Alabama Uniform Traffic Crash Report Page 1 NEXT To Begin Click NEXT Once the Traffic Crash Report Form has been successfully completed, it can be entered in to this Accident Report Database. Simply copy all information as it is recorded on the Crash Report into the corresponding Titles and categories within this program. The TAB key will cycle your cursor from one text field to the next, and the NEXT and BACK buttons will let you move freely both forward and backwards through the program.

Section 1 [Location and Time] 10. On Street, Road, or Hwy? 11. At Intersection or Between? (node 2) 12. And (Node 2) 13. (On) Street/Road/Hwy Code: 14. Node Code (1)  Node Code (2)  15. Feet/Miles From Node (1) 1. DPS Case #: 2. Local Case #: 3. Date: 4. Time: am pm 5. M T W R F 1. County: 2. City: 3. Local Zone: 4. Hwy Class: Check if Amendment: Check if Error Correction: Page 2 (Check Day of Week)

Section 1 [Location and Time]  Continue Filling in all applicable information. Page 3 16.Mile Post: 17.Control Access Hwy Loc: 18.Primary Contrib. Circums: 19.Primary Contrib. Unit No: 20.Manner of Crash: 21.1 st Harmful Event: 22.1 st Harmful Event Loc: 23.Most Harmful Event: 24.Clearance to Fixed Object: 25.Roadway Junction Feature (feet) 26.Manner of Crash: 27.Lat. Coordinates: 28.Long Coordinates: 29.Primary Contrib. Unit No: 30.Highway Side: Proceed to Section 2 (Driver / Vehicle Info) upon completion of this page

Section 2 [ Driver / Vehicle]  Driver Last Name:  Driver First Name:  Street Address:  City:  State:  Zip: Telephone:  DOB: Race:  Sex:  Driver’s License No: DL State: DL Class: CDL Status:  DL Status: List Restrictions:  List Endorsements: Less Than 25 Miles: Yes No Driver’s License Information Page 4  The Driver/Vehicle details found here in Section 2 directly correspond to the 2nd section of the Alabama Uniform Traffic Crash Report Driver’s Information

Section 2 [ Driver / Vehicle]  Place of Employment:  Liability Insur Comp:  Social Security No:  Driver Condition:  Sobriety/Officer Opinion: Alcohol: Drugs:  Type of Test Given: Add’tl Tests:  Travel Road Name:  Road Code:  Travel Direction:  Other Contrib. Circum: Page 5 Driver Information Additional Details on Driver Sequence of Events 1.Event 1 2.Event 2 3.Event 3 4.Event 4 5.First Harmful Event Location When Complete, Continue on to Vehicle Information.

Section 2 [ Driver / Vehicle] Page 6 Vehicle Information Details of Vehicle Involved in Accident Additional Vehicle Info  Haz. Cargo Released?  Attachment:  Oversized Load (Req’ Permit?) Yes No  If Yes, Did Owner Have Permit?Yes No  Contrib Defect: Speed Limit:  Est Speed Limit: Citation:  Damage Severity:  Under/Over: Towed?  Vehicle Towed by Whom?  To Where?  Vehicle Yr: Make:  Model: Body:  VIN Number:  Owner’s Name:  License Tag No:  State: Year:  Street or RFD:  City: State:  Zip: Type:  Usage: Emergency St:  Placard Req’d:  Hazard Cargo: Proceed to Section 3 once this section has been successfully completed.

Section 3 [ Driver / Vehicle]  Driver Last Name:  Driver First Name:  Street Address:  City:  State:  Zip: Telephone:  DOB: Race:  Sex:  Driver’s License No: DL State: DL Class: CDL Status:  DL Status: List Restrictions:  List Endorsements: Less Than 25 Miles: Yes No Driver’s License Information Page 7  The Driver/Vehicle details found here in Section 2 directly correspond to the 2nd section of the Alabama Uniform Traffic Crash Report Driver’s Information

Section 3 [ Driver / Vehicle]  Place of Employment:  Liability Insur. Comp:  Social Security No:  Driver Condition:  Sobriety/Officer Opinion: Alcohol: Drugs:  Type of Test Given: Add’tl Tests:  Travel Road Name:  Road Code:  Travel Direction:  Other Contrib. Circum: Page 8 Driver Information Additional Details on Driver Sequence of Events 1.Event 1 2.Event 2 3.Event 3 4.Event 4 5.First Harmful Event Location When Complete, Continue on to Vehicle Information.

Section 3 [ Driver / Vehicle] Page 9 Vehicle Information Details of Vehicle Involved in Accident Additional Vehicle Info  Haz. Cargo Released?  Attachment:  Oversized Load (Req’ Permit?) Yes No  If Yes, Did Owner Have Permit?Yes No  Contrib Defect: Speed Limit:  Est Speed Limit: Citation:  Damage Severity:  Under/Over: Towed?  Vehicle Towed by Whom?  To Where?  Vehicle Yr: Make:  Model: Body:  VIN Number:  Owner’s Name:  License Tag No:  State: Year:  Street or RFD:  City: State:  Zip: Type:  Usage: Emergency St:  Placard Req’d:  Hazard Cargo: Proceed to Section 3 once this section has been successfully completed.