The Mississippi Accident Report form is a standardized document used to record details of vehicle accidents within the state. This form captures essential information such as the time and location of the accident, the parties involved, and any injuries sustained. Completing this report accurately is crucial for legal and insurance purposes; fill out the form by clicking the button below.
The Mississippi Accident Report form serves as a crucial document for documenting vehicular incidents across the state. This standardized form captures essential details such as the date and time of the accident, involved vehicles, and the condition of the roadway at the time of the incident. It includes sections for recording the status of those involved, whether they were killed or injured, and provides space for witness information. The form also prompts officers to note specific crash circumstances, such as the first harmful event and contributing factors like weather conditions and visibility. Notably, it allows for detailed descriptions of each vehicle, including make, model, and damage assessment. The form's structured approach ensures that all pertinent information is collected systematically, facilitating a thorough investigation and aiding in accident analysis. Furthermore, the inclusion of diagrams and narratives enhances clarity, helping to visualize the accident scene and understand the sequence of events. This comprehensive documentation is vital for law enforcement, insurance companies, and legal proceedings, ensuring that every detail is accounted for in the aftermath of an accident.
Filling out the Mississippi Accident Report form can be a daunting task, especially after a stressful event like a car accident. Mistakes can happen, and they can lead to complications down the line. Here are nine common mistakes people often make when completing this important document.
First, many individuals forget to include the reported date and time. This information is crucial as it establishes a timeline of the incident. Leaving this section blank can delay the processing of the report and any subsequent claims. Always double-check that you’ve filled in the date and time accurately.
Second, people often misidentify the traffic flow direction. Whether it’s North, East, South, or West, getting this wrong can lead to confusion about how the accident occurred. Take a moment to consider the direction in which you were traveling and ensure it matches the form's requirements.
Another frequent error is neglecting to provide complete details about the vehicles involved. This includes the make, model, and color of each vehicle. Incomplete information can hinder investigations and claims processing, so it’s essential to fill out this section thoroughly.
Fourth, some individuals mistakenly assume that their insurance information is optional. It’s not! Providing your insurance company’s name and policy number is vital for any claims related to the accident. Ensure this information is accurate and up to date.
Fifth, many people forget to include witness information. If there were witnesses to the accident, their statements could be invaluable. Make sure to gather their names and contact details, and include them on the form.
Sixth, individuals often skip the section about injuries. Whether minor or severe, documenting injuries is crucial. Failing to report this can affect medical claims and legal proceedings later. Be sure to note all injuries sustained during the accident.
Seventh, people frequently overlook the collision narrative section. This is your chance to describe the accident in your own words. A clear, concise narrative can provide context that raw data cannot. Take the time to articulate what happened leading up to the crash.
Additionally, many individuals do not review the collision diagram carefully. This visual representation is important for illustrating how the accident occurred. Ensure that your diagram accurately reflects the positions of all vehicles involved.
Lastly, a common mistake is failing to sign the report. An unsigned document is often considered incomplete. Before submitting, make sure you have signed and dated the report to validate your information.
By avoiding these common pitfalls, you can ensure that your Mississippi Accident Report is filled out correctly. Taking the time to review and verify your information will help streamline the process and support any claims that may arise from the accident.
STATE OF MISSISSIPPI UNIFORM CRASH REPORT
Agency Number
Agency Case Number
Page
0 1
of
Agency Name
G1. County
G2. Status Code
C P U
G3. Reported Date (MM/DD/YYYY)
/ /
G4. Reported Time (2400)
G5. Officer Time
Arrival Time (2400)
10-24 Time (2400)
G6. Vehicles
G7. Killed
G8. Injured
G9. Address Number
G10. Street Name
G11. Hwy/County Road #
G12. Trafficflow Direction
N
E
S
W
G13. Int.
Y
G14. Distance
F
. M
G15. Direction
N E
S W
G16. Intersecting Street Name
G17. Int. Hwy/County Road #
G18. City Name
G19. Latitude
.
G20. Longitude
G21. First Harmful Event
Crash with OMV in road:
Rear end slow or stop
Rear end turn
Left turn same roadway Left turn cross traffic
Right turn cross traffic
Head on
Sideswipe
Angle
Hit and run
Non-Crash in Road
Overturn
Jackknife
Fell from vehicle
Other
Crash of MV in road with:
Pedestrian
Parked Vehicle
Train
Bicyclist
Deer
Animal (other than deer)
Fixed Object
Bridge/Culvert
Roadway
None
Embankment/Ditch/Curb
Location
Off-Roadway
Four-way Inter
Guardrail/Median Barrier
Median
T - Intersection
Crossover
Tree
Crash
Roadside
Type
Utility pole/light support
Shoulder
Driveway
G22.
Intersection
Other fixed object
Five-point or more
Parking Lot
Sign Post
Off Ramp
Signal standard
Gore
On Ramp
G23.
Path/Trail
Non-fixed Object
Building/Other Structure
RR Xing
Maint. Equip. - Not Moving
Traffic Circle/Round
Maint. Equip. - Moving
Other non-fixed object
Y - Intersection
G24. Roadway System
City Street
State Highway
U.S. Highway
County Road
Parking Lot/Private Drive
Interstate
Off Road
State Park
Daylight
Dry
Condition(2)
Condition
Dark-Lit
Wet
Water
LightG25.
Dark-Unlit
RoadG26.
Sand/Mud/Dirt/Oil/Gravel
WeatherG27.
D a w n
Ice
Slush
Dusk
Snow
Clear
Blown Debris
Relationship
Not Workzone Related
Rain
Fog/Smog/Smoke
Workzone
Within Construction Zone
Cloudy
Sleet/Hail
Advance Warning Area
High winds
G28.
WITNESS(ES)
G29. Workzone Type (2)
Intermittent or Moving Work Lane Closure
Lane Shift/Crossover
Shoulder/Median Work
Utility
G30.
First Name
MI
Last Name
G31.
Address
G32. Phone Number
G33.
City
G34.
State
G35. Zip Code
G36. Sex
M
G37. Age
G38.
G39.
G40. Phone Number
G41.
G42.
G43.
Zip Code
G44. Sex
G45. Age
G47. Investigating Officer Name (Please Print)
G48. Officer Signature
G46.
Badge Number
G49.
Reviewing Badge Number
G50. Reviewing Officer Initials
G51. Photos Taken
G52. Photographer and Badge #
Y N
4479140593
MUCR
Diagram/Narrative
N1. Collision Diagram
Page 0 2 of
North
Arrow
N2. Collision Narrative
1772140596
Person/Occupant
V0. Veh. # P0. Person #: Agency Number
P1. Person Type
Driver
Skater
Other non-motorist
Train Engineer
Hit and Run Driver
P2.
License #
P3. State
P4. CDL?
P5. DOB (MM/DD/YYYY)
Shoulder & Lap Belt
/
Complaint of Pain
StatusDLP12.
Suspended
SafetyEquip. (2)
EjectionP24.P23. Injury
Totally
Helmet
P6.
Lap Belt
Serious
Valid
Suspended - DUI
Life Threatening
Automated Restraint
Killed
P7. Address
P8. Phone Number
No License
Learner Permit
Shoulder Belt
Not
Expired
Improper DL
Child Safety Seat
Partially
P9.
P10. State
P11.
P14.Ticket #
1
Offense
Extricated
P13.Cited
Sex
White
Hispanic
P
2
P15.
Race
Xport
Not Transported
Police
Hearse
Black
P18. Medical
P17. EMS
AirbagPosition
EMS
Private Vehicle
ActionMotorist-
P16.
Agency Code
Facility Code
Left
Center
Right
No Defects Apparent
Obviously Intoxicated
Unknown
Pushing vehicle
Deployed - Front
Not Deployed
Physical Impairment
Deployed - Side
No Airbag
Entering/Crossing Roadway
Approaching/leaving vehicle
Hit and Run
Affected by Exhaust Fumes
Deployed - Both
P19.
Drinking - Not impaired
Using Drugs - Impaired
P20. Non
Walking/running/playing/cycling
Playing/working on vehicle
Alcohol Test Information
Drinking - Impaired
Using Drugs - Not Impaired
Serum
Fell Asleep/Fainted/Fatigue
Pending Lab Results
Working
Standing
Blood
Urine
No Apparent Improper Driving
Made Improper Turn
Not Visible (Dark Clothing)
Breath
(3)
Status
Test refused
Test given, pending
Circumstance
Failed to Yield Right of Way
Left of Center
Operating Defective Equipment
None given
Test given
Result
Following Too Closely
Failure to keep proper lane/Run off road
Passed Stop Sign
Speed Too Fast For Conditions
Avoidance
Pedestrian Actions
Contributing
Driving Under The Influence
Drove on Wrong Side of Road
Ran Red Light
Faulty Equipment
Illegally Crossing Median
Visibility Obstructed
Drug Test Information
Animal on Roadway
Fatigued/Asleep
Roadway Defects
P21.
Exceeded Lawful Speed
Improper Lane Change
Improper Backing
Improper Passing/Overtaking
Lying and/or illegally in roadway
See Crash Description
Occupant
O0. Vehicle #:
O1.
Front-Driver
3rd-middle
Shoulder and Lap Belt
Front-Middle
3rd-right
(2)
PositionO6.
Equip.Safety
O2. Address
O3.
Front-right
Sleeper of Truck Cab
Same as
2nd-left
Encl. Pass./Cargo Area
Person #
2nd-middle
Unencl. Pass./Cargo Area
O4.
O5.
2nd-right
Riding on Exterior
O7.
Unborn Child
3rd-left
Towed Vhcl./Trailer
O8.Sex
O9.Race
O10.Age
ExtricatedO11.
EjectionO12.
InjuryO13.Type
AirbagO14.
O16. EMS
O17. Medical
O15.
O3. Address
RaceO9.
0382395460
V0.
Vehicle #: V1. Total Occupants
Vehicle
Owner Information
V2. State
V3.
Year
V4.
License Plate Number
Same as V12.
Owner Name
V5.
Make
V6. Model Year
V13.
V7.
Vehicle Model
V8.
Vehicle Color
V14.
V10. Speed Zone V11. Est. Speed
V19. No Proof V17. Insurance Company Name
of Insurance
V9. Damage:
Heavy
Light
Collision w/ Person, Vehicle/Non-fixed Object
Non-Collision
Collision w/ Fixed Object
3
4
Animal
Cargo Loss/Shift
Attenuator/Cushion
Bridge Structure
EventsofSequence
Maintenance Equip.
Equipment Failure
Culvert
ActionVehicleV21.
Moving Vehicle
Fell/Jump from Vehicle
Curb
Fire/Explosion
Ditch
Immersion
Embankment
Fence
Slowing Vehicle
Median/Centerline
Guardrail
Stopped Vehicle in Road
Thrown/Falling Object
Mailbox
V20.
Off roadway/Left
Median Barrier
Off roadway/Right
Post/Pole/Support
Overturn/Rollover
Unit Separation
Other Fixed Object
Over Correcting/Steering
ConfigurationVehicleV22.
Passenger Car
School Bus
ContactInitialV23.
TravelofDirectionV24.
Light Truck
Under
Single-Unit Truck(2)
Truck/Trailer
Stationwagon/Van
Single-Unit Truck(3+)
Emergency Veh.
SUV
Farm Tractor
Commercial Bus
Motorcycle
Tractor/SemiTrailer
ATV
Tractor(2)
Farm Equip.
RV
Tractor(3)
Unknown Truck
ControlTrafficDevice
Channel-Painted
Officer
Straight/Level
Bridge
2 Lane
Channel-Physical
RR Flashing Signal
RoadV29.Design
CharacterRoad
Intersect two roads
Private Drive
4+
Flag Person
RR Signal and Gate
Curve/Level
Flashing Signal Red
Signal
Straight/Grade
Curve/Hillcrest
V26.
Flashing Signal Yellow
Stop Sign
V28.
No Passing
Railroad Sign
1 Lane
Yield Sign
Straight/Hillcrest
Begin/End Divided Road
V30. Divided?
V27. Device Functioning?
Curve/Grade
One-Way
V31. Center Turn Lane?
V15. State
V16. Zip Code
V18. Policy Number
Going Straight
Making Left Turn
Stopped
Slow/Stop in Road
Parked
Backing
Making Right Turn
3 Lane
Frontage/Ramp
One Way
Surface
Unpaved
Road
V32.
Yes
No
Lane Change
Leaving Parking
Overtaking/Passing
Parking Position
Making U Turn
In Tow
Right only
Bikeway
Both Sides
Left Only
V25.
Separate
Signed
Asphalt
Concrete
Dirt
Gravel
Other - See Narrative
V33. Towed?
V34. Authority:
Owner
V35. Towed By:
Commercial Vehicle
C1.
Carrier ID Number:
US DOT
Mexico
C2. Authority
MC
Canada
C3.
Carrier Name
C4.
Carrier Address
C5. City
C6. State
C7. Zip Code
C8. GVWR #
9614432302
Auto transporter
Flatbed
Bus<15
Garbage/refuse
Body
Bus 15+
Grain/chips/gravel
Cargo
Cargo tank
Concrete Mixer
Pole/log
C9.
Dump
Van/enclosed box
C10. Commodity Hauled
C11. Placard ID
C12. HAZMAT Released
Additional Occupants
O0. Vehicle #
O8.
O9.
O15.Xport
6895084358
Agency NumberAgency Case Number
o f
O5. State
AgeO10.
TypeInjuryO13.
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