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Submit a Motor Carrier Accident Report

NOTICE: The driver may be required to file an individual crash report DMV Form 735-0032 with Driver and Motor Vehicle Services (DMV) within 72 hours of crash. See DMV Form 735-0032 for driver reporting criteria. The crash report is available at all DMV and law enforcement offices, at the DMV Web site - www.oregon.gov/ODOT/DMV/forms/index.shtml - or by calling 503-945-5098.

INSTRUCTIONS: If checking a box under the Qualifying Vehicle column and a box under the Criteria column, complete the remainder of this online form and submit it to send the information to the Oregon Department of Transportation, Transportation Development Division, Crash Analysis & Reporting Unit. If no circumstances listed under the Criteria column apply, you are not required to submit this form.

Qualifying Vehicle
Commercial truck (GVWR over 10,000 lbs. or actual weight at time of crash even if GVWR is set under 10,000 lbs.)
Hazardous material placard
Commercial bus (designed for 8 or more passengers)
Farm vehicle (4 axles or more) operated for-hire (80,000 lbs. or less)
Farm vehicle (4 axles or more) operated over 80,000 lbs. (farmer's farm use only)

Criteria
Any person sustaining a fatality (within 30 days of the accident)
Any person sustaining injuries requiring treatment away from the scene
Any vehicle incurring disabling damage requiring removal from the scene by a tow truck or another motor vehicle

 

Motor Carrier Name

U.S. DOT Number      Oregon Account Number

Address      City      State      Zip

 

Driver Information

Driver Name (Last, First, Middle)

Date of Birth      Length of Employment - Years      Months

CDL / DL Number      State      License Class - A     B     C     D     M

Expiration Date of Medical Certificate

 

Complete the following two questions as if doing a recap of hours in time documents at times of accident.

At time of accident, total hours driving since last off-duty period

Total hours on duty during the previous -      7 consecutive days      8 consecutive days
(fill out one only, based on time documents)

Does your driver have a medical waiver?  Yes      No

Type of waiver (sight, diabetes, amputee, etc.)

 

Driver Injury Information
Your driver killed?    Yes    No Your driver injured?   Yes   No
Relief driver killed?   Yes   No Relief driver injured? Yes   No
Total number of passengers    Killed    Injured


Other Driver Injury Information
Total number of other drivers Killed Injured
Total number of other passengers Killed Injured
Total number of pedestrians Killed Injured
Total number of bicyclists Killed Injured

Other Motor Carrier Information (if 2 or more motor carriers were involved)

Motor Carrier Name

Vehicle License Number & State

Driver's Name      Driver's License Number & State

 

Motor Carrier Name

Vehicle License Number & State

Driver's Name      Driver's License Number & State

 

Motor Carrier Name

Vehicle License Number & State

Driver's Name      Driver's License Number & State

 

Motor Carrier Vehicle Information

Year      Make      Unit Number

Truck/Tractor/Bus License Plate Number & State      Total Number of Axles (including trailers)


      Tractor w/ 3 trailers
      Truck w/ 2 trailers
      Straight full trailer
      Doubles

      Tractor semi trailer
      Straight truck
      Bobtail
      Saddlemount

      Heavy haul
      Bus or van
      Auto or pickup 		 

Cargo Body Type
Van     Flatbed     Tanker     Container    Pole     Dump     Belly-Dump     Car Carrier
Livestock    Mobile Home Toter     Passenger     Drop-Box     Garbage     Bulk-Hopper
Mixer     Saddlemount     Wrecker     Fixed Load     Heavy Haul     Utility

Total length of vehicle/combination Total width of vehicle or cargo

Cargo weight      Gross vehicle weight

 

Commodity Information

Commodity being transported at time of crash

Was a hazardous commodity being hauled?  Yes      No

Was hazardous material released from the vehicle cargo (not a fuel release)?  Yes     No

Hazard Class

 

Crash Information

Location of crash (nearest city or town)

Highway & Milepoint / Street / County Road

Direction of your vehicle -N     S     E     W

Date of crash      Time a.m.     p.m.

Day of the week -Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday

 

Conditions at Time of Accident

Weather -Clear    Rain    Snow    Cloudy    Sleet    Fog    Other

Road Surface -Dry    Wet    Snowy    Icy    Other

Light Condition -Day    Dawn    Dusk    Artificial Lights    Dark    Other


Describe what happened by checking all boxes that apply. Your vehicle is always #1. If other vehicles were involved, check boxes for vehicles #2 and #3 to correspond to the actions of the same numbered vehicles listed above under "Other Driver Information."

Slowing-Stopping Vehicle #1 Vehicle #2 Vehicle #3
Stopped Vehicle #1 Vehicle #2 Vehicle #3
Rear-end Vehicle #1 Vehicle #2 Vehicle #3
Backing Vehicle #1 Vehicle #2 Vehicle #3
Making right turn Vehicle #1 Vehicle #2 Vehicle #3
Making left turn Vehicle #1 Vehicle #2 Vehicle #3
Making U turn Vehicle #1 Vehicle #2 Vehicle #3
Proceeding straight Vehicle #1 Vehicle #2 Vehicle #3
Intersection Vehicle #1 Vehicle #2 Vehicle #3
Entering traffic Vehicle #1 Vehicle #2 Vehicle #3
                                 (entering from shoulder, median, parking strip, or private drive)
Passing Vehicle #1 Vehicle #2 Vehicle #3
Changing lanes Vehicle #1 Vehicle #2 Vehicle #3
Sideswipe Vehicle #1 Vehicle #2 Vehicle #3
Head-on Vehicle #1 Vehicle #2 Vehicle #3
Skidding Vehicle #1 Vehicle #2 Vehicle #3
Vehicle out of control Vehicle #1 Vehicle #2 Vehicle #3
Roll-away Vehicle #1 Vehicle #2 Vehicle #3
Controlled RR Crossing Vehicle #1 Vehicle #2 Vehicle #3
Uncontrolled RR Crossing Vehicle #1 Vehicle #2 Vehicle #3
Ran off road Vehicle #1 Vehicle #2 Vehicle #3
Jackknife Vehicle #1 Vehicle #2 Vehicle #3
Overturn Vehicle #1 Vehicle #2 Vehicle #3
Separation of units Vehicle #1 Vehicle #2 Vehicle #3
Fire Vehicle #1 Vehicle #2 Vehicle #3
Explosion Vehicle #1 Vehicle #2 Vehicle #3
Cargo shift Vehicle #1 Vehicle #2 Vehicle #3
Cargo spill (hazardous) Vehicle #1 Vehicle #2 Vehicle #3
Cargo spill (non-hazardous) Vehicle #1 Vehicle #2 Vehicle #3
Other (deer, guardrail, etc.) Vehicle #1 Vehicle #2 Vehicle #3

Did your vehicle strike a parked vehicle?  Yes      No

Was your parked vehicle struck by another vehicle?  Yes      No

Description of accident by carrier official:

Name & Title of Person Submitting Report required
(Certifying that the information provided is true and accurate)
Contact Phone No:  *
E-Mail Address  *required
Confirm E-Mail Address  *required
Date
  

Motor carriers are required to maintain an accident register and keep copies of all accident reports for a period of three years after the accident (CFR Part 390.15).

  1. A motor carrier must make all records and information pertaining to an accident available to an authorized representative or special agent of the Federal Motor Carrier Safety Administration, an authorized State or local enforcement agency representative or authorized third party representative, upon request or as part of any investigation within such time as the request or investigation may specify. A motor carrier shall give an authorized representative all reasonable assistance in the investigation of any accident including providing a full, true and correct response to any question of the inquiry.

  2. For accidents that occur after April 29, 2003, motor carriers must maintain an accident register for three years after the date of each accident. For accidents that occurred on or prior to April 29, 2003, motor carriers must maintain an accident register for a period of one year after the date of each accident. Information placed in the accident register must contain at least the following:

        (b)(1) A list of accidents as defined at §390.5 of this chapter containing for each accident:
            (b)(1)(i) Date of accident.
            (b)(1)(ii) City or town, or most near, where the accident occurred and the State where the accident occurred.
            (b)(1)(iii) Driver Name.
            (b)(1)(iv) Number of injuries.
            (b)(1)(v) Number of fatalities.
            (b)(1)(vi) Whether hazardous materials, other than fuel spilled from the fuel tanks of motor vehicle involved in the accident, were released.

        (b)(2) Copies of all accident reports required by State or other governmental entities or insurers.
 
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