Weather Conditions
000 Clear
100 Blowing sand, soil, dirt
101 Blowing snow
102 Cloudy
103 Fog, smog, smoke
104 Freezing rain or freezing drizzle
105 Rain
106 Severe crosswinds
107 Sleet or hail
108 Snow
980 Other
999 Unknown
Rank
Badge #
First Harmful Event
Intersection
Approach
Intersection Geometry
Investigating Agency
MISSISSIPPI UNIFORM CRASH REPORT
CRASH INFORMATION
Agency #
Rev. 2021-1
Page
of
Vehicles
Involved
City
Latitude
Longitude
County
Police Notified Date/Time
Police Arrived Date/Time
Roadway Cleared Date/Time
10-24 Investigation Completed
Number of
Motorists
Number of
Non-Motorists
Non-Fatally Injured
Persons
Fatalities
Total Injuries
and Fatalities
Crash Date/Time
Secondary Crash
100 Cargo/equipment loss or shift
101 Fell/jumped from motor vehicle
102 Fire/explosion
103 Immersion, full or partial
104 Jackknife
105 Overturn/rollover
106 Thrown or falling object
198 Other non-collision harmful event
Non-Collision
Collision with Non-Fixed Object
200 Collision with animal (live)
201 Collision with motor vehicle in transport
202 Collision with parked motor vehicle
203 Collision with pedalcycle
204 Collision with pedestrian
205 Collision with railway vehicle (train, engine)
206 Collision with object at rest from MV in transport
207 Collision with falling/shifting cargo or anything set in motion by MV
208 Collision with work zone/maintenance equipment
209 Collision with farm equipment
297 Collision with other non-motorist
298 Collision with other non-fixed object
Collision with Fixed Object
300 Collision with bridge overhead structure
301 Collision with bridge pier or support
302 Collision with bridge rail
303 Collision with cable barrier
304 Collision with concrete traffic barrier
305 Collision with culvert
306 Collision with curb
307 Collision with ditch
308 Collision with embankment
309 Collision with fence
310 Collision with guardrail end terminal
311 Collision with guardrail face
312 Collision with impact attenuator/crash cushion
313 Collision with mailbox
314 Collision with traffic sign support
315 Collision with traffic signal support
316 Collision with tree (standing)
317 Collision with utility pole/light support
396 Collision with other post, pole, or support
397 Collision with other traffic barrier
398 Collision with other fixed object (wall, building, tunnel, etc.)
399 Collision with unknown fixed object
Location of First
Harmful Event
100 Gore
101 In parking lane or zone
102 Median
103 Off roadway, location unknown
104 On roadway
105 On shoulder, left side
106 On shoulder, right side
107 Outside road/right-of-way
108 Roadside
109 Separator/traffic island
999 Unknown
100 Angled / skewed
101 Roundabout / traffic circle
102 Perpendicular
970 Not applicable
Roadway Surface
Condition
000 Dry
100 Ice/Frost
101 Mud, dirt, gravel
102 Oil
103 Sand
104 Slush
105 Snow
106 Water (standing,moving)
107 Wet
980 Other
999 Unknown
Manner of Crash
000
100
101
102
103
104
105
106
980
999
Relation to Junction
000
100
101
102
103
104
105
106
107
108
980
999
Light Condition
101 Daylight
201 Dawn/Dusk
301 Dark - lighted
302 Dark - not lighted
399 Dark - unknown lighting
980 Other
999 Unknown
Environmental Conditions
Intersection Traffic
Control
000 No controls
100 Signalized
101 Stop -all way
102 Stop -partial
103 Yield
970 Not applicable
School Bus Relation
000 No
100 Yes, school bus directly involved
101 Yes, school bus indirectly involved
None
Animal(s)
Debris
Glare
Non-highway work
Obstructed crosswalks
Obstruction in roadway
Prior crash
Prior non-recurring incident
Regular congestion
Related to a bus stop
Road surface condition
(wet, icy, snow, slush, etc.)
Ruts, holes,bumps
Shoulders (none, low, soft, high)
Toll booth/plaza related
Traffic control device
Traffic incident
Visual obstruction
Weather conditions
Work zone (construction/
maintenance/utility)
Worn,travel-polished surface
Other
Unknown
CRASH REPORT - CRASH SUMMARY
1 Not an intersection
2 Two
3 Three
4 Four
5 Five or more
Traffic Flow
Direction
N North
Trafficway
Characteristics
100 Trafficway, on road
101 Trafficway, not on road
200 Non-trafficway
Property Ownership
100 Public property
200 Private property
Named road
Numbered road
Road Classification
100 Interstate
101 US highway
102 State highway
103 County road
104 City street
Address Number
Street Name
Road Number
LOCATION INFORMATION
Intersection Road Name
Intersection Road Number
Crash was at an intersection
CRASH CIRCUMSTANCES AND CONDITIONS
First Name
Middle Name
Last Name
Suffix
Printed Name
Signature
CRASH TIME INFORMATION
INVESTIGATING OFFICER
ROAD INFORMATION
000
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
980
999
Not an interchange area
Acceleration or deceleration lane
Crossover related
Driveway access or related
Entrance/exit ramp or related
Intersection or related
Non-junction
Railway grade crossing
Shared-use path or trail
Through roadway
Other location within an interchange
area (median, shoulder, and roadside)
Unknown
200
201
202
Parking lot/
private drive
State park
Off road
Not applicable
(not a divided highway)
X
S South
W West
E East
Not a collision between
two motor vehicles
Angle
Front to front
Front to rear
Rear to rear
Rear to side
Sideswipe, opposite direction
Sideswipe, same direction
Other
Unknown
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
Conductor
First
Middle
Last
Suffix
Unknown
Unknown
DOT Crossing Number
Unknown
Unknown
Engineer ID Number
Unknown
Unknown
Middle
Last
Suffix
First
TRAIN #
MISSISSIPPI UNIFORM CRASH REPORT
CRASH INFORMATION
Agency #
Rev. 2021-1
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CRASH REPORT - SUMMARY BACK
Work Zone Type
Law Enforcement Present
Work Zone
WORK ZONE CRASH INFORMATION
000 No
100 Yes
999 Unknown
Location Relative
to Work Zone
100 Before the first work zone warning sign
101 Advance warning area
102 Transition area
103 Activity area
104 Termination area
970 Not applicable
999 Unknown
000 No
100 Yes
970 Not applicable
999 Unknown
Worker(s) Present
000 No
100 Yes
970 Not applicable
999 Unknown
100 Lane closure
101 Lane shift / crossover
102 Work on shoulder or median
103 Intermittent or moving work
970 Not applicable
980 Other
999 Unknown
Photos Taken?
Rank
First Name
Middle Name
Last Name
Suffix
PHOTOGRAPHER
REVIEWING OFFICER
First Name
Middle Name
Last Name
Suffix
Rank
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
WITNESS #
State
City
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
First
Middle
Last
Suffix
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
WITNESS #
State
City
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
First
Middle
Last
Suffix
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
WITNESS #
State
City
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
First
Middle
Last
Suffix
Suffix
DESCRIPTION AND INFORMATION
Page
MISSISSIPPI UNIFORM CRASH REPORT
VEHICLE INFORMATION
Agency #
of
Motor Vehicle #
Rev. 2021-1
CRASH REPORT - MOTOR VEHICLE DESCRIPTION AND IDENTIFICATION
Tow Status
Insurance
Color
Model
Model Year
Make
Tow Authority
Initial Contact Point
Damage Extent
Damaged Areas
Hit and Run
000 No, did not leave the scene
100 Yes, driver and vehicle left scene
101 Yes, only driver left scene
Vehicle Body Type
100 Passenger car
101 Passenger van (less than 9 seats)
102 (Sport) utility vehicle
300 2-wheeled motorcycle
301 3-wheeled motorcycle
302 Moped or motorized bicycle
303 All-terrain vehicle / all-terrain cycle (ATV / ATC)
304 Golf Cart
305 Snowmobile
306 Low Speed Vehicle
307 Recreational off-highway vehicles (ROV)
308 Autocycle
Passenger Vehicles
Cycle / Low Speed
Towed By
100 Top
1
2
3
4
5
6
11
10
9
8
7
12
000 Non-collision
100 Top
999 Unknown
113 Undercarriage
114 Cargo Loss
DAMAGE
000 None
100 Minor damage
101 Functional damage
102 Disabling damage
990 Vehicle not at scene
State Property Damaged
TOWING
License Plate
State
Missing
Owner Name
Same as driver
Unknown
Owner Address
Same as driver
Unknown
City
State
Postal Code
Street
Uninsured at time of crash
VIN
Check if this vehicle
had no driver
200 Construction equipment (backhoe, bulldozer,etc.)
201 Farm equipment (tractor, combine,harvester, etc.)
Construction / Farm Equipment
Other
400 Single unit truck
401 Truck tractor
498 Other truck
505 School bus
506 Transit bus
507 Motorcoach
598 Other bus / large passenger vehicle
Trucks
Large Passenger Vehicle
980 Other
Vehicle Type
100 Motor vehicle in transport
101 Parked motor vehicle
102 Working vehicle / equipment
Unknown
500 Motor home
501 9 or 12 passenger van
502 15-passenger van
503 Large limo
504 Mini-bus
1
2
3
5
6
11
10
9
8
7
12
4
Unknown
001 Vehicle not at scene
001 Vehicle not at scene
103 Pickup
104 Cargo van
Number
Year
Company
NAIC #
Policy #
113 Undercarriage
100 Owner
101 Law enforcement
970 Not applicable
980 Other
000 None
100 Bridge overhead structure
101 Bridge pier or support
102 Bridge rail
200 Cable barrier
201 Concrete traffic barrier
202 Guardrail end terminal
203 Guardrail face
204 Impact attenuator/crash cushion
298 Other traffic barrier
300 Traffic sign support
301 Traffic signal support
302 Utility pole/light support
980 Other
000 Not towed
100 Towed, but not due to disabling
damage
101 Towed due to disabling damage
Non-expiring
Power Unit
Damaged?
000 No
100 Yes
999 Unknown
MISSISSIPPI UNIFORM CRASH REPORT
VEHICLE INFORMATION
Agency #
Motor Vehicle #
Rev. 2021-1
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100 Cargo/equipment loss or shift
101 Fell/jumped from motor vehicle
102 Fire/explosion
103 Immersion, full or partial
104 Jackknife
105 Overturn/rollover
106 Thrown or falling object
198 Other non-collision harmful event
200
201
202
203
204
205
206
207
208
209
297
298
300 Collision with bridge overhead structure
301 Collision with bridge pier or support
302 Collision with bridge rail
303 Collision with cable barrier
304 Collision with concrete traffic barrier
305 Collision with culvert
306 Collision with curb
307 Collision with ditch
308 Collision with embankment
309 Collision with fence
310 Collision with guardrail end terminal
311 Collision with guardrail face
312 Collision with impact attenuator/crash cushion
313 Collision with mailbox
314 Collision with traffic sign support
315 Collision with traffic signal support
316 Collision with tree (standing)
317 Collision with utility pole/light support
396
397
398
399
Non-Collision Events
Collision with Person / Vehicle / Non-Fixed Object
Collision with Fixed Object
Sequence of Events
1
2
3
4
Most Harmful Event
MOTOR VEHICLE EVENTS
Vehicle Usage
000 No special function
100 Bus - school (public or private)
101 Bus - childcare / daycare
102 Bus - transit / commuter
103 Bus - charter / tour
104 Bus - intercity
105 Bus - shuttle
198 Bus - other
200 Farm vehicle
201 Fire truck
202 Highway / maintenance
203 Mail carrier
204 Military
205 Ambulance
206 Police
Vehicle Maneuver
100 Backing
101 Changing lanes
102 Entering traffic lane
103 Leaving traffic lane
104 Making U-turn
105 Movements essentially straight ahead
106 Negotiating a curve
107 Overtaking/passing
108 Parked
109 Slowing
110 Stopped in traffic
111 Turning left
112 Turning right
980 Other
999 Unknown
Roadway Grade
100 Level
101 Uphill
102 Hillcrest
103 Downhill
104 Sag (bottom)
Roadway
Alignment
100 Straight
101 Curve left
102 Curve right
Barrier Type
000 None
100 Cable barrier
101 Concrete barrier (e.g. Jersey barrier)
102 Earth embankment
103 Guardrail
980 Other
Posted Speed Limit
# of Through Lanes
Trafficway Division
Emergency Vehicle Usage
000 Non-emergency, non-transport
100 Non-emergency transport
200 Emergency operation, emergency warning equipment not in use
201 Emergency operation, emergency warning equipment in use
970 Not applicable
999 Unknown
Travel Direction
000 Not on roadway
CRASH REPORT - MOTOR VEHICLE CIRCUMSTANCES AND EVENTS
207
208
209
210
211
212
213
214
215
980
999
MOTOR VEHICLE CIRCUMSTANCES
Permitted Travel
100 One-way
200 Two-way
# of Auxiliary Lanes
Vehicle Defects
000 None
100 Brakes
101 Exhaust system
102 Body doors
103 Steering
104 Power train
105 Suspension
106 Tires
107 Wheels
108 Lights (head,signal,tail)
109 Window / Windshield
110 Mirrors
111 Wipers
112 Truck coupling / trailer hitch / safety chains
980 Other
999 Unknown
Traffic Control Device Types and Statuses
Traffic Control Device Types
000 None
100 Person (including flagger,
law enforcement, crossing
guard, etc)
200 Bicycle crossing sign
201 "Curve Ahead" warning sign
202 "Intersection Ahead"
warning sign
203 Pedestrian crossing sign
204 Railroad crossing
205 "Reduce Speed Ahead"
warning sign
206 School zone sign
207 Stop sign
208 Yield sign
298 Other warning sign
Devices Present
300 Flashing railroad crossing
(may include gates)
301 Flashing school zone signal
302 Flashing traffic control signal
303 Lane use control signal
304 Ramp meter signal
305 Traffic control signal
398 Other signal
400 Bicycle crossing
401 Pedestrian crossing
402 Railroad crossing
403 School zone
498 Other pavement marking
(excluding edgelines,
centerlines, or lane lines)
980 Other
999 Unknown
Devices Inoperative
or Missing
1
1
2
2
3
3
4
4
Automation System Level Present
000 No automation
100 Driver assistance
101 Partial automation
102 Conditional automation
103 High automation
104 Full automation
199 Automation level unknown
999 Unknown
Automation System Level Engaged at Time of Crash
600 Southwest
HOV Lane Presence
000 None present
100 Separated barrier, flush (greater than
4 ft wide), raised or depressed median
101 Not separated, painted pavement markings,
post-mounted delineators
HOV Lane Relation
000 No
100 Yes
Unknown
N/A
000 No automation
100 Driver assistance
101 Partial automation
102 Conditional automation
103 High automation
104 Full automation
199 Automation level unknown
999 Unknown
000 Not divided
001 Not divided, with a continuous left turn lane
100 Divided, flush median (greater than 4 ft wide)
101 Divided, raised median (curbed)
102 Divided, depressed median
999 Unknown
Public utility
Non-transport emergency services vehicle
Safety service patrols - incident response
Other incident response
Rental truck (over 10,000 lbs)
Towing - incident response
Truck acting as crash attenuator
Taxi
Vehicle used for electronic ride-hailing
(transportation network company)
Other
Unknown
100 North
200 Northeast
300 East
400 Southeast
500 South
700 West
800 Northwest
999 Unknown
Collision with animal (live)
Collision with motor vehicle in transport
Collision with parked motor vehicle
Collision with pedacycle
Collision with pedestrian
Collision with railway vehicle (train, engine)
Collision with object at rest from MV in transport
Collision with falling, shifting cargo, or
anything set in motion by MV
Collision with work zone/maintenance equipment
Collision with farm equipment
Collision with other non-motorist
Collision with other non-fixed object
Collision with other post,pole,or
support
Collision with other traffic barrier
Collision with other fixed object
(wall, building, tunnel, etc.)
Collision with unknown fixed object
Non-Harmful Events
000 Cross centerline
001 Cross median
002 End departure (T-intersection, dead-end, etc.)
003 Downhill runaway
004 Equipment failure (blown tire, brake failure, etc.)
005 Ran off roadway left
006 Ran off roadway right
007 Reentering roadway
008 Separation of units
098 Other non-harmful event
COMMERCIAL MOTOR VEHICLE INFORMATION
Page
MISSISSIPPI UNIFORM CRASH REPORT
VEHICLE INFORMATION
Agency #
of
Motor Vehicle #
Rev. 2021-1
CRASH REPORT - COMMERCIAL MOTOR VEHICLE DESCRIPTION AND IDENTIFICATION
Year
Model
Special Sizing
Motor Carrier Type
License Plate
Make
VIN
Motor Carrier Address
Vehicle Configuration
GVWR/GCWR
Motor Carrier Identification
100 USDOT number
101 State number
970 Not applicable
999 Unknown/unable to determine
State
City
State
Postal Code
Street
Unknown
Number
of Axles
000 No special sizing
Motor Carrier ID Number
Hazardous Materials Placard
000 Did not carry hazardous materials
100 Carried hazardous materials with placard
200 Carried hazardous materials without placard
Hazardous Material ID
Hazardous Material Class
Hazardous Materials Released
from Vehicle Cargo Compartment
000 No, hazardous materials not released
100 Yes, hazardous materials released
970 Not applicable
100 Light (less than 10,000 lbs.GVWR/GCWR)
101 Medium (10,001 - 26,000 lbs GVWR/GCWR)
102 Heavy (greater than 26,000 lbs GVWR/GCWR)
970 Not applicable
999 Unknown
Commodity Hauled
Number of Axles
000 Not a qualifying vehicle
100 Vehicles 10,000 lbs or less placarded for hazardous materials
200 Bus/large van (seats 9-15 occupants, including driver)
201 Bus (seats more than 15 occupants, including driver)
999 Unknown
Cargo Body Type
109 Log
110 Pole trailer
111 Van / enclosed box
112 Vehicle towing another vehicle
999 Unknown
105 Flatbed
106 Garbage / refuse
107 Grain / chips / gravel
108 Intermodal container chassis
980 Other
000 No cargo body
100 Bus
101 Auto transporter
102 Cargo tank
103 Concrete mixer
104 Dump
970 Not applicable
000 Not a motor carrier
100 Interstate carrier
101 Intrastate carrier
102 Not in commerce / government
980 Not in commerce / other truck or bus
Motor Carrier Name
Unknown
TRAILER INFORMATION
TRAILER #
License Plate
VIN
Number of Axles
TRAILER INFORMATION
TRAILER #
License Plate
VIN
Number of Axles
TRAILER INFORMATION
TRAILER #
Year
Model
Make
Year
Model
Make
State
Number
State
Number
State
Number
1
2
3
4
5
6
7
8
9
970
999
100 Over-height
101 Over-length
102 Over-weight
103 Over-width
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Missing
Unknown
Unknown
Missing
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Missing
Unknown
Unknown
Unknown
Unknown
Unknown
300 Single-unit truck (2-axle and GVWR > 10,000 lbs.)
301 Single-unit truck (3 or more axles)
302 Truck pulling trailer(s)
303 Truck tractor (bobtail)
304 Truck tractor/semi-trailer
305 Truck tractor/double
306 Truck tractor/triple
307 Truck more than 10,000 lbs., cannot classify
Explosives
Gas
Flammable liquids
Other flammable substances
Oxidizing substances and organic peroxides
Toxic (poisonous) and infectious substances
Radioactive material
Corrosives
Miscellaneous dangerous goods
Not applicable
Unknown
Unknown
999 Unknown
999 Unknown
Damaged
000 No
100 Yes
999 Unknown
Damaged
000 No
100 Yes
999 Unknown
Damaged
000 No
100 Yes
999 Unknown
Air Bags Deployed
Motor Vehicle #
Name
DRIVER INFORMATION
Address
First
Street
Seating Position
DRIVER SEATING AND SAFETY INFORMATION
MISSISSIPPI UNIFORM CRASH REPORT
DRIVER INFORMATION
Agency #
Rev. 2021-1
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Restraint Systems Used
100 None used - motor vehicle occupant
101 Booster seat
102 Child restraint system - forward facing
103 Child restraint system - rear facing
104 Child restraint - type unknown
105 Lap belt only used
106 Shoulder and lap belt used
107 Shoulder belt only used
108 Stretcher
109 Wheelchair
199 Restraint used - type unknown
Race
100
101
102
103
980
999
Sex
Age
Middle
Last
Suffix
City
State
Postal Code
Unknown
Unknown
Front
Row
Left
Middle
Right
1
2
3
4
Oth
Unk
100
200
300
400
500
101
201
301
401
501
102
202
302
402
502
199
299
399
499
599
700 Unenclosed cargo area
701 Riding on motor vehicle exterior
(non-trailing unit)
800 Trailing unit
801 Sleeper section of cab (truck)
898 Other enclosed cargo area
970 Not applicable
999 Unknown
Ejection
000 Not ejected
100 Ejected, partially
101 Ejected, totally
970 Not applicable
999 Unknown
200 No helmet
201 DOT-compliant
motorcycle helmet
202 Not DOT-compliant
motorcycle helmet
299 Unknown if DOT-compliant
motorcycle helmet
Used Improperly?
Standard Vehicle Seats
Other Seating Positions
Extrication
000 No
100 Yes
Unk
600
601
602
699
Phone Number
Unknown
Unknown
Ethnicity
100 Hispanic
101 Other than Hispanic
999 Unknown
Date of Birth
Endorsements on License
DRIVER LICENSE INFORMATION
License Status
100 Valid license
000 Not licensed
001 Canceled or denied
002 Expired
003 Revoked
004 Suspended
999 Unknown
Alcohol Interlock Presence
Restrictions on License
100 H - Hazardous materials
101 N - Tank vehicle
102 P - Passenger
103 S - School
104 T - Double/triple trailers
105 X - Combination of tank vehicle and
hazardous materials
980 Other non-commercial license
endorsements (e.g., motorcycle, etc.)
999 Unknown
Endorsement Compliance
License Number
License State
License Class
Is Commercial DL?
Yes
No
000 No
100 Yes
000 None/not applicable
Commercial Driver License Status
100 Valid
101 Learner's permit
000 Canceled or denied
001 Disqualified
002 Expired
003 Revoked
004 Suspended
098 Other (not valid)
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other (knee, air belt, etc.)
970 Not applicable
999 Deployment unknown
Incident Responder
CRASH REPORT - DRIVER INFORMATION
Unknown
000 No endorsements required for the vehicle
100 Endorsements required, complied with
101 Endorsements required, not complied with
199 Endorsements required, compliance unknown
999 Unknown if endorsements required
000 No
100 EMS
101 Fire
102 Police
103 Tow operator
104 Transportation (i.e. maintenance workers, safety service patrol operators, etc.)
980 Other
999 Unknown
970 Not applicable
999 Unknown
970 Not applicable
999 Unknown
100 Female
101 Male
999 Unknown
000 None
100 Class A
101 Class B
102 Class C
200 Light commercial/taxi/chauffeur (MS class D)
300 Motorcycle only (class M, non-MS only)
400 Regular driver license class (MS classes R, T, P, and Y)
970 Not applicable
000 No
100 Yes
999 Unknown
970 Not applicable
980 Other
999 Unknown
American Indian or
Alaska Native
Asian or Pacific Islander
Black
White
Other
Unknown
Conditions at Time of Crash
Apparently normal
Asleep or fatigued
Emotional (depressed, angry, disturbed, etc.)
Ill (sick), fainted
Physically impaired
Under the influence of medications/
drugs/alcohol
Not applicable
Other
Unknown
Avoidance Maneuver
Driver Actions at Time of Crash
EMS Response Run #
Injury Status
MISSISSIPPI UNIFORM CRASH REPORT
DRIVER INFORMATION
Agency #
Rev. 2021-1
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Distraction Source
Distracted By
000
100
101
980
999
Speeding Related
000 No
100 Exceeded speed limit
101 Racing
102 Too fast for conditions
999 Unknown
Type of Medical Transportation
000 Not transported
100 EMS air
101 EMS ground
200 Law enforcement
980 Other
999 Unknown
EMS Response Agency
Facility Receiving Patient
100 Hands-free mobile phone
101 Hand-held mobile phone
102 Vehicle-integrated device
198 Other electronic device
200 Passenger or other non-motorist
201 External to vehicle/non-motorist area
298 Other
970 Not applicable
999 Unknown
000 No contributing action
100 Disregard other road markings
101 Disregard other traffic signs
102 Failed to keep in proper lane
103 Failed to yield right-of-way
104 Followed too closely
105 Improper backing
106 Improper passing
107 Improper turn
108 Operated motor vehicle in inattentive, careless, negligent, or erratic manner
109 Operated motor vehicle in reckless or aggressive manner
110 Over-correcting or over-steering
111 Ran off roadway
112 Ran red light
113 Ran stop sign
114 Swerved or avoided due to wind,slippery surface,motor vehicle,object,non-motorist in roadway,etc.
115 Wrong side or wrong way
980 Other contributing action
999 Unknown
Motor Vehicle #
MEDICAL INFORMATION
DRIVER CONDITION AND CIRCUMSTANCES
100 (K) Fatal Injury
101 (A) Suspected Serious Injury
102 (B) Suspected Minor Injury
103 (C) Possible Injury
104 (O) No Apparent Injury
000
100
101
102
103
104
970
980
999
CRASH REPORT - DRIVER CONDITION AND CIRCUMSTANCES
Suspected
Drug
Usage
Suspected
Alcohol
Usage
000 No
100 Yes
999 Unknown
Alcohol Test Results
Test Status
Drug Test Results
000 Results pending
001 Negative results with no actual value
100 Results received
101 Positive results with no actual value
970 Not applicable
999 Unknown
BAC
Drug Test Type
000 Test not given
001 Test refused
100 Test given
999 Unknown if tested
000 No
100 Yes
999 Unknown
970 Not applicable
999 Unknown
100 Blood
101 Urine
102 Both blood and urine
103 Saliva
198 Other
Alcohol Test Type
100 Blood
101 Blood clot
102 Blood plasma/serum
300 Urine
301 Vitreous
Test Status
000 Test not given
001 Test refused
100 Test given
999 Unknown if tested
DRIVER ACTIONS
000 No avoidance maneuver
100 Accelerating
101 Accelerating and steering left
102 Accelerating and steering right
103 Braking and steering left
104 Braking and steering right
105 Braking (lockup)
106 Braking (no lockup)
107 Braking (lockup unknown)
108 Releasing brakes
109 Steering left
110 Steering right
980 Other
999 Unknown
Unknown
Not distracted
Talking / listening
Manually operating a device
(e.g., texting, dialing, playing game, etc.)
Other
Unknown
970 Not applicable
980 Other
200 Breath
201 Preliminary breath test (PBT)
CITATIONS
MISSISSIPPI UNIFORM CRASH REPORT
PASSENGER INFORMATION
Total # of Passengers
Page
Agency #
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Rev. 2021-1
PASSENGER INFORMATION
Ejection
000 Not ejected
100 Ejected, partially
101 Ejected, totally
970 Not applicable
999 Unknown
Extrication
000 No
100 Yes
Injury Status
100 (K) Fatal injury
101 (A) Suspected serious injury
102 (B) Suspected minor injury
103 (C) Possible injury
104 (O) No apparent injury
Race
100 American Indian or Alaska Native
101 Asian or Pacific Islander
102 Black
103 White
980 Other
999 Unknown
Restraint Systems
100 None used - motor vehicle occupant
101 Booster Seat
102 Child restraint system - forward facing
103 Child restraint system - rear facing
104 Child restraint system - type unknown
105 Lap belt only used
106 Shoulder and lap belt used
107 Shoulder belt only used
108 Stretcher
109 Wheelchair
199 Restraint used - type unknown
Type of Medical Transportation
000 Not transported
100 EMS air
101 EMS ground
200 Law enforcement
980 Other
999 Unknown
Seating Position
Front
Row
Left
Middle
Right
1
2
3
4
Other
Unk
100
200
300
400
500
101
201
301
401
501
102
202
302
402
502
199
299
399
499
599
700 Unenclosed cargo area
701 Riding on motor vehicle exterior
(non-trailing unit)
800 Trailing unit
801 Sleeper section of cab (truck)
898 Other enclosed cargo area
970 Not applicable
999 Unknown
PASSENGER CODES
Ethnicity
100 Hispanic
101 Other than Hispanic
999 Unknown
Unk
600
601
602
699
200 No helmet
201 DOT-compliant motorcycle helmet
202 Not DOT-compliant motorcycle helmet
299 Unknown if DOT-compliant motorcycle helmet
970 Not applicable
980 Other
999 Unknown
Incident Responder
000 No
100 EMS
101 Fire
102 Police
103 Tow operator
104 Transportation
980 Other
999 Unknown
(i.e. maintenance workers, safety service patrol operators, etc.)
CRASH REPORT - PASSENGER INFORMATION
EMS Response Run #
Name
Address
PASSENGER #
Middle
Last
Suffix
First
Date of Birth
Sex
Phone Number
Ethnicity
EMS Response Agency
Injury Status
Seating Position
Restraint System
Ejection
Extrication
Type of
Medical
Transportation
Facility Receiving Patient
Street
City
State
Postal Code
MOTOR VEHICLE #
UNBORN CHILD OF
Air Bags Deployed
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other
970 Not applicable
Incident Responder
Race
999 Unknown
100 Female
101 Male
999 Unknown
Unknown
Used Improperly?
Unknown
Unknown
Age
EMS Response Run #
Name
Address
Middle
Last
Suffix
First
Phone Number
Ethnicity
EMS Response Agency
Injury Status
Seating Position
Restraint System
Ejection
Extrication
Type of
Medical
Transportation
Facility Receiving Patient
Street
City
State
Postal Code
Air Bags Deployed
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other
970 Not applicable
Incident Responder
Race
999 Unknown
Unknown
Used Improperly?
Unknown
Unknown
Date of Birth
Sex
100 Female
101 Male
999 Unknown
Age
EMS Response Run #
Name
Address
Middle
Last
Suffix
First
Phone Number
Ethnicity
EMS Response Agency
Injury Status
Seating Position
Restraint System
Ejection
Extrication
Type of
Medical
Transportation
Facility Receiving Patient
Street
City
State
Postal Code
Air Bags Deployed
000 Not deployed
100 Front
101 Side
102 Curtain
103 Other
970 Not applicable
Incident Responder
Race
999 Unknown
Unknown
Used Improperly?
000 No
100 Yes
Unknown
Unknown
Date of Birth
Sex
100 Female
101 Male
999 Unknown
Age
PASSENGER #
MOTOR VEHICLE #
UNBORN CHILD OF
PASSENGER #
MOTOR VEHICLE #
UNBORN CHILD OF
999 Unknown
000 No
100 Yes
999 Unknown
000 No
100 Yes
999 Unknown
Non-Motorist #
Contributing Circumstances
Non-Motorist Type
100
198
200
298
300
999
Safety Equipment
000
100
101
102
103
104
Location At Time of Crash
100 Intersection - marked crosswalk
101 Intersection - unmarked crosswalk
102 Intersection - other
103 Median/crossing island
104 Midblock - marked crosswalk
105 Shoulder/roadside
106 Travel lane - other location
Suspected Drug Usage
Conditions at the Time of the Crash
000
100
101
102
103
104
970
980
999
Origin/Destination
100 Going to or from school (K-12)
101 Going to or from transit
970 Not applicable
999 Unknown
Suspected Alcohol Usage
000 No
100 Yes
999 Unknown
Alcohol Test Results
Test Status
Drug Test Results
000
001
100
101
970
999
BAC
Drug Test Type
000 Test not given
001 Test refused
100 Test given
999 Unknown if tested
000 No
100 Yes
999 Unknown
Initial
Contact Point
100 Front (12 o'clock)
101 Right (3 o'clock)
102 Rear (6 o'clock)
103 Left (9 o'clock)
999 Unknown
970 Not applicable
999 Unknown
100 Blood
101 Urine
102 Both blood and urine
103 Saliva
198 Other
Alcohol Test Type
100 Blood
101 Blood clot
102 Blood plasma/serum
200 Breath
201 Preliminary breath test (PBT)
300 Urine
301 Vitreous
970 Not applicable
980 Other
Test Status
000 Test not given
001 Test refused
100 Test given
999 Unknown if tested
NON-MOTORIST INFORMATION
Page
MISSISSIPPI UNIFORM CRASH REPORT
NON-MOTORIST INFORMATION
Agency #
of
Rev. 2021-1
CRASH REPORT - NON-MOTORIST INFORMATION
Bicyclist
Other cyclist
Pedestrian
Other pedestrian (wheelchair,
person in a building, skater,
personal conveyance, etc.)
Occupant of a non-motor vehicle
transportation device
Unknown
Apparently normal
Asleep or fatigued
Emotional
(depressed,angry,disturbed,etc.)
Ill (sick), fainted
Physically impaired
Under the influence of
medication/drugs/alcohol
Not applicable
Other
Unknown
Results pending
Negative results with no actual value
Results received
Positive results with no actual value
Not applicable
Unknown
Name
Address
First
Street
Race
100
101
102
103
980
999
Sex
Age
Middle
Last
Suffix
City
State
Postal Code
Unknown
Unknown
Phone Number
Unknown
Unknown
Ethnicity
100 Hispanic
101 Other than Hispanic
999 Unknown
Date of Birth
Incident Responder
Unknown
000 No
100 EMS
101 Fire
102 Police
103 Tow operator
104 Transportation (i.e. maintenance workers, safety service patrol operators, etc.)
980 Other
999 Unknown
100 Female
101 Male
999 Unknown
American Indian or
Alaska Native
Asian or Pacific Islander
Black
White
Other
Unknown
NON-MOTORIST CIRCUMSTANCES
200 Signed route (no pavement marking)
201 Shared lane markings
202 On-street bike lanes
203 On-street buffered bike lanes
204 Separated bike lanes
205 Off-street trails/sidepaths
300 Driveway access
301 Non-trafficway area
302 Shared-use path or trail
303 Sidewalk
980 Other
999 Unknown
000 None
100 Helmet
101 Protective pads used (elbows, knees, shins, etc.)
102 Reflective wear (backpack, triangles, etc.)
103 Lighting
104 Reflectors
980 Other
999 Unknown
Struck by Vehicle #
Unborn Child of Non-Motorist #
Injury Status
100 (K)
101 (A)
102 (B)
103 (C)
104 (O)
Fatal Injury
Suspected Serious Injury
Suspected Minor Injury
Possible Injury
No Apparent Injury
105
106
107
108
109
110
Type of Medical Transportation
000 Not transported
100 EMS air
101 EMS ground
200 Law enforcement
980 Other
999 Unknown
EMS Response Run #
EMS Response Agency
Facility Receiving Patient
Unknown
NON-MOTORIST MEDICAL INFORMATION
980 Other
999 Unknown
NON-MOTORIST CONDITION
Distraction Source
Distracted By
000
100
101
980
999
100 Hands-free mobile phone
101 Hand-held mobile phone
102 Vehicle-integrated device
198 Other electronic device
200 Passenger or other non-motorist
201 External to vehicle/non-motorist area
298 Other
970 Not applicable
999 Unknown
Not distracted
Talking / listening
Manually operating a device (texting, typing,
dialing, playing game, etc.)
Other
Unknown
None (no improper action)
Dart / dash
Disabled vehicle related
(working on, pushing, leaving/approaching)
Entering/exiting parked/standing vehicle
Failure to obey traffic signs, signals, or officer
Failure to yield right-of-way
Improper passing
Improper turn/merge
Inattentive (talking, eating, etc.)
In roadway improperly
(standing, lying, working, playing)
Not visible (dark clothing, no lighting, etc.)
Wrong-way riding or walking
Action Prior to Crash
000
100
101
102
103
104
105
106
198
980
999
None
Adjacent to roadway (e.g.,shoulder,median)
Crossing roadway
Waiting to cross roadway
Walking/cycling along roadway against traffic
(in or adjacent to travel lane)
Walking/cycling along roadway with traffic
(in or adjacent to travel lane)
Walking/cycling on sidewalk
Working in trafficway (incident response)
In roadway -other
Other
Unknown
MISSISSIPPI UNIFORM CRASH REPORT
CRASH INFORMATION
Agency #
Rev. 2021-1
Page
of
CRASH REPORT - TRAIN INFORMATION
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
Conductor
First
Middle
Last
Suffix
Unknown
Unknown
DOT Crossing Number
Unknown
Unknown
Engineer ID Number
Unknown
Unknown
Middle
Last
Suffix
First
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
Conductor
First
Middle
Last
Suffix
Unknown
Unknown
DOT Crossing Number
Unknown
Unknown
Engineer ID Number
Unknown
Unknown
Middle
Last
Suffix
First
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
Conductor
First
Middle
Last
Suffix
Unknown
Unknown
DOT Crossing Number
Unknown
Unknown
Engineer ID Number
Unknown
Unknown
Middle
Last
Suffix
First
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
Conductor
First
Middle
Last
Suffix
Unknown
Unknown
DOT Crossing Number
Unknown
Unknown
Engineer ID Number
Unknown
Unknown
Middle
Last
Suffix
First
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
Conductor
First
Middle
Last
Suffix
Unknown
Unknown
DOT Crossing Number
Unknown
Unknown
Engineer ID Number
Unknown
Unknown
Middle
Last
Suffix
First
TRAIN #
Conductor ID Number
TRAIN CRASH INFORMATION
Company
Engineer
Conductor
First
Middle
Last
Suffix
Unknown
Unknown
DOT Crossing Number
Unknown
Unknown
Engineer ID Number
Unknown
Unknown
Middle
Last
Suffix
First
TRAIN #
WITNESSES
Page
MISSISSIPPI UNIFORM CRASH REPORT
WITNESSES
Agency #
of
Total # of Witnesses
Rev. 2021-1
CRASH REPORT - WITNESSES
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
City
WITNESS #
Name
Address
Phone Number
Age
Postal Code
Sex
State
First
Middle
Last
Suffix
CRASH REPORT - DIAGRAM
Scene #
MISSISSIPPI UNIFORM CRASH REPORT
DIAGRAM
Agency #
Rev. 2021-1
Page
of
CRASH DIAGRAM
MISSISSIPPI UNIFORM CRASH REPORT
NARRATIVE
Agency #
Rev. 2021-1
Page
of
CRASH NARRATIVE
CRASH REPORT - NARRATIVE
CRASH REPORT - PHOTOS
MISSISSIPPI UNIFORM CRASH REPORT
PHOTOS
Agency #
Rev. 2021-1
Page
of
PHOTOS