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.
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.
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.
-4-
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Incorrect or missing signatures. The report requires the signature of the driver or an authorized person, and missing signatures may invalidate the document.
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.
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.
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.
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.
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:
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:
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.
Truth: The form specifies that all information should be printed or typed in black or dark blue ink to ensure legibility.
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.
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.
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.
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.
Truth: Personal information submitted on the accident report is used for official purposes and is handled in accordance with privacy laws and regulations.
Truth: Single-vehicle accidents causing death, injury, or significant property damage also require reporting.
Truth: Accidents involving pedestrians or cyclists need to be reported if they result in death, injury, or property damage meeting the reporting threshold.
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.
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:
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.
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