Content Navigation

In the Commonwealth of Massachusetts, the Motor Vehicle Crash Operator Report form serves as a crucial document for drivers involved in accidents. Completing this form is not just a matter of protocol; it is a legal requirement under M.G.L. Chapter 90, Section 26. Drivers must file a report within five days if any person is killed or injured, or if property damage exceeds $1,000. This form captures essential details about the crash, including the location, time, and vehicles involved. Sections guide the operator through various aspects, such as providing personal information, detailing the circumstances of the crash, and listing any witnesses. The report also requires a diagram of the incident, which helps visualize the events leading up to the crash. Furthermore, it is important for the operator to send copies of the completed report to the local police department, their insurance company, and the Registry of Motor Vehicles. Failing to comply with these requirements may lead to penalties, including the suspension of driving privileges. Understanding the form and its components is vital for ensuring that all necessary information is accurately reported and submitted in a timely manner.

Ma Vehicle Accident Report Example

Commonwealth of Massachusetts

Motor Vehicle Crash Operator Report

When should I complete a Crash Report?

M.G.L. Chapter 90, Section 26 requires a person who was operating a motor vehicle involved in a crash in which (i) any person was killed or (ii) injured or (iii) in which there was damage in excess of $1,000 to any one vehicle or other property, to complete and file a Crash Operator Report with the Registrar within five (5) days after such crash (unless the person is physically incapable of doing so due to incapacity). The person completing the report must also send a copy of the report to the police department having jurisdiction on the way where the crash occurred. If the operator is incapacitated but is not the vehicle’s owner, the owner is required to file the crash report within the five (5) days based on his/her knowledge and information obtained about the crash. The Registrar may require the owner or operator to supplement the report and he/ she can revoke or suspend the license of any person violating any provision of this legal requirement. A police department is required to accept a report filed by an owner or operator whose vehicle has been damaged in a crash in which another person unlawfully left the scene even if damage to the vehicle does not exceed $1,000.

How To Complete This Form

Please carefully complete all sections of this form that apply to your crash, circling the answer where appropriate. Illegible reports will be returned to you.

Section A: Crash Location

Provide the city/town where the crash occurred, the date and time of the crash, and the number of vehicles involved.

Complete section A1 or A2.

Use official names of all locations, streets and landmarks.

Use street name and route #, if applicable.

Be as precise as possible when describing the location.

Provide enough information to locate the crash to a specific point, not just a street or roadway.

Section B: Vehicle Yon Were Driving

Provide information on your license and the vehicle you were driving.

Use the codes provided to indicate the cause of the crash.

Section C: You and Your Passengers

Provide information on you and your passengers at the time of the crash.

Use the codes provided to indicate occupant information.

Section D: Other Vehicles Involved in the Crash

Provide information on the other vehicle(s) and operator(s) involved in the crash.

If more than one vehicle involved, please use additional form completing Section D only.

Section E: Non-Motorist(s) Involved

Provide information on the non-motorist(s) involved in the crash.

If more than one non-motorist involved, please use additional form completing Section E only.

Section F: Crash Conditions

Use the codes provided to indicate the conditions at the time of the crash.

Section G: Crash Diagram

Draw a diagram of how the crash occurred.

On the diagram, Vehicle 1 represents your vehicle.

Section H: Witness Information

List all the people who saw the crash but were not involved.

Section I: Property Damage Information

Indicate all non-vehicular property that was damaged in the crash.

Section J: Description of What Happened

Describe the crash including events prior to the crash for your vehicles and all other vehicles.

Section K: Signature

Please sign and print your name and indicate the date you completed the form.

Where to send completed reports:

Mail or deliver one copy to the local police department or state police in the city or town where the crash occurred.

Mail one copy to your Insurance Company.

Mail one copy to the RMV at the following address:

Registry of Motor Vehicles Crash Records

P.O. Box 55889 Boston, MA 02205-5889

CRASH102_1119

A. Crash Location

A1. City/Town Where Crash Occurred

 

A2. Date of Crash

 

 

 

 

A3. Time of Crash

 

 

AM

A4. # Vehicles Involved:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please complete Section A1 or A2 below to indicate the location of the crash. If you need

 

A5. Did the crash occur at an

 

Yes

No

additional space to describe the crash location, please use Section J on the last page of this form.

intersection of two or more streets?

 

 

 

 

 

 

 

If Yes.

Step 1. Please indicate the route or roadway where

If No.

 

Step 1. Please

indicate the route, roadway and address where the

 

you were travelling when the crash occurred:

 

crash occurred:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

at Street or Address Number:

 

 

 

 

 

 

 

 

 

 

 

 

The crash occurred on Route #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

on the Street/Roadway known as

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 2. What was the name (or names) of the intersecting streets?

Step 2. Please provide as much of the following specific location information as possible:

 

 

 

 

 

 

 

 

The crash occurred

 

 

 

(indicate direction as N/S/E/W)

 

 

 

 

 

 

 

 

 

 

 

 

 

(estimate number of feet)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of:

a) Mile Marker number

 

 

 

 

 

 

 

 

 

 

OR: b) Exit Number

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR: c) Intersecting

 

 

 

 

 

 

 

Route# Name of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/Roadway

 

 

 

 

 

 

 

Roadway/Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Route#

 

 

Name of Roadway/Street

 

 

OR: d) Landmark

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Vehicle You Were Driving

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B1. Number of occupants in vehicle (including yourself):

 

 

B2. Was vehicle damage above $1000?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B3. Driver’s License Number

B4. License State

B5. DOB

 

B6. Age

B7. Sex

 

 

M

 

X

B8. License Class

D

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

 

U

 

Unknown

C

B

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B9. Commercial Driver’s License Endorsements

P (Passenger transport)

T (Doubles/Triples)

H (Hazardous)

X (Tank and Hazardous)

N (Tank vehicles)

S School Bus

B11. Your Full Name (Last, First, Middle)

B12. Street Address

City

B10. Vehicle Travel Direction

N

S

E

W

State

 

 

Zip Code

B13. Insurance Company

B14. Vehicle Registration #

B15. Reg. Type

B16. Reg. State

B17. Vehicle Year

B18. Vehicle Make

B19. Indicate your type of vehicle

4

Bus (16 or more passengers)

9 Truck tractor (bobtail)

1

Passenger car

5

Bus (9-15 passengers)

 

10 Tractor/semi-trailer

2

Light truck (van, mini-van,

 

6

Single-unit truck (2 axles)

11 Tractor/doubles

 

pick-up, sport utility)

 

7

Single-unit truck (3 or more axles)

12 Tractor/triples

 

3

Motorcycle

 

8 Truck/trailer

 

13 Unknown heavy truck

 

 

 

B20. Full Name of Vehicle Owner (Last, First, Middle)

 

 

B21. Street Address

City

 

 

 

 

 

 

 

 

 

 

14 Motor home/ recreational vehicle

15 Moped

16 Low Speed

Vehicle

State

17 All terrain vehicle( ATV)

18Snowmobile

97Other

99Unknown

Zip Code

B22. What Was Your Vehicle Doing Prior to the Crash?

 

5 Changing lanes

 

8 Making U-turn

 

 

11 Parked

1 Travelling straight ahead

3 Turning right

6 Entering traffic lane

 

9 Overtaking/passing

 

97 Other

2 Slowing or stopped

 

 

4 Turning left

 

 

 

 

7 Leaving traffic lane

 

10 Backing

 

 

 

99 Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B23. Please Indicate the Sequence of Events as they occurred to YOUR Vehicle

What happened first?

Second?

 

Third?

 

Fourth?

by writing the corresponding number (1-52, or 97, 99) in up to 4 boxes below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Collision with

9

Railway vehicle

 

25

Median barrier

32 Crash cushion/

Non-Collision

 

47

Jackknife

1 Motor vehicle in traffic

10

(train, engine)

 

26

Ditch

Impact attenuator

40 Ran off road right

48

Cargo/equipment loss

2 Parked motor vehicle

Other movable object

27

Embankment/

33 Bridge

41 Ran off road left

 

 

or shift

3 Pedestrian

11

Unknown movable

 

Sloping shoulder

34 Bridge overhead

42 Cross median/

 

49

Separation of units

4 Cyclist

 

object

 

28

Highway traffic

structure

 

centerline

 

50

Downhill runaway

5 Animal- deer

20

Curb

 

 

signpost

35 Other fixed

43 Overturn/rollover

51

Other non-collision

21

Tree

 

29

Overhead sign

object (wall,

44 Equipment failure

6 Animal- other

 

building, tunnel)

52

Unknown non-collision

22

Utility pole

 

 

support

36 Unknown fixed

 

(blown tire, brakes,

7 Moped

 

30

Fence

 

etc)

 

97

Other

23

Light pole or other

 

 

8 Work zone

31

Mailbox

object

45 Fire/explosion

 

99

Unknown

 

post/support

 

 

 

 

maintenance

24

Guardrail

 

 

 

 

 

46 Immersion

 

 

 

 

equipment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B24. Was your

 

 

Vehicle Towed

Yes

No

from the Scene

 

 

Due to Damage?

 

 

B25. Vehicle Damaged Area (check up to three)

2

3

4

 

 

 

0 None

97 Other

1

9

5

10 Undercarriage

99 Unknown

 

 

 

11 Totaled

 

8

7

6

 

 

CRASH102_1119

File Breakdown

Fact Name Description
Legal Requirement According to M.G.L. Chapter 90, Section 26, a crash report must be completed if there is a death, injury, or property damage exceeding $1,000.
Filing Deadline The report must be filed with the Registrar within five days of the crash, unless the operator is physically incapable of doing so.
Police Notification A copy of the report must also be sent to the police department that has jurisdiction over the area where the crash occurred.
Owner's Responsibility If the operator is incapacitated and not the vehicle's owner, the owner must file the crash report based on their knowledge of the incident.
Supplemental Reporting The Registrar may require additional information from the owner or operator and can revoke or suspend licenses for non-compliance.
Non-Motorist Reporting Police departments must accept reports from owners or operators if another party unlawfully leaves the scene, regardless of damage amount.

Guide to Using Ma Vehicle Accident Report

Filling out the Massachusetts Vehicle Accident Report form is an important step to ensure that all necessary information about the crash is documented. This form must be completed and submitted within five days of the accident. Following the steps below will help you accurately fill out the report.

  1. Section A: Crash Location - Provide the city or town where the crash occurred, along with the date and time. Specify the number of vehicles involved. Complete either Section A1 or A2, using official names for locations and being as precise as possible.
  2. Section B: Vehicle You Were Driving - Fill in your driver’s license number, state, date of birth, and other relevant vehicle information. Use the provided codes to indicate the cause of the crash and whether there was damage above $1,000.
  3. Section C: You and Your Passengers - List your name and the names of all passengers in your vehicle, along with their addresses and dates of birth. Include codes for occupant information such as seating position and safety equipment used.
  4. Section D: Other Vehicles Involved in the Crash - Provide details about other vehicles and their drivers involved in the crash. If there are multiple vehicles, use an additional form for this section.
  5. Section E: Non-Motorist(s) Involved - If any pedestrians or cyclists were involved, provide their information. Use an additional form if there are multiple non-motorists.
  6. Section F: Crash Conditions - Use the codes to describe the conditions at the time of the crash, including light and weather conditions.
  7. Section G: Crash Diagram - Draw a diagram indicating how the crash occurred, marking your vehicle as Vehicle 1.
  8. Section H: Witness Information - List the names and contact information of any witnesses who saw the crash but were not involved.
  9. Section I: Property Damage Information - Indicate any non-vehicular property that was damaged in the crash.
  10. Section J: Description of What Happened - Provide a detailed description of the events leading up to the crash.
  11. Section K: Signature - Sign and print your name, and indicate the date you completed the form.

Once the form is completed, it is essential to send copies to the appropriate parties. One copy should be delivered to the local police department or state police, another to your insurance company, and a third to the Registry of Motor Vehicles at the specified address.

Get Answers on Ma Vehicle Accident Report

  1. When should I complete a Crash Report?

    In Massachusetts, if you are involved in a vehicle accident, you must complete a Crash Report if any of the following occur: someone is injured or killed, or there is property damage exceeding $1,000. This report must be filed with the Registrar within five days of the accident. If you are unable to do so due to physical incapacity, the vehicle owner must file the report based on their knowledge of the incident. It’s essential to comply with this requirement, as failure to do so could lead to license suspension or revocation.

  2. How do I complete the Crash Report form?

    Completing the Crash Report requires careful attention to detail. Start by filling out the sections that apply to your specific accident. Key areas include:

    • Crash Location: Provide the exact city or town, date, and time of the accident.
    • Vehicle Information: Include your driver's license number and details about the vehicle you were driving.
    • Passenger Information: List all passengers in your vehicle, including their names and any injuries sustained.
    • Crash Description: Describe the events leading up to the crash in detail.

    Make sure your handwriting is clear; illegible reports will be returned. After completing the form, send copies to your local police department, your insurance company, and the Registry of Motor Vehicles.

  3. What if the other driver leaves the scene?

    If another driver flees the scene of the accident, you still need to file a Crash Report. Massachusetts law requires that you report the incident to the police, even if the damage is below $1,000. The police department is obligated to accept your report, which helps in documenting the incident and may assist in any potential claims with your insurance.

  4. What happens if I don’t file a Crash Report?

    Failing to file a Crash Report when required can lead to serious consequences. The Registrar has the authority to suspend or revoke your driver's license if you do not comply with the reporting requirements. Additionally, not filing could complicate any insurance claims or legal proceedings related to the accident. It’s always best to ensure that the report is completed and submitted on time to avoid these potential issues.

Common mistakes

Filling out the Massachusetts Vehicle Accident Report form can be a daunting task, and many people make mistakes that could complicate the process. One common error is not providing enough detail about the crash location. It's essential to include the exact city or town, the date and time, and specific street names or landmarks. Vague descriptions can lead to confusion and may cause the report to be returned.

Another frequent mistake involves skipping sections that may seem irrelevant. Every part of the form is important, including information about passengers and other vehicles involved. Omitting details about other parties can lead to delays and misunderstandings. It’s better to provide too much information than too little.

Many individuals also fail to use the correct codes when indicating the cause of the crash or conditions at the time. The form includes specific codes for various scenarios, and using them correctly is crucial. Mislabeling can misrepresent the situation and may affect any claims or legal proceedings that follow.

Another mistake is neglecting to sign and date the report. A signature is required to validate the information provided. Without it, the report may not be accepted, leading to further complications. Always double-check that you have signed and printed your name before submitting the form.

People often overlook the requirement to send copies of the report to the appropriate parties, such as the local police department and your insurance company. Failing to do this can lead to issues with documentation and may affect your insurance claims. Ensure that you have sent all necessary copies within the required timeframe.

Lastly, many individuals do not keep a copy of the completed report for their records. It’s important to retain a copy for your own reference. This can be invaluable if questions arise later or if further information is needed. Keeping organized records helps in managing any follow-up actions that may be necessary.

Documents used along the form

When involved in a vehicle accident in Massachusetts, several forms and documents may be necessary in addition to the Motor Vehicle Crash Operator Report. Understanding these documents can help ensure that all required information is properly submitted and that you comply with state regulations.

  • Police Accident Report: This document is prepared by law enforcement officers who respond to the accident scene. It contains details about the crash, including the circumstances, involved parties, and any citations issued. This report can be crucial for insurance claims and legal proceedings.
  • Insurance Claim Form: After an accident, you will likely need to file a claim with your insurance company. This form provides essential information about the accident, damages, and injuries sustained. Completing this accurately can expedite the claims process and help you receive compensation for your losses.
  • Medical Report: If anyone involved in the accident sustained injuries, medical reports documenting these injuries will be necessary. These reports detail the nature of the injuries, treatment received, and any ongoing care required. They are vital for insurance claims and potential legal actions.
  • Witness Statements: Collecting statements from witnesses who observed the accident can provide additional context and support your account of events. These statements can be submitted to law enforcement and insurance companies to strengthen your case.

Being aware of these additional documents can help you navigate the aftermath of a vehicle accident more effectively. Each plays a role in ensuring that all aspects of the incident are documented and that you receive the support and compensation you need.

Similar forms

  • Police Report: Similar to the MA Vehicle Accident Report, a police report documents the details of an accident. It includes information about the parties involved, witness statements, and the officer's observations. Both reports serve as official records for insurance claims and legal proceedings.

  • Insurance Claim Form: This document is used to report an accident to an insurance company. Like the MA Vehicle Accident Report, it requires details about the incident, damages, and involved parties. Both forms aim to facilitate the claims process and ensure accurate information is provided.

  • Incident Report: Often used in various contexts, an incident report captures the specifics of an event, including accidents. It shares similarities with the MA Vehicle Accident Report in that it outlines what occurred, who was involved, and any resulting damages or injuries.

  • Medical Report: Following an accident, a medical report documents any injuries sustained. This report is similar to the MA Vehicle Accident Report in that it provides critical information for insurance claims and legal cases, focusing on the health impacts of the incident.

  • Property Damage Report: This document details damages to property resulting from an accident. It parallels the MA Vehicle Accident Report by requiring information on the extent of damage and involved parties, serving as a basis for compensation claims.

Dos and Don'ts

When filling out the Massachusetts Vehicle Accident Report form, it’s essential to follow specific guidelines to ensure your report is accurate and complete. Here are ten important dos and don’ts to keep in mind:

  • Do provide clear and legible information in all sections of the form.
  • Do include the exact location of the crash, using official names of streets and landmarks.
  • Do indicate the number of vehicles involved and any injuries sustained.
  • Do send a copy of the report to the local police department as required.
  • Do describe the crash thoroughly in Section J, including events leading up to it.
  • Don't leave any sections blank; incomplete forms may be returned.
  • Don't provide vague descriptions of the crash location; be as specific as possible.
  • Don't forget to sign and date the report before submission.
  • Don't use unofficial names or abbreviations for locations.
  • Don't delay in submitting the report; it must be filed within five days of the crash.

Misconceptions

  • Misconception 1: Only serious accidents require a Crash Report.
  • Many people believe that a report is only necessary for severe accidents. In reality, any crash resulting in injury, death, or property damage exceeding $1,000 mandates a report.

  • Misconception 2: You can file the report anytime after the accident.
  • The law requires that the report be filed within five days of the accident. Delays can lead to penalties.

  • Misconception 3: Only the driver needs to complete the report.
  • If the driver is incapacitated, the vehicle's owner must file the report based on their knowledge of the incident.

  • Misconception 4: You don’t need to report minor accidents.
  • Even minor accidents can require a report if the damage exceeds $1,000 or if someone is injured.

  • Misconception 5: You can skip sections if they don’t apply to you.
  • Every section of the report should be completed as much as possible. Incomplete forms may be returned.

  • Misconception 6: The police department can refuse to accept your report.
  • Police are required to accept reports from owners or operators, even if the damage is below the $1,000 threshold in certain situations.

  • Misconception 7: You don’t need to send copies to anyone else.
  • In addition to filing with the police, you must send copies to your insurance company and the Registry of Motor Vehicles.

  • Misconception 8: The report is only for insurance purposes.
  • While it is important for insurance claims, the report also serves legal and regulatory functions.

  • Misconception 9: You can only describe the crash in general terms.
  • Specific details about the crash, including a diagram, are essential for clarity and accuracy.

  • Misconception 10: The report will not affect your driving record.
  • Violating the reporting requirements can lead to license revocation or suspension, impacting your driving record.

Key takeaways

Key Takeaways for Filling Out the MA Vehicle Accident Report Form:

  • Complete the report within five days if the crash involved injuries, fatalities, or property damage exceeding $1,000.
  • Provide precise details about the crash location, including official street names and landmarks, to ensure accurate reporting.
  • Include comprehensive information about all vehicles and individuals involved, including passengers and non-motorists.
  • Accurate descriptions of the crash events and conditions are crucial; use the designated codes for clarity.
  • Submit copies of the completed report to the local police department, your insurance company, and the Registry of Motor Vehicles.