Escolar Documentos
Profissional Documentos
Cultura Documentos
PROVINCIAL OFFICE
PHILIPPINE NATIONAL POLICE
3. POLICE STATION: TRAFFIC ACCIDENT REPORT FORM 4. REGIONAL OFFICE
5. NUMBER OF VEHICLES INVOLVED 9. ACCIDENT SEVERITY 10. Month 11. Day 12. Year
6. NUMBER OF DRIVER CASUALTIES F. Fatal Accident DATE:
7. NUMBER OF PASSENGER CASUALTIES S. Serious Injury Accident 13. Day of the Week
M Minor Injury Accident 14. TIME (Military Time)
8. NUMBER OF PEDESTRIAN CASUALTIES
D. Property Damage Only
15. JUNCTION (TYPE) 16. TRAFFIC CONTROL 17. COLLISION TYPE 18. MOVENMENT
1. None 1. Head On 6. Hit Object in Road 1. 1-Way
1. Not at Junction 5. Y 2. Centerline 2. Rear End 7. Hit Object Off Road 2.
3. Pedestrian Crossing 2-Way
3. Right Angle 8. Hit Parked Vehicle
2. 6. 4. School Crossing
4. Side Swipe 9. Hit Pedestrian
5. Police Controlled
3. 7. Railway 5. Overturned Vehicle 10. Hit Animal 19. SEPARATION
6. Traffic Lights
7. Stop Sign 1. Median
4. 8. Other 8. Give Way 11. Other ......................... 2. Not Median
9. Other ....................
20. WEATHER 21. LIGHT 22. ROAD CHARACTER 23. SURFACE 24. SURFACE TYPE 25. MAIN CLAUSE 26. ROAD CLASS
1. Fair 1. Straight+Flat CONDITION 1. Vehicle Defect 1. National
2. Rain 1. Daylight 2. Curve Only 1. Dry 1. Concrete 2. Road Defect 2. Provincial
3. Wind 2. Dawn/Dust 3. Incline Only 2. Wet 2. Asphalt
4. Smoke 3. Night (lit) 3. Muddy
3. Human Error 3. City
4. Curve+Incline 3. Gravel
5. Fog 4. Night (unlit) 4. Flooded 4. Other 4. Municipal
6. Dazzle 5. Bridge ......... 4. Earth
5. Other 5. Barangay
7. Storm 6. Crest
27. ROAD REPAIRS 28. HIT & RUN 29. LOCATION TYPE
1. Yes .................... 1. Yes .................... 1. Urban Area ....................
2. No ..................... 2. No ..................... 2. Rural Area .....................
LOCATION
Name of City/Town/Barangay: _________________________________ Distance ............... (km/m)
Landmark 1 ............................ Distance ............... (km/m)
Name of Road _____________________ BETWEEN
_______________ Landmark 2 ........................... Distance ............... (km/m)
SUPERVISING OFFICER
PASSENGER CASUALTIES : Complete 1 Full Line for each passenger casualty = see reference boxes below
NAME AND ADDRESS 46. VEH. NO 47. SEX 48. AGE 49. INJURY/ HOSP 50. POSITION 51 Action
PEDESTRIAN CASUALTIES : Complete 1 Full Line for each pedestrian casualty = see reference boxes below
NAME AND ADDRESS 52. SEX 53. AGE 54. INJURY/ HOSP 55. POSITION 56 Action
49. PASSENGER INJURY 50. PASSENGER POSITION 51. PASSENGER 55.PEDESTRIAN 56. PEDESTRIAN
FOR 54. PEDESTRIAN INJURY 1. Front Seat ACTION LOCATION ACTION
REFERENCE 2. Rear Seat 1. None 1. On Pedestrian Crossing 1. None
ONLY F. Fatal 3. M/C Passenger 2. Boarding 2. Within 50m ped Crossing 2. Crossing Road
S. Serious 4. Bus Passenger 3. Alighting 3. On Central Refuge 3. Walking along Road
DO NOT
M Minor 5. Outside Sitting 4. Falling 4. In Road Centre 4. Walking along Edge
CIRCLE 6. Outside Standing 5. Other 5. On Footpath/Verge 5. Playing on Road
6. On Footpath