicle going north then turning left, code 'N' for Original Direction of Travel)

Vehicle 1

 

Vehicle 2

Street or Highway

Street or Highway

Description

Did Peace Officer investigate?

 

Yes

 

No

Department

 

 

 

If you did not have automobile liability insurance coverage for this accident, please check this box

 

.

 

If you had automobile liability insurance coverage for this accident, please complete insurance information below:

Failure To Complete Insurance Coverage Information Requested Below May Result In A Suspension Of Your Driving And/Or Registration Privileges.

Step 9.

Name of Insurance Company (Not Agent) Providing Insurance To Cover Your Liability For Damage Or Injury To Others:

Name of Agent Who Sold Policy

Agent Address

Policy No.

 

Policy Period: From

 

To

 

V.I.N. No.

 

 

 

 

 

Name of Driver

 

 

 

 

 

Name of Owner

 

 

 

 

 

Name of Policyholder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

Signature of Driver of Vehicle No. 1

If Signed By Person Other Than Driver, Give Reason

IMPORTANT: This accident should also be reported directly to your insurance company. Failure to report may jeopardize your automobile liability insurance.

-4-

Form Information

# Fact Detail
1 Form Identification The form used is identified as Form 433002 08-10.
2 Reporting Requirement An accident must be reported if it occurs within Iowa and causes death, personal injury, or total property damage of $1,500.00 or more.
3 Submission Deadline The accident report form must be returned within 72 hours to avoid suspension of driving privileges.
4 Completion Instructions Instructions detail that the report should be filled out completely, printed or typed in black or dark blue ink.
5 Information Required Key information required includes accident details, driver and vehicle details for all parties involved, and injury and property damage specifics.
6 Vehicle Type Codes Includes specific codes for various vehicle types involved in the accident.
7 Location Specificity Stresses the importance of providing a specific accident location.
8 Insurance Information Requirement Failure to complete insurance coverage information can result in suspension of driving and registration privileges.
9 Investigation Indication Asks if there has been a Peace Officer investigation.
10 Governing Laws This form adheres to Iowa's regulations on traffic accidents reporting, underpinning the legal requirement for accident notification.

Detailed Guide for Writing Iowa Accident Report

Filling out the Iowa Accident Report form is a critical step after being involved in a motor vehicle accident within the state, particularly if the incident resulted in death, personal injury, or significant property damage. Accurately completing this form and returning it within 72 hours is required to avoid possible suspension of driving privileges. The process involves detailing the accident, providing driver and vehicle information, and describing the injuries sustained. Here’s how to accurately fill out the form:

  1. Start by noting the accident's specifics on the "Report of Motor Vehicle Accident" portion. Include the accident's date, day of the week, time, and the number of vehicles involved. Also, fill in the number of fatalities, injuries, and the estimated total damage cost.
  2. Input all drivers' and vehicles' information involved in the crash. It’s essential to provide each driver's name, license number, and the state where the license was issued. Also, include each vehicle owner's name, license plate number, and state. Use additional paper if the accident involved more than two vehicles or drivers, ensuring to number additional parties and vehicles appropriately.
  3. Select the correct vehicle type code from the provided list, ranging from passenger cars and trucks to motorcycles and farm equipment, assigning the appropriate code to each vehicle involved.
  4. Clearly describe the accident's location, being as specific as possible about the county, whether it occurred within city limits, and notable landmarks or intersections.
  5. Using the second page of the form, assign the correct accident codes that describe your vehicle's involvement, such as the specific collision manner, action, and conditions at the accident time.
  6. If property beyond the involved vehicles was damaged, document the type and owner of the property, with an estimate of the damage.
  7. For every person injured or killed in the accident, provide their information, including vehicle number, name, address, gender, date of birth, injury description, and any relevant codes related to the injury, such as severity and seat belt usage.
  8. On the provided diagram, sketch the accident scene, indicating the direction of the involved vehicles and key elements like traffic signals or signs. Confirm whether a peace officer investigated the accident.
  9. Complete the insurance information section on the back of the form. This includes the insurance company name, policy number, agent's name, and the driver, owner, and policyholder's names. This step is crucial to avoid potential suspension of driving or registration rights.
  10. Sign the report at the perforated line. If someone other than the driver is signing the report, they must provide the reason for doing so. Tear off this portion and mail it to the Iowa Department of Transportation Office of Driver Services at the address provided.

By carefully following these steps, you can ensure that your Iowa Accident Report form is correctly filled out, providing a thorough account of the incident. This document is not only a legal requirement but also a critical piece of information for insurance and legal purposes following an accident.

Get Answers on Iowa Accident Report

Who needs to complete the Iowa Accident Report form?

Any driver involved in an accident within the State of Iowa that results in death, personal injury, or total property damage of $1,500.00 or more must complete the Iowa Accident Report form. This requirement applies irrespective of the location within the state where the accident occurred.

What is the deadline for submitting the Iowa Accident Report form?

The form must be submitted within 72 hours of the accident. Failure to meet this deadline may lead to the suspension of your driving privileges. It is crucial for drivers to complete and return the form promptly to avoid potential penalties.

How should the Iowa Accident Report form be filled out?

All information on the form should be printed or typed using black or dark blue ink. The form consists of several steps, including providing details about the accident, vehicles, and drivers involved, as well as completing diagrams and describing the accident. Accurate completion of all sections is important for a comprehensive report. If the accident involves more than two vehicles or drivers, additional forms or sheets of paper should be attached, ensuring that they are clearly labeled with corresponding vehicle and driver numbers.Where should the completed Iowa Accident Report form be sent?

The completed form should be mailed to the Iowa Department of Transportation, Office of Driver Services, at P.O. Box 9235, Des Moines, IA 50306-9235. This address is provided to ensure that the report reaches the appropriate department for processing. Make sure to keep a copy for your records before mailing the original form.

Common mistakes

  1. Not using black or dark blue ink can lead to readability issues, causing important details to be missed or misinterpreted.

  2. Failing to use the additional sheet of paper for more than two vehicles or drivers involved, leading to incomplete information being provided.

  3. Misidentifying the vehicle type code can lead to inaccurate categorization of vehicles involved, affecting the accuracy of the report.

  4. Omitting specific location details of the accident can hinder the ability to accurately determine the site and circumstances, potentially affecting the outcome of any claims.

  5. Incorrectly completing or skipping the Accident Codes section can lead to a misrepresentation of how and why the accident occurred.

  6. Not signing the report can result in the report being considered invalid, risking the suspension of driving privileges due to non-compliance.

It is crucial to fully and accurately complete the Iowa Accident Report form to avoid potential legal or financial repercussions.

Documents used along the form

When navigating through the aftermath of an accident in Iowa, understanding the array of forms and documents that might accompany the Iowa Accident Report Form is crucial. These documents play a vital role in providing a comprehensive overview of the incident, facilitating the processing of claims, and ensuring that all legal requirements are met. Here's an overview of some of the key documents often used alongside the accident report form:

  • Medical Records: Documentation of any injuries sustained in the accident, including hospital visits, treatments received, and medical opinions.
  • Photographs of the Accident Scene: Images capturing the accident scene, vehicle damages, and any relevant road conditions or landmarks, providing a visual context to the written report.
  • Police Report: A detailed report compiled by the responding law enforcement officers, offering an authoritative third-party perspective on the accident.
  • Witness Statements: Written or recorded accounts from individuals who observed the accident, contributing additional viewpoints and details to the event’s narrative.
  • Insurance Policy Information: Detailed information regarding the insurance coverage of the parties involved, necessary for processing claims and determining liability.
  • Vehicle Repair Records: Documents detailing the repairs undertaken on the vehicle(s) involved, including cost estimates and actual expenses incurred.
  • Proof of Lost Wages: If the accident led to an inability to work, documentation from an employer outlining the lost income during the recovery period is necessary.

Each of these documents serves a unique purpose, contributing pieces to the overall puzzle of the accident's circumstances. Together, they enable involved parties, insurance companies, and legal professionals to reconstruct the event accurately, assess damages and injuries, and resolve any claims or disputes arising from the incident. Understanding how to compile and utilize these documents effectively can significantly streamline the accident recovery process.

Similar forms

The Iowa Accident Report form shares characteristics with the National Highway Traffic Safety Administration's (NHTSA) crash report forms used across the United States. Both documents gather comprehensive details about motor vehicle accidents, including the date, time, location, and severity of the accident. Information on the drivers, vehicles involved, weather conditions at the time of the accident, and a narrative description of how the incident occurred is collected to help authorities and insurance companies assess the situation. This similarity exists because both forms aim to systematically capture accident data to improve road safety and facilitate insurance claims processing.

Insurance claim forms for auto accidents also resemble the Iowa Accident Report form in several ways. For instance, both documents require detailed information about the accident, including specifics about the drivers and vehicles involved, damages incurred, and a description of the accident. The primary goal of both documents is to establish the facts surrounding the accident to determine financial liability and compensation. While the Iowa form focuses on legal and safety reporting requirements, insurance claim forms emphasize assessing liability and damages for financial purposes.

Another document similar to the Iowa Accident reassure form is the Driver’s Crash Report (Blue Form) used in some states for accidents that do not require police involvement. Like the Iowa form, it gathers details from the accident scene, including personal, vehicle, and environmental conditions, to be reported by the driver. Both forms serve as self-reported accounts of the incident, essential for the legal and insurance processes following an accident. They provide a structured way for drivers to document important details when law enforcement does not file a report.

State-specific Department of Motor Vehicles (DMV) accident report forms are also akin to the Iowa Accident Report form. Although details may vary per state, these forms generally collect similar information regarding accident specifics, driver and vehicle details, and circumstances surrounding the incident. They are essential for updating driving records, assessing infractions, and informing safety measures. The design of these forms takes into account the need for comprehensive data to aid in legal, safety, and insurance assessments post-accident.

The Occupational Safety and Health Administration's (OSHA) incident report forms, while focused on workplace safety, share a core function with the Iowa Accident Report form. Both are designed to collect in-depth details about an incident to analyze causes and prevent future occurrences. Where the Iowa form concentrates on vehicle accidents, OSHA forms tackle workplace accidents, highlighting their shared emphasis on safety and prevention.

Incident report forms used by property and casualty insurance companies for claims involving property damage, theft, or liability bear resemblance to the Iowa Accident Report form in their function of documenting incidents comprehensively. Both types of documents require detailed information to assess claims or liabilities accurately, thereby facilitating the resolution process for the affected parties. The structured data collection helps insurers determine coverage applicability and financial responsibility.

Police incident reports, created following law enforcement's response to accidents or crimes, parallel the Iowa Accident Report form in several respects. Both documents serve as official records of an event, detailing what happened, who was involved, and other pertinent information. They are critical for legal and administrative purposes, providing a basis for investigations, insurance claims, and in some cases, court proceedings.

Automobile appraisal forms used for assessing vehicle damages after an accident share similar objectives with the Iowa Accident Report form. While the Iowa form documents accident details for reporting and legal purposes, appraisal forms focus specifically on evaluating the extent and cost of damages to a vehicle. Both are integral to the insurance claim process, aiding in determining compensation for damages.

Medical report forms for injuries sustained in accidents also find common ground with the Iowa Accident Report form. Medical reports detail the nature, extent, and cause of injuries for diagnosis and treatment, while the Iowa form captures the overall accident context in which the injuries occurred. Together, they provide a comprehensive picture of the accident’s impact on health, contributing to insurance and legal processes.

The Federal Railroad Administration's (FRA) accident/incident reporting forms, used for incidents involving railroads, align with the Iowa Accident Report form's broader goals of safety and accountability. Both document types record detailed information about incidents, including causes and consequences, to inform safety improvements and regulatory compliance. Despite differences in their transportation focus, the importance of accurate, comprehensive incident documentation unites these forms in purpose.

Dos and Don'ts

When filling out the Iowa Accident Report form, accuracy and thoroughness are vital. Here are several important dos and don'ts to keep in mind:

  • Do print or type all information using black or dark blue ink. This helps ensure that your report is legible and can be processed quickly and accurately.
  • Do not leave any fields blank. If a section does not apply to your situation, it's appropriate to enter "N/A" (not applicable) rather than leaving it empty. This clarifies that you did not simply overlook the question.
  • Do provide detailed and specific location information for the accident. The more precise you can be, the easier it will be for the report to be understood and processed.
  • Do not guess specifics like driver license numbers, vehicle license plate numbers, or insurance policy numbers. Incorrect information can lead to complications or delays. If you're unsure, it's better to note that the information is currently unavailable.
  • Do utilize the correct codes provided for vehicle types, accident types, weather conditions, etc., as these standardized codes help to ensure clarity and prevent misunderstandings.
  • Do not omit the diagram and description of the accident. Even though this might seem complex, a simple drawing and clear description of what happened are invaluable for accurately conveying the circumstances of the accident.
  • Do check the boxes accurately for the injury section, ensuring the vehicle number in which the injured party was riding is completed. Accurately describing the nature of injuries and checking the appropriate box for injury severity is crucial for understanding the accident's impact.
  • Do not forget to sign the report. An unsigned report might not be processed, as your signature verifies the authenticity and accuracy of the information provided.
  • Do return the completed form within 72 hours to avoid potential suspension of your driving privileges. This deadline is crucial and shows compliance with state law.

By following these guidelines, you can fill out the Iowa Accident Report form both effectively and efficiently, ensuring that all necessary information is provided clearly and accurately.

Misconceptions

Understanding the nuances of the Iowa Accident Report form is crucial for drivers in Iowa. There are several common misconceptions about this document that need to be addressed to ensure proper compliance with state laws and regulations. Here are four key misunderstandings often encountered:

  • Misconception 1: The report only needs to be filed if the police were involved in the accident. This is not accurate. Regardless of police presence or involvement at the scene of the accident, if the event results in death, personal injury, or total property damage of $1,500.00 or more, the accident report form must be completed and submitted within 72 hours to avoid potential suspension of driving privileges.
  • Misconception 2: All accidents must be reported, no matter how minor. The form clearly states that only accidents causing death, personal injury, or property damage exceeding $1,500.00 require reporting. This means that very minor accidents with damages below this threshold do not need to be documented with this form.
  • Misconception 3: The report form is complicated and requires legal advice to fill out. While the form is detailed, it is designed to be completed by individuals involved in the accident without the need for legal assistance. Instructions are provided to guide users through each step, emphasizing the need for clear, printed information, and directing them to use additional sheets if necessary for multiple vehicles or drivers.
  • Misconception 4: If you weren't at fault, you don't need to file this report. Fault is not a determining factor in whether an accident report needs to be filed. The form must be submitted if the accident meets the criteria for reporting based on injury, death, or property damage, regardless of who was at fault. This document is crucial for official records and may be needed for insurance claims or legal proceedings.

Correctly understanding and following the requirements for the Iowa Accident Report form ensures that drivers comply with state laws, protect their driving privileges, and maintain accurate records for insurance and legal purposes.

Key takeaways

Understanding the Iowa Accident Report form is crucial for anyone who finds themselves involved in a motor vehicle accident within the state. This document is not just a piece of paper but a vital tool that can significantly impact the aftermath of an accident. Here are key takeaways to help navigate the complexities of this form:

  • Every motor vehicle accident occurring in Iowa that results in death, personal injury, or total property damage of $1,500 or more must be reported using the Iowa Accident Report form. This criteria ensures that significant accidents are officially documented.
  • The form requires submission within 72 hours of the accident. This tight timeframe underscores the importance of promptly and accurately filling out the form to avoid complications, such as the suspension of driving privileges.
  • Accurate and complete information is paramount. From the accident details like date, time, and location, to personal information about the drivers, vehicles, and any property damage, each section must be filled out meticulously.
  • Identification of the accident location with as much specificity as possible is vital. The description assists in the accurate documentation and analysis of the accident scene, which can be crucial for insurance and legal purposes.
  • Detailed injury information is required, including the severity of the injuries sustained. This information is critical for insurance claims and must align with the medical records.
  • The form includes a section for drawing a diagram of the accident. This visual representation can help in understanding how the accident occurred and is a crucial component of the report.
  • Failure to provide insurance information on the form can lead to a suspension of both driving and registration privileges. It highlights the direct link between the report and the driver’s legal ability to operate a vehicle.
  • Lastly, signing the accident report form is a declaration that the information provided is accurate to the best of the signer's knowledge. It is a legal document, and as such, accuracy and honesty are critical.

By understanding these key elements, individuals can navigate the process of reporting a motor vehicle accident in Iowa more effectively. Accurate and timely completion of the Iowa Accident Report form is not only a legal requirement but also a crucial step in ensuring that all parties involved receive the appropriate support and resolution following an accident.

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