Peace Officer Traffic Crash Report Form
Complete this form to record the essential facts of a traffic crash, including incident details, officer information, involved vehicle count, conditions, and a crash narrative.
Crash Incident Details
Crash Date
*
-
Month
-
Day
Year
Date
Crash Time
*
Hour Minutes
AM
PM
AM/PM Option
Crash Location
*
City/Township or Jurisdiction
*
Officer and Report Information
Officer Name
*
First Name
Last Name
Badge / Employee Identifier
Agency or Department Name
*
Report Number
*
Crash Summary and Involved Vehicles
Number of Vehicles Involved
*
Crash Type / Severity
*
Please Select
Property Damage Only
Injury Reported
Fatality Reported
Unknown
Weather and Road Conditions at Time of Crash
Clear
Rain
Snow
Fog
Wet Road
Icy Road
Daylight
Dark
Unknown
Narrative Crash Description
*
Submit Report
Should be Empty: