Get Iowa Accident Report Form in PDF Launch Editor Now

Get Iowa Accident Report Form in PDF

The Iowa Accident Report Form, identified by its code Form 433002 08-10, serves a crucial purpose for drivers in Iowa. Whenever an accident takes place within the state's boundaries that results in death, personal injury, or total property damage totaling $1,500.00 or more, this form must be completed. Not only does it provide a systematic way to document accident details, but failure to submit this form within 72 hours could lead to a suspension of driving privileges. This form demands careful attention to detail, instructing users to fill it out fully, using black or dark blue ink, and includes various steps from detailing the accident specifics to insurance information.

Click the button below to learn more about accurately completing and submitting the Iowa Accident Report Form.

Launch Editor Now
Content Navigation

In the event of a traffic accident within the state of Iowa that results in death, personal injuries, or property damage exceeding $1,500, individuals are mandated to complete the Iowa Accident Report form. This structured formality ensures that all relevant details concerning the mishap are systematically captured and reported within a 72-hour window to avoid potential suspension of driving privileges. The document meticulously guides involved parties through various steps, from documenting basic accident information, such as date, time, and extent of injuries or damages, to providing detailed descriptions of vehicles, drivers, and the accident scene itself. It stresses the importance of accuracy and completeness in filling out the report, placing a strong emphasis on the inclusion of driver's license numbers, vehicle ownership details, and the specific conditions under which the accident occurred. Furthermore, the form covers a wide array of specifics including vehicle types, accident locations, traffic and weather conditions at the time of the accident, and even details about non-motorists if they were involved. By encouraging a comprehensive account of the incident, the form aims to facilitate a smooth investigative process and supports the accurate assessment of any claims or legal considerations that may follow.

Preview - Iowa Accident Report Form

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-

File Breakdown

Fact Number Fact Detail
1 The Iowa Accident Report Form is known as Form 433002 08-10.
2 It is mandatory to report accidents in Iowa causing death, personal injury, or property damage of $1,500 or more.
3 The report must be submitted within 72 hours to avoid suspension of driving privileges.
4 Users are instructed to use black or dark blue ink and print or type the information.
5 The form includes specific sections for driver, vehicle, and accident details, including a diagram and description section.
6 Vehicle type codes range from 01 (Passenger Car) to 88 (Other), with specific codes for various types of vehicles.
7 The location of the accident is crucial and must be described with as much specificity as possible.
8 Accident codes include information on the weather, surface conditions, vision obscured, and driver condition at the time of the accident.
9 Contributing circumstances can involve up to two driver-related factors and include specific actions like "Ran traffic signal" or "Driving too fast for conditions".
10 The back side of the report requires insurance information to be completed, and failure to do so may result in the suspension of driving and/or registration privileges.

How to Use Iowa Accident Report

When an accident transpires within Iowa's boundaries, resulting in either injury, death, or property damage surpassing $1,500, it necessitates the completion and submission of the Iowa Accident Report Form. This report serves the critical function of documenting the incident thoroughly, which is pivotal for insurance claims, legal proceedings, or personal record-keeping. Timely submission, specifically within 72 hours, is crucial as procrastination or failure to report could lead to the suspension of driving privileges. This step-by-step guide aims to streamline the process, ensuring clarity and compliance in filling out the form.

  1. Start by using black or dark blue ink and print or type to ensure readability. Begin the "Report of Motor Vehicle Accident" section with the accident date, time, day of the week, and provide details such as the number of vehicles involved, and the total number of injuries, fatalities, and estimated property damage.
  2. Detail information for all drivers and vehicles involved in the accident. This includes driver's name, driver's license number and state, vehicle owner's name, and the vehicle’s license plate number and state. For additional vehicles or drivers, attach an additional form or sheet of paper, marking them as vehicles and drivers 3, 4, 5, etc.
  3. For the box labeled "vehicle type code," utilize the specific codes provided to classify each vehicle involved. These range from passenger cars (01) to trains (22), covering a variety of vehicle types including trucks, motorcycles, and non-motor vehicles.
  4. Describe the accident location with as much precision as possible, specifying if the event occurred within city limits and providing specific road names or landmarks.
  5. Complete the Accident Codes section, referencing page 2 for the correct codes to describe your vehicle’s involvement in the accident. This includes the type of collision, roadway conditions, and any contributing factors.
  6. If the accident resulted in property damage beyond the vehicles involved, provide detailed information about the damage and the property owner's details.For each individual injured or killed in the accident, fill out the injury section completely, including vehicle number, gender, name, address, nature of injuries, and injury status codes as outlined in the instructions.
  7. Create an accident diagram on the provided outline back of the form, including the initial direction of travel for each vehicle involved, and mark whether a peace officer investigated the scene.
  8. Enter the insurance information, including the name of the insurance company, policy number, and policy period, to avoid suspension of your driving and registration privileges.
  9. Sign the report at the designated section on the form's last page. If someone other than the driver is signing the form, they must state their relationship to the driver and the reason for signing on their behalf.

After completation, detach the form along the perforated line and mail it to the Iowa Department of Transportation Office of Driver Services at the address provided on the form. Timely and accurate reporting not only fulfills a legal requirement but also ensures the protection of your driving privileges and aids in the efficient processing of insurance claims or legal matters that may arise from the accident.

Key Details about Iowa Accident Report

What is the Iowa Accident Report form and who needs to fill it out?

The Iowa Accident Report form is a document required by the Iowa Department of Transportation for any accident occurring within the state that results in death, personal injury, or total property damage of $1,500 or more. It must be filled out by individuals involved in such accidents to report the details to the state. This includes drivers of the vehicles involved in the accident.

What information is needed to complete the Iowa Accident Report form?

To complete the form, you will need to provide details about the accident, such as the date, location, and time it happened, descriptions of the vehicles involved (including type, make, year, and license information), details about the drivers and any injuries or fatalities that occurred, and information on property damage. Additionally, you must provide specifics about the accident's circumstances using provided codes for vehicle action, weather conditions, and other contributing factors.

What happens if I don't report an accident in Iowa?

Failing to report an accident in Iowa that meets the reporting criteria can result in the suspension of your driving privileges. It's crucial to submit the completed accident report form within 72 hours of the incident to avoid potential penalties.

How do I submit the Iowa Accident Report form?

After filling out the report, sign it and return it to the Iowa Department of Transportation Office of Driver Services at the provided address, which is P.O. Box 9235, Des Moines, IA 50306-9235. Make sure to tear off the form at the perforated line before sending it.

Are there any parts of the form that require special attention?

Yes, it's important to accurately complete the accident codes section, describe the accident diagram and description section with as much detail as possible, and ensure all insurance coverage information is filled out fully. Lacking information in these sections may result in processing delays or issues with your driving privileges.

What if more than two vehicles are involved in the accident?

If more than two vehicles are involved in the accident, you should use additional forms or attach extra sheets of paper, making sure to number the additional vehicles and drivers appropriately (as vehicle/driver No. 3, 4, 5, etc.), to ensure all information is reported.

How do I report an accident involving a pedestrian or a bicycle?

If involved in an accident with a pedestrian or a bicyclist, you should mark "PEDESTRIAN" or "Bike" in the driver space provided for Vehicle No. 2 on the form and then complete the section for Non-Motorist in Step 7 with the relevant details.

Is it necessary to complete the accident diagram?

Yes, completing the accident diagram provides a visual representation of the accident, which can help clarify the events that occurred. Use the outlines provided to sketch the scene, including street names, directions of travel, and points of impact.

What should I do if I did not have insurance at the time of the accident?

If you did not have automobile liability insurance coverage at the time of the accident, you must indicate this on the form by checking the appropriate box. Be aware that failing to have insurance can lead to the suspension of your driving and/or registration privileges.

Can I report the accident directly to my insurance company instead of using this form?

While you should also report the accident to your insurance company, it is mandatory to submit the Iowa Accident Report Form to the Iowa Department of Transportation if the accident meets the state’s reporting criteria. Reporting only to your insurance company does not fulfill this legal requirement.

Common mistakes

  1. Filling out the form with an incorrect pen color, not using black or dark blue ink as required. This specific pen color is necessary for clarity and legibility, ensuring all details are easily read and processed.

  2. Not including all drivers and vehicles involved. It's critical to provide information for every person and vehicle involved in the accident. If there are more than two, additional forms or sheets must be appended with the report.

  3. Forgetting to use vehicle type codes or using them incorrectly. Each vehicle involved must be classified properly using the provided specific codes to accurately describe the type of vehicle in question.

  4. Being vague or inaccurate about the accident location. The form requires precise details about where the accident occurred for proper documentation and any necessary follow-up.

  5. Omitting or incorrectly detailing the property damage beyond the vehicles involved. Any external property damage must be reported accurately, including details of what was damaged and the extent of the damage.

  6. Incomplete injury information section. It is essential to thoroughly document injuries, specifying which vehicle's occupants were injured and detailing the nature and severity of their injuries.

  7. Misrepresentation or omission of insurance information could lead to a suspension of driving privileges. Failing to fully complete the insurance information section compromises the coverage validation process.

  8. Incorrect or missing signatures. The report requires the signature of the driver or an authorized person, and missing signatures may invalidate the document.

  9. Not providing additional narrative or diagrams when necessary for clarity. Sometimes, complex accidents cannot be adequately described without a detailed narrative or a diagram, and omitting these details can lead to misunderstandings about the event.

Documents used along the form

When dealing with a motor vehicle accident in Iowa, it’s critical to ensure all necessary documentation is gathered in conjunction with the Iowa Accident Report form. This comprehensive approach aids in streamlining the post-accident process, from insurance claims to legal proceedings. Below is a breakdown of seven other essential forms and documents often used with the Iowa Accident Report form, each serving a vital role in thoroughly documenting accident details and implications.

  • Medical Release Form: This form authorizes the release of medical records related to injuries sustained in the accident. It's crucial for insurance claims and legal matters to prove the extent and nature of the injuries.
  • Insurance Claim Form: Submitted to the involved parties' insurance companies, this form initiates the claim process by detailing the accident and the damages or injuries incurred.
  • Witness Statement Form: Witnesses can provide objective accounts of the accident, which can be invaluable in determining fault. This form captures their observations and contact information for future reference.
  • Vehicle Damage Assessment Form: Used by auto repair shops and insurance adjusters, this form outlines the extent of damage to the vehicles involved, helping in the evaluation for repair or replacement.
  • Police Report: While the Iowa Accident Report is a self-reported document, a police report is an official account of the accident as documented by responding officers, providing an authoritative perspective on the incident.
  • Photographic Evidence: Though not a form, photos taken at the scene can significantly complement written reports by visually documenting the damage, road conditions, signage, and other relevant details.
  • Release of Liability Form: This legal document, when signed, releases one party from future claims by the other. It’s often used when settlements are reached, ensuring no further legal action regarding the accident.
  • Similar to the Release of Liability, this form specifically pertains to property damage, signifying that reparations for property damage have been accepted, preventing further claims.

Together with the Iowa Accident Report form, these documents form a comprehensive dossier that supports the involved parties through insurance negotiations, legal challenges, and personal record-keeping. Ensuring each is properly filled out and filed can significantly ease the typically stressful aftermath of an accident.

Similar forms

The Iowa Accident Report form shares similarities with the Uniform Police Traffic Accident Report used across various states in the United States. Both documents are designed to capture detailed information about traffic accidents, including the date, location, parties involved, and circumstances surrounding the incident. They require information on vehicle types, driver details, weather conditions, and the manner of the crash, ensuring a comprehensive data collection for law enforcement and traffic safety analysis. The focus on standardized codes for vehicle action, crash type, and injury severity enhances data consistency and reliability for statistical purposes.

Another comparable document is the Driver’s Motor Vehicle Accident Report often required by insurance companies. This form is filled out by drivers involved in an accident and submitted to their insurance provider as part of the claim process. It collects similar information, such as the accident date, location, driver details, and a description of the accident. Both the Iowa Accident Report form and the insurance report emphasize the importance of providing a detailed account of the accident to facilitate the claims process and determine liabilities and coverage.

The Occupational Safety and Health Administration (OSHA) Form 300, known as the Log of Work-Related Injuries and Illnesses, also parallels the Iowa Accident Report form in its meticulous approach to documenting incidents. Though OSHA Form 300 focuses on workplace injuries and illnesses, both forms serve a similar purpose in collecting detailed information about incidents, including descriptions, outcomes, and involved parties’ details, to improve safety and prevent future occurrences. The systematic recording of such data aids in identifying patterns and implementing preventive measures.

The Federal Railroad Administration (FRA) Accident/Incident Reporting System echoes elements of the Iowa Accident Report form through its comprehensive approach to documenting rail-related incidents. It requires detailed reports on accidents, including time, location, cause, and injury details, much like the Iowa form's detailed vehicle and accident scene descriptions. Both systems ensure thorough documentation to aid in investigations, improve safety standards, and develop preventive strategies against future incidents.

The National Highway Traffic Safety Administration (NHTSA) Crash Report Form serves a similar function to the Iowa Accident Report form by collecting detailed information on vehicular accidents for analysis and safety improvement purposes. It includes data on crash circumstances, vehicle information, road conditions, and passenger details. Both forms are crucial for data gathering that informs policy decisions, road safety measures, and public awareness campaigns about traffic safety and accident prevention.

A Maritime Accident Report Form, used for documenting accidents and incidents on navigatory waters, resembles the Iowa document in its systematic approach to capturing incident details, including vessel information, accident description, weather conditions, and personnel involved. Although focusing on maritime rather than roadway incidents, both forms collect critical information that aids in preventing future accidents through improved safety regulations and practices.

The Aviation Accident/Incident Report shares similarities with the Iowa Accident Report form in its aim to meticulously document air-related accidents and incidents. It captures detailed information about the flight, aircraft involved, nature of the accident, contributing factors, and passenger details. While pertaining to different transportation modes, both forms play a crucial role in gathering data essential for investigating accidents, enhancing safety protocols, and ultimately reducing the frequency and severity of future incidents.

Dos and Don'ts

When filling out the Iowa Accident Report Form, there are key dos and don’ts to ensure the process is completed correctly and efficiently. Here’s a list to guide you through:

  • Do print or type all information clearly using black or dark blue ink to ensure readability.
  • Do completely fill in every section to the best of your ability, providing detailed and accurate information about the accident.
  • Do include all pertinent details about each driver and vehicle involved, such as driver's name, driver license number, vehicle owner's name, and license plate number.
  • Do describe the accident location as specifically as possible, including road names and intersection details if applicable.
  • Do carefully complete the accident diagram and description, indicating the initial direction of each vehicle and the specifics of the crash.
  • Don't leave any sections blank. If a section does not apply to your incident, mark it with “N/A” for not applicable.
  • Don't wait to submit the form. It must be returned within 72 hours to avoid possible suspension of your driving privileges.
  • Don't guess on details or information. If you’re unsure about specific facts, such as the exact amount of damage, note that the information is an estimate or unknown.

Misconceptions

Many people have misconceptions about the Iowa Accident Report form. It’s essential to clear up these misunderstandings to ensure accurate and timely reporting of accidents. Here are ten common misconceptions and the truth behind each:

  • Misconception: You only need to report an accident if it occurs on a public road.
  • Truth: Accidents occurring anywhere within the State of Iowa that result in death, injury, or property damage of $1,500 or more must be reported, regardless of the location.

  • Misconception: You can use any color of ink to fill out the form.
  • Truth: The form specifies that all information should be printed or typed in black or dark blue ink to ensure legibility.

  • Misconception: Reporting the accident to the police is sufficient; you don't need to submit the form.
  • Truth: Even if the police have been involved, you are still required to submit the accident report form within 72 hours to avoid the risk of suspension of your driving privileges.

  • Misconception: If you didn't cause the accident, you don't need to report it.
  • Truth: The requirement to report an accident does not depend on who was at fault. Any accident meeting the reporting criteria must be reported by all involved parties.

  • Misconception: You do not have to report the accident if there were no injuries, only vehicle damage.
  • Truth: The accident must be reported if it results in total property damage of $1,500.00 or more, regardless of the presence or absence of personal injuries.

  • Misconception: The form is too complicated and requires legal assistance to complete.
  • Truth: While the form is detailed, it is designed for drivers to complete without needing legal assistance. Carefully following the instructions provided with the form should suffice.

  • Misconception: Personal information provided on the form will be made public.
  • Truth: Personal information submitted on the accident report is used for official purposes and is handled in accordance with privacy laws and regulations.

  • Misconception: You only need to report accidents involving another vehicle, not single-vehicle accidents.
  • Truth: Single-vehicle accidents causing death, injury, or significant property damage also require reporting.

  • Misconception: Pedestrian and bicycle accidents do not need to be reported if there are no serious injuries.
  • Truth: Accidents involving pedestrians or cyclists need to be reported if they result in death, injury, or property damage meeting the reporting threshold.

  • Misconception: If you start filling out the report and realize you made a mistake, you need to request a new form.
  • Truth: Mistakes can be crossed out neatly, and the correct information can be written in. It’s more important to submit the form within the required timeline than to have it be error-free.

Addressing these misconceptions is crucial for ensuring compliance with the reporting requirements and for maintaining the integrity of the accident reporting process in Iowa.

Key takeaways

Filling out the Iowa Accident Report form correctly and submitting it on time is crucial for drivers involved in an accident within the state. Here are eight key takeaways to ensure you complete the form accurately and maintain compliance with Iowa law:

  • Reportable accidents: Accidents must be reported if they result in death, personal injury, or total property damage of $1,500.00 or more.
  • Submission deadline: The completed accident report form must be submitted within 72 hours to avoid the risk of having your driving privilege suspended.
  • Importance of detail: It's essential to fill out the report as completely as possible, using black or dark blue ink.
  • Vehicle and driver information: Include comprehensive details about all drivers and vehicles involved, such as names, license numbers, and states.
  • Accident description and diagram: Provide a detailed description and diagram of the accident, ensuring that your vehicle is correctly identified if you are vehicle No. 1.
  • Insurance information is critical: Failing to complete the insurance coverage section may lead to suspension of your driving and registration privileges.
  • Non-motorist involvement: If the accident involved a pedestrian, pedalcyclist, or any non-motorist, include specific information in the designated sections.
  • Legal compliance: Accurately reporting an accident using the Iowa Accident Report form is not only a legal requirement but also essential for processing insurance claims and determining liability.

By following these guidelines and carefully completing the Iowa Accident Report form, individuals can navigate the post-accident process more smoothly and ensure compliance with state regulations.

Please rate Get Iowa Accident Report Form in PDF Form
4.74
(Incredible)
187 Votes

Create Other PDFs