DR 2447 (02/01/06)
COLORADO DEPARTMENT OF REVENUE
MAIL TO: STATE OF COLORADO
MOTOR VEHICLE
TRAFFIC RECORDS
DENVER, CO 80261-0016
STATE OF COLORADO TRAFFIC ACCIDENT REPORT
AMENDED/SUPPL.
UNDER $1,000
CDOT Code
Case #
Date of Accident
Officer Number
Number Killed
Number Injured
B
Agency Code
Traffic Unit #
1 or _______
•
County #
Signature
Detail
______ Miles ______ Feet
N
S
E
W
OF:
___________________________________ At: ___________________________________
Latitude _________ _________ _________ Longitude _________ _________ ________
Investigated Total Vehicles District Number Public Property/ Photos Taken Railroad Crossing Const. Zone Highway
Interchg.
@ Scene
Employee
Related
Related
Veh.
L
Location Route, Street, Road
Parked
Bicycle
Pedestrian
Traffic Unit #
Non-Contact Veh. 2 or _______
Non-Vehicle
First
MI
Street Address
Personal Phone
(
City
State
Driver License Number
ZIP
CDL
Parked
Bicycle
Last Name
Pedestrian
Non-Vehicle
)
Sex
DOB
Non-Contact Veh.
L
M
M
MI
Personal Phone
(
(
Bridge
Related
First
Street Address
Bus. Phone
State
Veh.
)
City
State
Driver License Number
ZIP
CDL State
)
N
Bus. Phone
(
)
Sex
DOB
N
Primary Violation
Primary Violation
DUI
DUI
Violation Code
Year
County
Officer Name
Last Name
C
K
K
Agency
Date of Report
B
PAGE ______ OF ______ PAGES
DOR Code
MILEPOINT
City
Time (24 Hr.)
PRIVATE PROPERTY
HWY NUMBER
INTERSTATE HWY
STATE HWY
CITY ST/CNTY RD
A
B
COUNTER REPORT
Citation Number
Make
Model
Common Code
Violation Code
Body Type
Year
Citation Number
Make
Common Code
Model
Body Type
State or Country
Color
P
P
D
License Plate Number
State or Country
License Plate Number
Color
Vehicle Identification Number
Vehicle Identification Number
Vehicle Owner Last Name
E
Address
Same
First
Same
Towed Due to Damage
To:
MI
City
State ZIP
Vehicle Owner Last Name
Address
First
Same
Towed Due to Damage
To:
By:
Same
City
MI
State ZIP
By:
Q
Q
F
Trailer VIN#___________________________
G
____ Undercarriage
_____ Undercarriage
Insurance Company
None
No Proof
Trailer VIN#___________________________
1- Slight
2- Moderate
3- Severe
Exp. Date
_____ Undercarriage
Insurance Company
Policy Number
None
____ Undercarriage
No Proof
1- Slight
2- Moderate
3- Severe
Exp. Date
R
R
Policy Number
H
J
Owner Damaged Prop. Last Name
First
MI
Address
City
State ZIP
Owner Damaged Prop. Last Name
First
MI
Address
City
State ZIP
T.U. POS. REST.ENDO.
#
SAFETY
EQUIP.
AIR BAG
SUSPECTED INJ.
EJECT ALCO DRUG SEV. AGE SEX NAME / ADDRESS
S
S
T
T
Approved By
I.D. #
Date
PAGE ______ OF ______ PAGES
AA
Case #
DOR CODE
Accident Date
Agency
HH
Describe Accident
AA
HH
BB
BB
JJ
CC
JJ
CC
KK
DD
KK
DD
EE
LL
EE
LL
FF
MM
FF
MM
GG
NN
Carrier Name
GG
T.U. #
GG
Address
T.U. #
Carrier Name
GG
Address
NN
US DOT
ICC
State DOT
Carrier Identification #
US DOT
ICC
Carrier Identification #
NN
State DOT
NN
TRAFFIC ACCIDENT REPORT
OVERLAY A
A. LOCATION
K. VEHICLE / VEHICLE COMBINATION
01.
02.
03.
04.
05.
FMC (Overlay C) Required
01. Vehicle / Vehicle Combination
(10,001 lbs. and over)
02. School Bus (all school buses)
03. Non-school Bus (9 occupants or more
including driver) in commerce
04. Transit Bus
GVWR 10,000 lbs. or Less
05. Passenger Car / Passenger Van
06. Passenger Car / Passenger Van W/ Trailer
07. Pickup Truck / Utility Van
On Roadway
Ran Off Left Side
Ran Off Right Side
Ran Off ‘T’ Intersection
Vehicle Crossed Center Median
Into Opposing Lanes
06. On Private Property
B. HARMFUL EVENT SEQUENCE
NON-COLLISION ACCIDENT
01. Overturning
02. Other Non-Collision
COLLISION WITH PEDESTRIAN
03. School Age To / From School
04. Pedestrian on Toy Motorized Veh.
1st 05. All Other Peds
COLLISION WITH MOTOR VEHICLE
IN TRANSPORT
06. Front to Front
2nd 07. Front to Rear
08. Front to Side
09. Rear to Side
10. Rear to Rear
MOST
11. Side to Side-Same Direction
12. Side to Side-Opposite Direction
COLLISION WITH OTHER VEHICLE
13. Parked Motor Vehicle
14. Railway Vehicle/Light Rail
15. Bicycle
16. Road Maintenance Equipment
COLLISION WITH ANIMAL
17. Domestic Animal
18. Wild Animal
COLLISION WITH OBJECT
19. Light Pole / Utility Pole
20. Traffic Signal Pole
21. Sign
22. Guard Rail
23. Cable Rail
24. Concrete Highway Barrier
25. Bridge Structure
26. Vehicle Debris or Cargo
27. Culvert or Headwall
28. Embankment
29. Curb
30. Delineator Post
31. Fence
32. Tree
33. Large Rocks or Boulder
34. Railroad Crossing Equipment
35. Barricade
36. Wall or Building
37. Crash Cushion / Traffic Barrel
38. Mailbox
39. Other Fixed Object (Specify in
Narrative)
40. Other Object (Specify in
Narrative)
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Pickup Truck / Utility Van W/Trailer
SUV
SUV W/Trailer
Motor Home
Motorcycle
Bicycle
Motorized Bicycle
Farm Equipment
Hit & Run Unknown
Light Rail
Other (Describe in Narrative)
L. DIRECTION OF TRAVEL – PRIOR TO IMPACT
01.
02.
03.
04.
North
Northeast
East
Southeast
05.
06.
07.
08.
South
Southwest
West
Northwest
M. VEHICLE MOVEMENT – PRIOR TO IMPACT
01.
02.
03.
04.
05.
06.
07.
08.
09.
Going Straight
Slowing
Stopped in Traffic
Making Right Turn
Making Left Turn
Making U-Turn
Passing
Backing
Entering / Leaving Parked Position
10.
11.
12.
13.
14.
15.
16.
Parked
Changing Lanes
Avoiding Object in Roadway
Weaving
Spun Out of Control
Drove Wrong Way
Other (Describe in Narrative)
N. ROADWAY SPEED LIMIT - Vehicles Only
Traffic Unit #1 or ________
Traffic Unit #2 or ________
C. APPROACH/OVERTAKING TURN
01. Approach Turn
02. Overtaking Turn
03. Not Applicable
P. ESTIMATED VEHICLE SPEED - Vehicles Only
Traffic Unit #1 or ________
D. ROAD DESCRIPTION
01.
02.
03.
04.
At Intersection
Driveway Access Related
Intersection Related
Non-Intersection
05.
06.
07.
08.
Alley Related
Roundabout
Highway Interchange
Parking Lot
E. ROAD CONTOUR
01. Straight On-Level
02. Straight On-Grade
03. Curve On-Level
04. Curve On-Grade
05. Hillcrest
F. ROAD SURFACE
01.
02.
03.
04.
Concrete
Blacktop
Brick or Block
Gravel, Slag or Stone
05. Dirt
06. Other (Describe in Narrative)
07. Unknown
G. ROAD CONDITION
01.
02.
03.
04.
05.
06.
07.
Dry
Wet
Muddy
Snowy
Icy
Slushy
Foreign Material
08.
09.
10.
11.
12.
Dry W/Visible Icy Road Treatment
Wet W/Visible Icy Road
Treatment
Snowy W/Visible Icy Road
Treatment
Icy W/Visible Icy Road Treatment
Slushy W/Visible Icy Road
Treatment
H. LIGHTING CONDITION
01.
02.
03.
04.
Daylight
Dawn or Dusk
Dark - Lighted
Dark - Unlighted
Q. DRIVER ACTIONS (Officer Opinion Only)
00.
01.
02.
03.
04.
05.
06.
07.
08.
09.
No Action
Exceeded Safe/ Posted Speed
Impeded Traffic
Failed to Yield ROW
Disregard Stop Sign
Failed to Stop at Signal
Disregarded Other Device
Improper Turn
Turned from Wrong Lane or Position
Other Improper Turns
10.
11.
12.
13.
14.
15.
16.
17.
Lane Violation
Improper Passing on Left
Improper Passing on Right
Followed Too Closely
Improper Backing
Signaling Violation
Reckless Driving
Careless Driving (if used,
block R can not be coded "00")
R. DRIVER - MOST APPARENT HUMAN CONTRIBUTING
FACTOR (Officer Opinion Only)
00.
01.
02.
03.
04.
05.
06.
07.
08.
No Apparent Contributing Factor
Asleep at the Wheel
Driver Fatigue
Illness / Medical
Driver Inexperience
Aggressive Driving
Driver Unfamiliar With Area
Driver Emotionally Upset
Evading Law Enforcement Officer
09.
10.
11.
12.
13.
14.
Physical Disability
DUI, DWAI, DUID
Distracted / Passenger
Distracted / Cell Phone
Distracted / Radio
Distracted / Other
i.e. Food, Objects, Pet, etc.
15. Other Factor (Describe
in Narrative)
S. BY PEDESTRIAN ACTION (Officer Opinion Only)
J. ADVERSE WEATHER CONDITION
00. None
01. Rain
02. Snow / Sleet / Hail
Traffic Unit #2 or ________
03. Fog
04. Dust
05. Wind
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
Cross Against Signal
Cross / Enter at Intersection
Cross / Enter NOT at Intersection
Standing in Roadway
Playing in Roadway
Soliciting Rides
Walking in Roadway in Direction of Traffic
Walking in Roadway Against Direction of Traffic
Entering / Exiting Vehicle
Pushing / Working on Vehicle
Lying in Roadway
Other (Describe in Narrative)
T. VEHICLE DEFECT / CONDITION (Officer Opinion Only)
00.
01.
02.
03.
04.
05.
06.
07.
08.
09.
No Vehicle Defects
Defective Head Light(s)
Defective Brake/Tail Light(s)
Defective Signaling Device
Brakes Defective/Out of Adjustment
Defective Tires
Sudden Tire Failure
Improper Tires for Conditions
Mechanical Failure
Obstructed Window(s)
10. Improper Load
11. Spilled Load – Commercial
Aggregate
12. Spilled Load – Commercial
Non- Aggregate
13. Spilled Load – Other
14. Parking Violation
15. Other Defect(s) (Describe
in Narrative)
OVERLAY B
Traffic Unit #
Position In / On Vehicle
14
➟
03
06
09
02
05
08
01
04
07
10/11
12
01.
02-09.
10.
11.
12.
13.
14.
15.
13
Compliance with Driving Restrictions
Driver
Passengers
Other ENCLOSED passenger/cargo area
Other UN-ENCLOSED passenger/cargo area
Sleeper Section of Truck
Trailer
Riding/Hanging on to Exterior of vehicle or trailer
Pedestrian
00. Not Restricted
01. Complied With Restrictions
02. Did Not Comply With Restrictions
03. Compliance With Restrictions Not Known
No Driving Endorsements
Compliance with Driving Endorsements 00.
01. Endorsements Required and Complied With
02. Endorsements Required and Not Complied With
03. Endorsements Required and Compliance Not Known
Safety equipment used
Air Bag
USE (Restraints & MC Eye
Protection)
00. Not used
01. Properly used
02. Improperly used
03. Unknown
04. Bicycle
SYSTEM
A. None
B. Shoulder and Lap Belt
C. Shoulder belt only
D. Lap belt only
E. Child safety restraint
F. Motorcycle
G. Bicycle
00. Not Equipped
01. Not Deployed
02. Deployed at pos. only
03. Deployed at pos. & others
Ejection
04.Not deployed at pos.,
deployed at others
05.Unknown
00. No
01. Yes - Partial
02.
03.
Suspected alcohol
(Officer Opinion Only)
A. None
B. Front
C. Side
F. Unknown
G. Bicycle Helmet
D. Curtain
E. Rear
F. Multiple
Yes - Full
Extricated
00. No
01. Yes
02. Unknown
Suspected drugs
(Officer Opinion Only)
Injury Severity
HELMET
A. N/A (Cars/Trucks)
B. No Helmet
C. Available, not used
D. Helmet Improperly used
E. Helmet Properly used
00. No
01. Yes
02. Unknown
00. No injury
01. Complaint of injury
02. Evident - non-incapacitating
03. Evident - incapacitating
04. Fatal
Sex
Name / Address
Sex
Age MUST BE in whole Numbers (Under the Age of 1 year Age = 0 )
Age
Injury Severity
Suspected drugs (Officers Opinion Only)
Suspected alcohol (Officers Opinion Only)
Ejection
Air Bag -Type
Air Bag -Deployment
-Helmet
-Use
Safety Equipment Used -System
Compliance with Driving Endorsements
Compliance with Driving Restrictions
Position In / On Vehicle
Traffic Unit #
Age Age MUST BE in whole Numbers (Under the Age of 1 year Age = 0 )
Name / Address
OVERLAY C
FEDERAL MOTOR CARRIER INFORMATION
AA. CARRIER TYPE
HH. HAZARDOUS MATERIALS
01.
02.
03.
04.
Did the vehicle have a hazardous material placard?
00. No
01. Yes
Interstate
Intrastate
Government Vehicle (10,001lbs. GVWR and over)
Not in Commerce (10,001lbs. GVWR and over)
(If #4 is chosen, complete only blocks CC, DD, EE, FF, and GG or NN.)
BB. SOURCE OF NAME
01.
02.
03.
04.
Log Book
Shipping Papers, Truck, Bus, or Trip Manifest
Driver
Side of Vehicle
JJ. HAZARDOUS MATERIALS
Was hazardous cargo from the placarded truck released?
(Do not count fuel from the vehicle fuel tank)
00. No
01. Yes
CC. GROSS VEHICLE WEIGHT RATING
01. Under 10,001 Pounds
02. 10,001 to 26,000 Pounds
03. 26,001 Pounds and Over
DD. TOTAL NUMBER OF AXLES
Enter the total number of axles including truck and trailer.
KK. HAZARDOUS MATERIALS
Enter the four digit number from the placard. If no number on the placard
enter the four digit identification number from the shipping paper(s).
➟
Sample
EE. VEHICLE CONFIGURATION
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
2nd
3rd
4th
Enter the one digit number taken from the bottom of the placard.
MM. LIQUID HAZARDOUS MATERIALS
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
Enter the amount of bulk liquid cargo at time of accident.
01. 0 to 1,000 gallons
02. 1,001 to 2,000 gallons
03. 2,001 to 3,000 gallons
04. 3,001 to 4,000 gallons
05. 4,001 to 5,000 gallons
06. 5,001 to 6,000 gallons
07. 6,001 to 7,000 gallons
08. 7,001 to 8,000 gallons
09. 8,001 gallons and over
Bus/ Limousine (seats 9-15 occupants including the driver)
Bus/Limousine (seats 16 or more occupants including the driver)
Van/ Enclosed Box
Cargo Tank
Flatbed/Pickup
Dump Bed
Concrete Mixer
Auto Transporter
Garbage Refuse
Grain, Chips, Gravel
Pole
Intermodal Container
Vehicle Towing another Vehicle
Fire Aparatus
Ambulance
No Cargo Body
Other (Describe in Narrative)
GG.
1st
LL. HAZARDOUS MATERIALS
Passenger Car (only if HM placarded)
Light Truck (only if HM placarded)
Bus/ Limousine
Single-unit Truck (2 axles)
Single-unit Truck (3 or more axles)
Truck and Trailer
Truck Tractor (Bobtail)
Truck Tractor and Semi-Trailer
Truck Tractor and Double Trailers
Truck Tractor and Triple Trailers
Other (Describe in narrative)
FF. CARGO BODY TYPE
Block AA
Top
SEQUENCE OF ACCIDENT EVENTS
NON-COLLISION
COLLISION
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Ran Off the Road
Jackknifed
Overturning
Downhill Runaway
Cargo Loss or Shift
Explosion or Fire
Separation of Units
Crossed the Median/Center Line
Equipment Failure (Tires, etc.)
Other (Describe in Narrative)
KK
1 3
6 9
Pedestrian
Motor Vehicle inTransport
Parked Motor Vehicle
Train
Pedal Cycle (Bicycle, Tricycle, etc.)
Animal
Fixed Object
Work Zone Maintenance Equipment
Other Movable Object
Other (Describe in Narrative)
NN .
Block AA
Bottom
1st
2nd
3rd
4th
COLORADO INVESTIGATOR’S FATAL TRAFFIC ACCIDENT SUPPLEMENTAL REPORT
PAGE ______ OF ______ PAGES
Case #
DOR CODE
Accident Date
Agency
EMERGENCY MEDICAL SERVICES
(Record all time using 24 Hr. time)
Time Notified
ACCIDENT AVOIDANCE MANEUVER
Time Arrived @ Scene Time Arrived @ Hospital
00.
01.
02.
03.
04.
05.
06.
If times are unknown provide name of responding services
Traffic
Unit #1
or ___
Traffic
Unit #2
or ___
Traffic
Unit #3
or ___
Traffic
Unit #4
or ___
Traffic
Unit #1
or ___
Traffic
Unit #2
or ___
Traffic
Unit #3
or ___
Traffic
Unit #4
or ___
FIRE/HAZARDOUS MATERIALS INVOLVEMENT
TRAFFICWAY FLOW
01.
02.
03.
04.
No Avoidance Maneuver
Braking (Skid marks evident)
Braking (Per driver, no skid marks evident)
Braking (Per witness, no skid marks evident)
Steering (Evidence or stated)
Steering & Braking (Evidence or stated)
Other Avoidance Maneuver
00.
01.
02.
03.
04.
05.
Not Divided (Two Way)
Divided, Median W/O Barrier
Divided, Median W/Barrier
One Way
NUMBER OF TRAVEL LANES
No Fire/No Haz-Mat Cargo
No Fire/Haz-Mat Cargo Not Involved
No Fire/Haz-Mat Incident
Vehicle Fire/No Haz-Mat Cargo
Vehicle Fire/Haz-Mat Cargo Not Involved
Vehicle Fire/Haz-Mat Incident
If the accident is totally contained on half of a divided
highway (physical barrier not painted median), only
count the number of travel lanes on that half.
TRAFFIC CONTROL DEVICE
FUNCTIONING
01.
02.
03.
04.
05.
List the Most Significant Types of Traffic Control Devices
No Controls
Not Functioning
Functioning Improperly
Functioning Properly
Unknown
MUST BE COMPLETED FOR ALL PERSONS INVOLVED EXCEPT UNINJURED BUS/RAILWAY PASSENGERS.
(A) Traffic Unit Number (list Traffic Unit Number as on DR 2447)
(B) Position in Vehicle
➟
14
03
06
09
02
05
08
01
04
07
10/11
12
(C) Ejection Path 00. Not Ejected/ Not applicable
01. Through Side Door Opening
02. Through Side Window
03. Through Windshield
(D) Alcohol Suspected
(Officer Opinion Only)
13
04.
05.
06.
07.
Driver
Passengers
Other ENCLOSED passenger/cargo area
Other UN-ENCLOSED passenger/cargo area
Sleeper Section of Truck
Trailer
Riding/Hanging on to Exterior of Vehicle or Trailer
Pedestrian
Through Back Window
Through Back Door/Tailgate Opening
Through Roof Opening (sun roof/convertible top down)
Through Roof (convertible top up)
Yes > 01. Preliminary Breath Test
02. SFST
03. Observed
(E) Tested for Alcohol 00. Not Tested 03. Urine
01. Blood
02. Breath
01.
02-09.
10.
11.
12.
13.
14.
15.
04. Passive Alcohol Sensor
05. Other method
08. Other Path (e.g. back of pickup truck)
09. Unknown
No > 06. Preliminary Breath Test
07. SFST
08. Observed
09. Passive Alcohol Sensor
10. Other method
06. By Coroner
04. Other
05. Refusal
(F) Other Drug/Impairment Suspected
(Officer Opinion Only)
(G) Tested for Other Drugs
Yes > 01.
02.
03.
04.
00. Not Tested
01. Blood
Drug Recognition Expert
SFST
Observed
Other
02. Breath 04. Other
03. Urine 05. Refusal
No > 05.
06.
07.
08.
Drug Recognition Expert
SFST
Observed
Other Method
06. By Coroner
(H) Dead at Scene 00. No
01. Yes
Name
Taken to
Date
Expired
Time