GENERAL INSTRUCTIONS

MOTOR VEHICLE CRASH REPORT OVERLAY NO. 1

1.
2.

North Dakota Department of Transportation, Safety Division

DOT 2356 (Rev.07-2013)

3.

CRASH AND GENERAL INFORMATION

A. REPORT TYPE
1. Original
2. Supplemental

B. CRASH TYPE
1. Traffic
2. Non-Traffic

t
t

t
t

C. CRASH SEVERITY
1. Fatal
2. Non-incapacitating Injury

3. Non-Reportable

3. PDO
4. Incapacitating Injury

D. HIT AND RUN

1. Yes
2. No
E.
1.
2.
3.

AGENCY TYPE
Highway Patrol
City Police
County Sheriff

4. BIA
5. Campus PD
6. Military Police

G.
0.
1.
2.
3.
4.

RELATION TO ROADWAY
On Roadway
5. Outside Shoulder-Left (Includes Ditch)
Shoulder
6. Outside Shoulder-Right (Includes Ditch)
Median
7. Off Roadway Location Unknown
Gore
8. Parking Lot
Private Property
9. Alley
10. Separator

H.
1.
2.
3.
4.
5.

RELATION TO JUNCTION
Non-Junction
6.
Intersection
7.
Interchange Area
8.
Alley / Driveway Access
9.
Entrance / Exit Ramp
10.

Railroad Grade Crossing

Bridge
Intersection Related
Crossover Related
Other Crossing

I. ROADWAY GEOMETRICS
1. Straight (On Level)
3. Curve (On Level)
2. Straight (On Grade)
4. Curve (On Grade)
J.
1.
2.
3.
4.
5.

5. Hill Crest

TRAFFICWAY
Not Divided (Two-Way Traffic)
Divided Highway (Median Strip Without Barrier)
Divided Highway (Median Strip With Barrier)
One-Way Trafficway
Not Divided (With Continuous Left-Turn Lane)

L.
1.
2.
3.
4.

M. SURFACE TYPE
(SURFACE TYPE)
1. Concrete
4. Dirt
2. Asphalt
5. Brick
3. Gravel / Scoria

N.
0.
1.
2.

O.
0.
1.
2.

P. LIGHT
0. Unknown
1. Daylight

7. Park Ranger

F. INTERSECTION TYPE
5. Y-Intersection
1. Non-Intersection
3. Four-Way Intersection 6. Roundabout
2. T-Intersection
4. Five + Roads
7. Traffic Circle

K. ACCESS CONTROL
1. No Control (Unlimited Access)
2. Full Control (Only Ramp Entry and Exit)

5. Possible Injury

ROAD CONDITION
Normal
Under Construction / Maintenance
Soft / Defective Shoulder
Obstruction / Flood

3. Partial Access Control

5.
6.
7.
8.
9.

Debris On Road
Reduced Road Width
Holes / Ruts / Bumps / Washout
Loose Material Surface
Worn, Travel-Polished

6.
7.
8.
9.

(IF BRIDGE DECK)

Concrete Bridge Deck
Asphalt Bridge Deck
Metal Bridge Deck
Wood Bridge Deck

SURFACE CONDITION
Oil
3. Mud / Dirt / Gravel
Dry
4. Snow
Wet
5. Slush

6.
7.
8.
9.

Ice / Compacted Snow

Frost
Water
Sand

WEATHER
Unknown 3. Rain
Clear
4. Snow
Cloudy
5. Blowing Snow

6.
7.
8.
9.

Sleet / Hail / Freezing Rain

Fog / Smoke / Dust
Severe Wind
Blowing Sand / Soil / Dirt

2. Dawn
3. Dusk

4. Dark (Lighted)
5. Dark (Not Lighted)

Q1. WORK-ZONE RELATED

0. Not Applicable
2. Advance
1. Before first warning sign
Warning Area

Q2. TYPE OF WORK ZONE

0. Not Applicable 2. Lane Shift / Crossover
1. Lane Closure
3. Work on Shoulder / Median

t Q3.

WORKERS PRESENT
0. Not Applicable
1. Yes

2. No

3. Transition Area
4. Activity Area
5. Termination Area
4. Intermittent or
Moving Veh.
5. Other*

R.
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.

UNIT CONFIGURATION
Passenger Car
Pickup / Van / Utility
Bus (Seats For > 16, Incl. Driver)
School Bus
Motorhome / Camper
Snowmobile
Off Highway Veh. (OHV)
Motorcycle
Moped
Pedalcycle
Const. Equip.
Emergency Vehicle

14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.

S. ATTACHMENTS
0. None
1. Single Trailer
T.
00.
01.
02.
03.
04.
05.

CARGO BODY TYPE

Not Applicable
Van / Enclosed Box
Dry Bulk Cargo Tank
Liquid Bulk Cargo Tank
Gaseous Bulk Cargo Tank
Flatbed / Platform

Farm Equipment
Modified Vehicle
Hit-and-Run Vehicle
Roadway Maintenance Vehicle
Other Publicly-Owned Vehicle
Pedestrian
2-Axle 6-Tire Single Unit Truck / Stepvan
3 or More Axles Single Unit Truck
Single Unit Truck
Truck Tractor
Unknown Heavy Truck
Low Speed Vehicle (Golf Car, Segway)
Other Pedestrian (Wheelchair)

2. Double Trailer

06. Dump
07. Concrete Mixer
08. Auto Transporter
09. Garbage / Refuse
10. Bus (16 Incl. Driver)
11. Combination *

V. ORIGINAL DIRECTION OF TRAVEL

3. East
1. North
2. Northeast
4. Southeast

W. TRAFFIC CONTROL
00. None
01. Stop Sign
02. No-Passing Zone
03. Flashing Beacon
04. RR Signals With Gates
05. RR Signals Only

USE BLACK INK OR TYPE ONLY

COMPLETE ALL BLOCKS UNLESS OTHERWISE
DIRECTED. EXCEPTIONS ARE LISTED IN
APPENDIX A OF THE OFFICER'S MANUAL.
ALL ITEMS WITH AN ASTERISK (*) MUST BE
EXPLAINED IN THE NARRATIVE.

5. South
6. Southwest

3. Triple Trailer

12. Special Permit Load

13. Hopper
14. Pole
90. Other *
99. Unknown

7. West
8. Northwest

06. RR Crossing
12. School Zone Signs
07. Officer / Flagperson
13. Warning Signs
08. Traffic Signal
99. Unknown
09. Yield Sign
10. Barricade
11. Control Not Visible / Broken

X. OBSERVATIONS *EXPLAIN IN NARRATIVE

00. None
08. Traffic Signals
01. Need Signing
09. Clearance Height
02. Trees / Shrubs / Tall Grass / Crops
10. Road Maintenance
03. Pavement Markings
11. Delineators / Bridge Markings
04. Hill / Curve
12. Guardrail
05. Narrow Bridge / Roadway
13. Geometrics
06. Rough Road
14. Speed Limit
07. Lighting
15. Sight Obstruction*
Y.
1.
2.
3.
4.
5.
6.

MANNER OF COLLISION
Angle (Not Specific)
Rear-End
Head-On
Sideswipe (Same Direction)
Sideswipe (Opposite Direction)
Rear-to-Rear

7.
8.
9.
10.
11.

Non-Collision With Motor Vehicle in Transport

Angle (Same Direction)
Angle (Opposite Direction)
Right Angle
Rear to Side

_Z._ FIRST
_ _ _HARMFUL
_ _ _ EVENT
______________________
AA._ SEQUENCE
_
_ _ _ _ _OF_EVENTS
______________________
BB. MOST HARMFUL EVENT
______________________________
COLLISION WITH OBJECT - NOT FIXED
COLLISION WITH FIXED OBJECT
01. Motor Vehicle in Transport
30. Impact Attenuator
02. Motor Vehicle in Transport in Other Rdwy 31. Bridge / Pier / Abutment
03. Pedestrian
32. Bridge Parapet End
04. Pedalcycle
33. Bridge Rail
05. Railway Train
34. Guardrail Face
06. Deer
35. Guardrail End
07. Other Large Game
36. Median Barrier (Concrete Traffic Barrier)
08. Farm Animal
37. Highway Traffic Sign Post
09. Small Animal
38. Overhead Sign Support
10. Parked Motor Vehicle
39. Luminaire / Light Support
11. Other Object (Not Fixed)
40. Utility Post
12. Work Zone / Maintenance Equipment
41. Other Post / Pole / Support
NON-COLLISION
42. Culvert
19. Fell / Jumped from Vehicle
43. Curb
20. Overturn / Rollover
44. Ditch
21. Fire / Explosion
45. Embankment
22. Immersion
46. Fence
23. Jackknife
47. Mail Box
24. Downhill Runaway
48. Tree
25. Cargo Loss or Shift
49. Other Fixed Object
26. Separation of Units
50. Bridge Overhead Structure
27. Ran off Roadway
51. Other Traffic Barrier
28. Other Non-Collision
52. Traffic Signal Support
29. Thrown / Falling Object

MOTOR VEHICLE CRASH REPORT OVERLAY NO. 2

OCCUPANT, WITNESS, AND PROPERTY INFORMATION
OCCUPANT SEAT POSITION
11.
12.
13.
21.
22.
23.
31.
32.
33.
41.
42.
43.

11 12 13
21 22 23

31 32 33
41 42 43

Front Seat-Left Side (Motorcycle Driver)

Front Seat-Middle
Front Seat-Right Side
Second Seat-Left Side (Motorcycle Passenger)
Second Seat-Middle
Second Seat-Right Side
Third Row-Left Side (Motorcycle Passenger)
Third Row-Middle
Third Row-Right Side
Fourth Row - Left Side
Fourth Row - Middle
Fourth Row - Right Side

50.
51.
52.
55.
56.
80.
94.
95.
96.
97.
99.

Sleeper Section of Cab (Truck)

Passenger in Other Enclosed Passenger or Cargo Area (Non-Trailing Unit)
Passenger in Unenclosed Passenger or Cargo Area (Non-Trailing Unit)
Riding on Vehicle Exterior (Non-Trailing Unit)
Passenger in Trailing Unit
Bus Passenger
Damage Prop. (Public)
Damage Prop. (Private)
Pedestrian
Witness
Unknown

AGE - In Years (Code 00 for infants under 1 year, 99 for unknown.)

SEX

M - Male

F - Female

U - Unknown

ALCOHOL/OTHER DRUG INVOLVEMENT (ADI)

0. Neither Alcohol nor Other Drugs Present
1. Yes (Alcohol Present)

2. Yes (Other Drugs Present)

3. Yes (Alcohol and Other Drugs Present)

9. Unknown

ALCOHOL TESTING (AT)

994 Test Refused
995 Test Not Given

0.14 AC is Coded 014

993 Field Sobriety Test Only

996 Test Given ( Results Unknown)

OTHER DRUG TESTING (DT)

0. Not Given
1. No Drugs Reported

2. Drugs Reported (If So, Specify *)

7. Test Given (Results Unknown)

8. Test Refused

*Identify results for the five regulated substances: Marijuana, Cocaine, Opiates, Amphetamines, & PCP.

SAFETY EQUIPMENT/RESTRAINTS
00.
01.
02.
03.
04.
05.
06.
07.

98. Not Applicable

99. Restraint Use Unknown

Not Installed
Not in Use
Lap Belt Only
Shoulder Belt Only or Automatic Belt Improperly Used
Lap and Shoulder Belts
Automatic Belts (Properly Used)
Equipment Failed
Helmet Worn

CHILD RESTRAINTS
10.
13.
14.
15.
16.

Child Not Restrained

Child Restraint System - Forward Facing
Child Restraint System - Rear Facing
Booster Seat
Child Restraint Type Unknown

AIR BAG
0. Not Applicable / None
2. Airbag Not Deployed

3. Deployed - Front
4. Deployed - Side

INJURY CLASS.
0. None
1. Fatal

5. Deployed - Other (knee, air belt)

6. Deployed - Combination

2. Incapacitating
3. Non-Incapacitating
4. Possible / Claimed

TAKEN TO MEDICAL FACILITY

1. Yes

2. No

3. Unknown

EJECTED
0. Not Applicable
1. Not Ejected
2. Totally Ejected
UNIT
NUMBER

q q

3. Partially Ejected
9. Unknown

Do not list operator / pedestrian name and address. List

where fatalities and injuries were taken.

q q q

q q q q

A Summary By Unit Number, of

the Sequence of Actions,
Events, Contributing Factors,
Citations, and Vehicle Damage.

MOTOR VEHICLE CRASH REPORT OVERLAY NO. 3

ACTION SEQUENCE, CITATIONS, AND DAMAGE
TOWED DUE TO DAMAGE

1. Yes

2. No

9. Unknown

EXTENT OF DAMAGE

0. None

1. Minor

2. Functional

3. Disabling
02

POINT OF FIRST CONTACT

00.
01.
02.
03.
04.
05.

None
Center Front
Right Front
Right Side
Right Rear
Center Rear

06.
07.
08.
09.
10.

Left Rear
Left Side
Left Front
Top and Windows
Under Carriage

11.
12.
13.
98.
99.

Submerged
Burned
Total (All Areas)
Other *
Unknown

03

02

04

01

09

08

03

07

05

9. Unknown
04

09

01

05

06

08

07

06

DRIVER CONDITION
0. Appeared Normal
1. Had Been Drinking

EVASIVE ACTION

2. Illegal Drug Use

3. Physical Impairment

4. Fatigue
5. Asleep

6. Sick
7. Medication

1. Slowed / Stopped
2. Accelerated

3. Turned Right
4. Turned Left

5. Backed Up
6. Did Nothing

8. Other *
9. Unknown

CITATIONS/WRITTEN WARNINGS
00.
01.
02.
03.
04.
05.
06.

None
DUI (Alcohol)
DUI (Drugs)
Care Required
Careless Driving
Failed to Yield
Failed to Stop

07.
08.
09.
10.
11.
12.
13.

Following
Improper Turning
Improper Backing
Overtaking
Wrong Way
Speeding
Defective Equipment

14. Illegal Parking

98. Other Offense *
NOT CONTRIBUTING TO CRASH
15. Open Container
16. Driver's License
17. Left Crash Scene
18. No Insurance

CONTRIBUTING FACTORS
00.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.

No Clear Contributing Factor

Vision Obstructed*
Speed
Vehicle Mechanical Failure
Wrong Way
Failed to Yield
Following Too Close
Weather
Defective Equipment
Improper Evasive Action
Improper Backing
Improper Overtaking
Drove Left of Center
Physical Obstruction

15. Animal in Roadway

16. Traffic Control Device Inoperative /
Missing / Obstructed
17. Non-Highway Work
18. Too Fast for Conditions
19. Disregard Traffic Signs
20. Ran Red Light
21. Disregard Other Road Markings
22. Improper Turn
23. Failed to Keep in Proper Lane
24. Operated Vehicle in Erratic,
Reckless, Careless, Negligent
or Aggressive Manner
25. Over-Correcting / Over-Steering

VEHICLE MOVEMENT
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
16.
17.

Going Straight
Turning Left
Turning Right
Backing
Passing
Wrong Side of Road
Wrong Way on One-Way
Starting in Traffic
Entering / Leaving Parked Position
Merging / Diverging
Changing Lanes
Driverless Vehicle (Moving)
Driverless Vehicle (Stalled)
Driverless Vehicle (Stopped)
U-Turn
Swerving
Negotiating Curve

26. Improper Lane Change

27. Attention Distracted Communication Devices
(Cell Phone, Pager)
28. Attention Distracted Electronic Device
( Navigation Device,
Palm Pilot)
29. Attention Distracted Other Inside Vehicle
30. Attention Distracted Other Outside Vehicle
98. Other * (Explain
in Narrative)

18. Slowing / Stopping

19. Stopped
20. Waiting to Turn Left
21. Waiting to Turn Right
22. Waiting for Traffic Signal
23. Waiting for Pedestrian
24. Waiting for Vehicle To Turn
25. Waiting for Vehicle Ahead
PEDESTRIAN MOVEMENT
31. Crossing at Intersection
32. Crossing Not at Intersection
33. Moving With Traffic
34. Moving Against Traffic
35. Pedestrian / Pedalcycle on Roadway
36. Entered Into Vehicle Path
37. Not on Roadway
38. Other Action on Roadway
39. Walking to / from School