Also Known As:
- Vehicle Crash Report
- Motor Accident Report
- Report on Car Accident
- Car Crash Report
- Vehicle Damage Report
DMV Incident Reports
The table below lists official documents to be used by civilians to report a crash to the DMV or state police. These are separate from police reports and are usually used for state recordkeeping purposes. In order for an incident to be considered “reportable,” at least one of the following usually has to apply:
- The accident results in injury or death
- Property damage exceeds the legal threshold (usually between $250 and $1000, depending on the state)
- Police did not file a separate report
Drivers should also be aware of the deadlines for submitting reports to the DMV, which are typically stated on the form itself.
Sample
DRIVER INFORMATION
Full Name: [DRIVER NAME] Date of Birth: [DATE]
Address: [ADDRESS] Phone: [PHONE] E-Mail: [E-MAIL]
Driver’s License No.: [DL NO.] State of Issue: [STATE]
Estimated Repair Cost: $[AMOUNT]
Vehicle Information:
Vehicle Owner Name: [OWNER NAME] Address: [ADDRESS] Date of Birth: [DATE]
Vehicle Make: [MAKE] Model: [MODEL] Year: [YEAR] License Plate No.: [PLATE NO.]
Insurance Information:
Insurance Company Name: [INSURANCE COMPANY NAME]
Policy Holder Name: [POLICY HOLDER NAME]
Policy Period: [START DATE] to [END DATE] Policy No.: [POLICY NO.]
Signature: __________________ Date: [MM/DD/YYYY]
OTHER PARTY
Role: ☐ Driver ☐ Pedestrian ☐ Bicyclist ☐ Other: [OTHER]
Full Name: [FULL NAME] Date of Birth: [DATE]
Address: [ADDRESS] Phone: [PHONE] E-Mail: [E-MAIL]
Driver’s License No.: [DL NO.] State of Issue: [STATE]
Estimated Repair Cost: $[AMOUNT]
Vehicle Owner Name: [OWNER NAME] Address: [ADDRESS] Date of Birth: [DATE]
Vehicle Make: [MAKE] Model: [MODEL] Year: [YEAR] License Plate No.: [PLATE NO.]
Vehicle Information:
Vehicle Owner Name: [OWNER NAME] Address: [ADDRESS] Date of Birth: [DATE]
Vehicle Make: [MAKE] Model: [MODEL] Year: [YEAR] License Plate No.: [PLATE NO.]
Insurance Information:
Insurance Company Name: [INSURANCE COMPANY NAME]
Policy Holder Name: [POLICY HOLDER NAME]
Policy Period: [START DATE] to [END DATE] Policy No.: [POLICY NO.]
INCIDENT DETAILS
Date of Incident: [MM/DD/YYYY] Time: [TIME] ☐ AM ☐ PM
Location: [INCIDENT LOCATION]
Describe the Incident: [DESCRIBE INCIDENT]
Police Notified? ☐ Yes ☐ No
If yes, enter name of agency/precinct and accident no.: [AGENCY AND ACCIDENT NO.]
INJURIES / DEATH / DAMAGE
Did the incident result in injury or death? ☐ Yes ☐ No
If yes, describe: [DESCRIBE INJURIES/DEATH]
Describe damage to vehicles and/or other property: [DESCRIBE DAMAGE]
WITNESSES
Were there witnesses to the incident? ☐ Yes ☐ No
If yes, enter the witnesses’ names and contact info:
- Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
- Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
- Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]