Get Or Form 735-46b 2016

Reset Form DMV PAGE OREGON POLICE TRAFFIC CRASH REPORT ADDITION OF POLICE INCIDENT / CASE NUMBER CRASH DATE COUNTY UNIT NAME LAST FIRST MIDDLE DRIVER LICENSE NUMBER STATE SEX DOB RACE PED PHONE ADDRESS BIC PRK VEHICLE OWNER PRP SAME FIRE Y N STD SPD PST SPD INSURANCE COMPANY NONE WORK CELL HOME INSURANCE POLICY NUMBER EJECTED EXTRCTD VEHICLE IDENTIFICATION NUMBER VIN Y P N VEHICLE TOWED DUE TO VEHICLE DAMAGE Y BY N LICENSE PLATE NUMBER STATE YEAR UNKNOWN DRIVER TAKEN TO VEHICLE DAMAGE FRONT MARK ALL THAT APPLY DAMAGE ESTIMATE ROLLOVER UNDERCAR UNDER 2500 TOTALED OVER 2500 INJURY MAKE Y MODEL NONE INSTLD COLOR EQUIPMENT STYLE COMPLAINT OF PAIN VISIBLE INCAPACITATED FATAL NO EQP USED LAP ONLY LAP / SHLDR CHLD RST-PRP A/BAG-DEPLYD SHLDR ONLY HELMET A/BAG-NOT DP ACTION / ARREST / CITES USE ARROW TO SHOW FIRST IMPACT SHADE IN DAMAGED AREA UNIT SEX PASSENGER NAME WITNESS PASSENGER TAKEN COMPLAINT OF PAIN VISIBLE INJURY LOCATION LF CF RF LR CR RR OTHER Y P N Y N DISTRIBUTION OFFICER NAME / NUMBER 735-46B 1-18 DATE AGENCY APPROVED BY STK 300025 EMS ARRIVAL AM PM Check ONE box in all categories. SURFACE CONDITION A ROAD CHARACTER STRAIGHT and LEVEL STRAIGHT w/ GRADE CURVED and LEVEL CURVED w/ GRADE VEH 3 NUMBER OF LANES TOTAL NUMBER OF LANES ROAD FLOW ONE WAY TRAFFIC NOT PHYSLY DIVIDED SURFACE TYPE CONCRETE BLACKTOP / ASPHALT GRAVEL DIRT B MEDIAN TYPE UNPAVED BARRIER CONT LEFT TURN VEH RELATED FACTORS BRAKES STEERING POWER PLANT SUSPENSION TIRES EXHAUST LIGHTS SIGNALS WINDOWS / WINDSHLD RESTRAINT SYSTEM WHEELS COUPLING CARGO VEHICLE MOVEMENT BACKING STOPPED STRAIGHT AHEAD TURNING RIGHT TURNING LEFT MAKING U-TURN ENTER TRAFFIC LANE LEAVE TRAFFIC LANE OVERTAKING CHANGING LANES AVOIDING MANEUVER MERGING PARKING NEGOTIATING A CURVE TRAILER TYPE LOG BUNK SEMITRAILER POLE TRAILER FULL TRAILER MOBILE HOME UTILITY TRAILER TRAVEL TRAILER BOAT TRAILER HORSE TRAILER VEHICLE IN TOW OTHER / UNKNOWN TRUCK CONFIGURATION TRUCK 2 or 3 AXLE TRUCK / TRACTOR-SEMI TRUCK and TRAILER DOUBLE TRAILERS TRIPLE TRAILERS DROMEDARY and SEMI HEAVY HAUL CONFIG BUS OTHER Explain VIOLATION TRAFFIC CONTROL TYPE DRIVER INSTRUCTION PERMIT SCHOOL BUS LIGHTS LICENSE RESTRICTION OFFICER / CROSSING EXPIRED LICENSE GUARD or FLAGGER OUT OF CLASS TRAFFIC SIGNAL w/ SUSPNDED / REVOKED PEDESTRIAN CONTROL UNLICENSED FLASHING BEACON DRIVER FACTORS STOP SIGN DRIVER YIELD SIGN RR CROSSING GATES RR CROSSING BUCKS CELL PHONE USE RR FLASHING SIGNAL OBSTRUCTED VIEW RR CROSSING w/ FAILED TO YIELD ROW PAVEMENT MARKINGS DISRGRD TRAF SIGN LANE CONTRLS / LINES TOO FAST FOR COND / STRIPES / DEVICES MADE IMPROPER TURN SCHOOL SIGNAL WRONG SIDE/WAY OTHER REG SIGN FOLLOW TOO CLOSELY TURN LANES IMPROPER LANE CHNG IMPROPER BACKING IMPROPER PASSING IMPROPER SIGNAL DEVICE CONDITION FATIGUE / DROWSY NO MALFUNCTION ILL DOWN / MISSING BLACKOUT TURNED FROM INATTENTIVE PROPER POSITION DISTRACTED OBSCURED BY IMPROP RESTR EQP USE PARKED VEHICLE IMPAIRMENT VEGETATION LIGHTS MALFUNCTION PASSENGER FACTORS LIGHTS STUCK GATES INOPERATIVE PASS GATE ARM MISSING UNDER INFL - DRUGS OTHER RR MALFUNCTN UNDER INFL - ALCOHOL INTERFERED w/DRIVER OTHER IMPAIRMENT UNDER INFL - MARIJUANA DETERMINED BY INTOXILYZER TEST BLOOD OR URINE TEST FIELD SOB. TEST OBSERVED SPEECH ODOR ETC. DRE EVALUATION STATEMENTS RESULTS OF TEST D1 C D Check ALL boxes that apply in categories with . DRY WET SNOW / SLUSH ICY MUDDY DEBRIS RUTS / HOLES / BUMPS WORN / POLISHED LOW / SOFT SHOULDER LOCAL CODES NO TEST GIVEN TEST REFUSED TESTED FOR DRUGS RESLTS NOT AVAILABLE E.