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.
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.
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
= Deployed front of person
= Not ejected
= Pedestrian
2
= Shoulder and lap belt used
= Deployed side of person
= Partially ejected
= Pedalcyclist (bicycle, tricycle,
3
= Lap belt only used
= Deployed both front/side
= Totally ejected
unicycle, pedal car)
4
= Shoulder belt only used
= Other deployment (explain
= Not applicable
= Skater
5
= Child safety seat used
in narrative
(motorcycle,
8
6
= Helmet used
= Not deployed
bicycle, etc.)
9
Motorcycle Seating Position
Seating
- Motorcycle Driver
Position
- Motorcycle Passenger
- Other (explain in
narrative)
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
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(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)
= On Roadway
= Roadside (ditch)
6 = Outside Trafficway
= Shoulder
= Grassy Area between
= Median
exit ramp and roadway
MANNER OF CRASH/COLLISION
7 = Sideswipe,
= Non-collision
= Broadside
= Head-on
= Sideswipe,
opposite direction
= Rear-end
same direction
= Angle, oncoming
left turn
VEHICLE ACTION
= Movement essentially
= Changing lanes
= Stopped for
straight
= Entering traffic lane
stop sign/signal
= Turning left
(merging)
= Legally Parked
= Turning right
= Leaving traffic lane
= Illegally Parked /
WEATHER CONDITIONS (up to two)
= Clear
= Rain
= Partly cloudy
= Sleet, hail, freezing
= Cloudy
rain
= Fog, smoke
= Snow
= Mist
= Severe winds
SURFACE CONDITIONS
= Dry
= Slush
= Wet
= Sand, mud, dirt, oil,
= Ice
gravel
7
= Water (standing,
moving)
VISION OBSCURED
10 = Blowing sand, soil, dirt, snow
88 = Other (explain in narrative)
99 = Unknown
8 = Other (explain in
= Making U-turn
= Backing
Unattended
= Overtaking/passing
= Slowing/stopping
= Other (explain in
narrative
FIRST HARMFUL EVENT
Non-collision events:
24
= Railway vehicle/train
35
= Guardrail
= Overturn/rollover
25
= Animal
36
= Concrete barrier
= Jackknife
26
= Other non-fixed object
(median or right side)
= Other non-collision
(explain in narrative)
37
= Tree
Collision with fixed object:
38
= Poles (utility, light,
Collision with:
30
= Bridge/bridge rail/
etc.)
= Non-motorist (see
overpass
39
= Sign post
non-motorist type)
31
= Underpass/structure
40
= Mailbox
= Vehicle in traffic
support
41
= Impact attenuator
= Vehicle in/from other
32
= Culvert
42
= Other fixed object
roadway
33
= Ditch/Embankment
23
= Parked motor vehicle
34
= Curb/island/raised median
= Not obscured
= Moving vehicles
= Blowing snow
= Trees/crops
= Person/object in or
= Fog/smoke/dust
= Buildings
on vehicle
= Embankment
= Blinded by sun or
= Sign/billboard
headlights
= Hillcrest
= Frosted windows/
= Parked vehicles
windshield
DRIVER CONDITION
= Apparently normal
= Illness
= Physical impairment
= Asleep, fainted,
= Emotional (e.g.,
fatigued, etc.
depressed, angry,
= Under the influence of
disturbed)
alcohol/drugs/
medications
CONTRIBUTING CIRCUMSTANCES Driver (up to two)
TYPE OF ROADWAY JUNCTION/FEATURE
Non-intersection::
= Other non-intersection
= Intersection with ramp
= No special feature
= On-ramp merge area
= Bridge/overpass/
Intersection:
= Off-ramp diverge area
underpass
= Four-way intersection
= On-ramp
= Railroad crossing
= T-intersection
= Off-ramp
= Business drive
= Y-intersection
= With bike/pedestrian
= Farm/residential drive
- Five-leg or more
path
= Alley intersection
- Offset four-way
= Other intersection
= Crossover in median
intersection
TRAFFIC CONTROLS
= No controls present
= No Passing Zone
= Traffic director
= Traffic signals
(marked)
= Workzone signs
= Flashing traffic control
= Warning sign
= Other control (explain
signal
= School zone signs
in narrative)
= Stop signs
= Railway crossing
= 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
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
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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
R
Last Name of Driver 1
First Name
Middle Initial
I
Last Name of Driver 2
V
Number and Street
City
State
Zip Code
E
Last Name of Owner 1
----
Last Name of Owner 2
O
w
N
No. of Occupants
Plate Number
State of Registration
Year
V.I.N.
Est. Cost of Repairs
H
C
Vehicle Year & Make
Step 3.
Vehicle Type Code
L
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
Feet
Miles
and
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
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)
- North
- East
W
- South
- West
S
- 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
Description
Did Peace Officer investigate?
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.
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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:
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.
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.
Not using black or dark blue ink can lead to readability issues, causing important details to be missed or misinterpreted.
Failing to use the additional sheet of paper for more than two vehicles or drivers involved, leading to incomplete information being provided.
Misidentifying the vehicle type code can lead to inaccurate categorization of vehicles involved, affecting the accuracy of the report.
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.
Incorrectly completing or skipping the Accident Codes section can lead to a misrepresentation of how and why the accident occurred.
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.
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:
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.
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.
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:
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.
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:
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.
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:
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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