Printable Maryland Motor Vehicle Accident Report Template

The Maryland Motor Vehicle Accident Report is a crucial document used to record the details of motor vehicle accidents occurring within the state. This form captures essential information such as the date, time, location, and parties involved in the accident, as well as any injuries or damages incurred. Completing this report accurately is vital for legal and insurance purposes, so be sure to fill it out by clicking the button below.

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Printable Maryland Motor Vehicle Accident Report Template

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The Maryland Motor Vehicle Accident Report form serves as a crucial document for documenting the details surrounding vehicle accidents within the state. This form captures essential information, such as the date and time of the accident, the types of injuries sustained, and the circumstances leading to the incident. It includes sections for identifying the vehicles involved, the drivers, and any witnesses, ensuring that all pertinent data is collected systematically. Additionally, the form allows for the inclusion of diagrams, which can visually represent the scene of the accident, enhancing clarity and understanding. Investigating officers play a key role in completing this report, as they provide their identification and agency details, ensuring accountability and thoroughness in the investigation process. The report also categorizes the severity of the accident, whether it resulted in fatalities, injuries, or property damage, and captures any relevant traffic conditions at the time. By standardizing the information collected, this form aids law enforcement and insurance companies in their investigations and claims processes, ultimately contributing to a more organized and efficient handling of motor vehicle accidents in Maryland.

Maryland Motor Vehicle Accident Report Preview

State of Maryland Motor Vehicle Accident Report

REPORT NO.																		1				PAGE OF					ACCIDENT DATE										3		ACCIDENT TIME 4							REPORT TYPE													5	RESEARCH										6		LOCAL CASE NUMBER									7				LOCAL CODES						8				PHOTOS ?
510345																								2																								FATAL				INJURY					PDO																																							NO		9
510345																						1		1			1		1			2 6				0 4			1	0			0		7			HIT & RUN NON-TRAFFIC																								2005-040123																								YES
INVESTIGATING OFFICER ID																								10			AGENCY AND AREA										11		SUPERVISING OFFICER ID																12		REVIEWER ID #													13		CODE - AND - NAME OF MUNICIPALITY																			14				COUNTY
																																																																																																		15
Albert Green															2397												J		E							0		1	Linda Williams												c99						Brad Linquist										j45					0 0			3				Annapolis																0 2
Albert Green															2397												J		E					0		0		1	Linda Williams												c99						Brad Linquist										j45					0 0			3				Annapolis																0 2
RD CHAR						RTE NUM Accident Occurred On																		17				ROAD NAME																											18		IN LANE			TRAF SIG					ON RAMP					0		Ramp Number (Direction)														0-Not Ramp					IN INTERSECTION
			16																																																								19		NO 20					NO		21		0				1 N-W				2 W-N 3 E-N 4 N-E										22				NO						23
0		2				U S						9		7																																											N 2				YES					YES				5 S-E				6 E-S				7 W-S			8 S-W					9 Other						YES
RD COND						INT-RTE																		25				INTERSECTING ROAD NAME or Log Mile Reference Manual description.																																		26			MILEPT										27			DIR		Dist. of Acc fr INT-RTE/Ref. & Dir.																		29
0 1			24			M		D				3		0			1																																																													28				0	0		6									Ft			N
			24																																																																											28																Ft
																																																																																														Mi
RD DIV									ACCIDENT									Show & Label: Roads, Traffic Units, the Travel Direction																																		DESCRIBE ACCIDENT briefly: identify units by numbers. Also identify the following																																														33
			30						DIAGRAM									consistent with the Log Mile Reference Manual, and Movement																																		a) the OBJECT DAMAGED & NATURE OF DAMAGE (Property other than vehicles) and																																														33
0		4	30						DIAGRAM									consistent with the Log Mile Reference Manual, and Movement
																		of Traffic Units.																																		b) the NAME & ADDRESS OF OWNER when applicable.
																		of Traffic Units.																																		b) the NAME & ADDRESS OF OWNER when applicable.
SRF COND																																																				Veh1 was going northbound when a deer entered the roadway. Veh1 slowed to avoid
0		2	34
0		2																																																		the deer as it ran across the road. Veh2, speeding, was unable to brake in time and
C/M ZONE																																																				rear-ended Veh1.
NO			35																																																	rear-ended Veh1.
NO			35
YES

JUNCT'N
			36
0		0
EVENT - 1
			37
0		1
EVENT - 2
0		0	38
0		0
FIX OBJ
0		5	39
0		5
COLL		TY
			40
0		3
LIGHT
			41
0		1
WEATHER
			42
0		3
UNIT #			43			NAME					(First,			Middle,						Last)																										44			SEX		45	UNIT #			43		NAME			(First,		Middle,				Last)																													44	SEX		45
0		1				Brandy																	E												Orr														0	2		0 2					Walter												O											Joseph																0			1
TYPE			46			ADDRESS (No.,										Street, City, State, Zip)																					TEL		Work				Res			47			INJ		48	TYPE			46		ADDRESS				(No., Street, City, State,											Zip)											TEL			Work			Res						47	INJ		48
OF			46			4602 Oldham St																																	6 4 1 6 1 9 2 0 6 5										0 2			OF			46		4676 Everett St																												5 4 0 4 5 8 4 6 7 6											0		3
UNIT																																																	0 2			UNIT																																												0		3
UNIT																																																	EMS		49	UNIT																																												EMS		49
DRIVER						Annapolis																				MD			24744																				EMS		49	DRIVER					Annapolis															MD			84381																					EMS		49
"PED"						Annapolis																				MD			24744																				0			"PED"					Annapolis															MD			84381																						A
MOVEMENT						CONDITN						SUBST					TEST				RESULT						FOR					AGE						TYPE		LOCAT'N					OBEY				VISIBL			MOVEMENT					CONDITN			SUBST				TEST				RESULT					FOR					AGE						TYPE			LOCAT'N				OBEY					VISIBL
0		3	50			0	51					0		52	0			53						54			PEDS								55				56	57						58					59	0	3		50		0		51		0	52		0		53				54			PEDS							55					56			57							58			59
0		3				0	1					0		1	0				0								ONLY																									0	3				0		2		0	1		0		0							ONLY
SPEED LIMIT						SAF. EQU						EQ PROB					EJECT				CITATION NUMBER (S)																									64			FAULT			SPEED LIMIT					SAF. EQU			EQ PROB				EJECT				CITATION NUMBER (S)																											64	FAULT
			60				61							62				63																															NO 65						60				61			62				63																															NO 65
5		0				1	1					1		3	0			1																															YES			5	0				1		3		0	1		0		1																															YES
GOING						DRIVER'S LICENSE NUMBER																																							STATE				CLASS			GOING					DRIVER'S LICENSE NUMBER																																		STATE					CLASS
			66																																					67						68					69				66																																	67							68			69
0		1				429945408																																							M D				3			0 1					331481440																																			M D				2
CONTINU						DR DATE OF BIRTH												71			IRREGULAR CONDITION														72		HM SPILL			HAZ MAT NUMBER												CONTINU					DR DATE OF BIRTH									71		IRREGULAR CONDITION												72			HM SPILL				HAZ MAT NUMBER
			70												1			9				PARKED							CAUGHT FIRE										73												74				70									1		9			PARKED							CAUGHT FIRE									73													74
0		1				0	9					2		0	4				1			HIT & RUN							DRIVERLESS									N	Y													0	4				0	8			1	7		4		2			HIT & RUN							DRIVERLESS								N		Y
BODY TY						COMMER.								U. S. DOT NUMBER																			ICC NUMBER											BODY TY			CDL?					BODY TY					COMMER.					U. S. DOT NUMBER																	ICC NUMBER											BODY TY					CDL?
			75			VEHICLE																							76											77					78				NO		79				75		VEHICLE																		76													77			78						NO	79
0		2				ONLY																																											YES			0	2				ONLY																																								YES
MOST HE						OWNER OR CARRIER NAME (Write "SAME" if Driver)																															TEL		Work				Res									MOST HE					OWNER OR CARRIER NAME (Write "SAME" if Driver)																										TEL			Work			Res
			80																																																81				80																																											81
0		1				Same																																														0	1				Bryan													H							O'Neil										3 5 2 7 8 4 3 8 7 1
CONTRIB						OWNER / CARRIER ADDRESS																																														CONTRIB					OWNER / CARRIER ADDRESS
CIRCUM-																																																			83	CIRCUM-					3119 Brighton Ave																																									83
STANCES																																																			83	STANCES					3119 Brighton Ave																																									83
		82-1																																						TOWED VEH (S)											84		82-1																																		TOWED VEH (S)											84
4		6																																																		1 8					Annapolis															MD 47344
		82-2				YEAR & MAKE OF VEHICLE																									MODEL									1st IMPACT PT.						87			1		0		82-2				YEAR & MAKE OF VEHICLE																				MODEL										1st IMPACT PT. 87									0		1
																											85												86										1		0																						85												86											0		1
2		6				8	4													FORD											Tempo									MAIN IMPACT						88			0		9	2 1					0 4						TOYT														Matrix										MAIN IMPACT								88	0		2

		82-3				EXP YR & REGISTR # STATE																				AREAS DAMAGED													INSURER														82-3				EXP YR & REGISTR # STATE															AREAS DAMAGED													INSURER
																						89															90														91																			89											90																	91
						0	5					WGQ 562									M D				0		9			1		0			0		8															2 2					0 8			MZZ 539								M D				1	5			1		7		1	6
		82-4				VEHICLE ID NUMBER																																	POLICY NUMBER														82-4				VEHICLE ID NUMBER																												POLICY NUMBER
																																					92														93																														92																	93
						21427BEW 770WMS 731																																																			50452VKW 299SFL 391
DAM EXT						VEHICLE REMOVED BY																																	VEHICLE REMOVED TO													DAM EXT					VEHICLE REMOVED BY																												VEHICLE REMOVED TO
			94																																		95														96				94																										95																	96
0		3																																																		0		2
TRAFFIC						SEATING							CODE all injured & uninjured PASSENGERS below. Use "W" for witness in TRAF UNIT and SEAT columns.																																																																			SAFETY					EQUIP			INJUR				EJEC-					EMS
UNIT #						POSITION							WRITE NAME & ADDRESS of Injured Passengers and Witnesses.																																																Witness telephone #.										SEX						AGE			EQUIP					PROB.			SEVER					TION				UNIT
			97							98																																																										99				100						101			102				103			104							105			106
0		1				0	5						Eric									G			Crosby											3448 Lillibridge St											Annapolis									MD 60665						1 4 8 9 5 8 5 6 8 1								0 1				0	2			6		1 1					0 1			0 1				0 1						0
0		1				0	3						Gavin									K			Sakic											2678 Brookview Dr											Annapolis									MD 15424						2 7 9 8 0 4 1 2 9 6								0 1				0	3			5		1 3					0 1			0 3				0 1					A
0		2				0	4						Elaine									H			Geller											3636 Monterey Dr											Annapolis									MD 38364						6 4 0 8 1 9 5 2 1 6								0 2				0	2			8		1 3					1 3			0 3				0 1					A
0		2				0	5						Penny									D			Manning											2638 S 55th St											Annapolis									MD 50596						4 8 6 3 8 1 6 9 8 3								0 2				0	1			8		1 1					0 1			0 1				0 1						0
0		2				0	6						Harold									Y			Mason											4946 Valley Rd											Annapolis									MD 62828						3 3 3 8 4 2 2 1 4 0								0 1				0	6			7		1 3					0 1			0 2				0 1						0
0		2				0	3						Ross									U			Williams											2753 Brighton Ave											Annapolis									MD 52732						1 7 9 6 4 3 3 9 0 7								0 1				0	0			4		1 4					1 3			0 2				0 1						0

E UNIT				INJURED TAKEN BY:																			INJURED TAKEN TO:																			EMS RUN REPORT #										E UNIT				INJURED TAKEN BY:														INJURED TAKEN TO:																		EMS RUN REPORT #
M	107				EmergyStat													108					Annapolis General																109		34-235							110				M	107													108																			109											110
S A					EmergyStat																		Annapolis General																		34-235											S
MSP FORM #1										(3/95)

MSP - CENTRAL RECORDS DIVISION COPY

Click for Maryland Motor Vehicle Accident Report File

Form Attributes

Fact Name	Description
Purpose	The Maryland Motor Vehicle Accident Report form is used to document details about motor vehicle accidents occurring in the state. It helps law enforcement and insurance companies assess the incident.
Governing Law	This form is governed by Maryland Transportation Code § 20-104, which requires drivers involved in accidents to provide necessary information.
Filing Requirement	Drivers must file this report with the Maryland State Police if the accident results in injury, death, or property damage exceeding $1,500.
Information Collected	The form collects essential information such as accident date, time, location, involved parties, and details about vehicles and injuries.
Submission Deadline	The completed report should be submitted within 15 days of the accident to ensure compliance with state regulations.

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