PNP Form File No.
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TRAFFIC ACCIDENT INVESTIGATION REPORT
I. WHERE:
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(Near/Km Post Nr) (Near Intersection/Landmark)
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(Hwy/St/Rd) (Dist/Bo) (Mun/City) (Prov.)
II. WHEN:
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(Day of Week) (Date) (Time)
III. WHAT:
Vehicles vs. 1. Another Vehicle 5. Pedestrian 9. Pedestrian
2. Pedestrian 6. Pedestrian 10. Pedestrian
3. Animal 7. Pedestrian 11. Pedestrian
4. Motorcycle 8. Pedestrian 12. Pedestrian
TYPE OF ACCIDENT: 1. Fatal 2. Fatal 3. Fatal
IV. HOW:
1. Head-on 4. Sideswipe-same direction With of road _____m/ft ______
2. Rear-end 5. Sideswipe-same direction With of shoulder _____m/ft ______
3. Angle 6. Sideswipe-same direction Number of lines _____
V. VEHICLE
Number of vehicles involved
(Use supplemental TAIR if more than two vehs.)
Vehicle 1 Vehicle 2
TYPE: _________________________________ ____________________________
Make and Model _________________________ ____________________________
Plt. Nr. Decal Nr. _________________________ ____________________________
Classification and Place of Issue _____________ ____________________________
Driven By ______________________________ ____________________________
Address ______________________________ ____________________________
Occupation ______________________________ ____________________________
Driver’s Lic. Nr. _________________________ ____________________________
Nationality ______________________________ ____________________________
Age ___________________________________ ____________________________
Sex & Status ____________________________ ____________________________
Driving Experience _______________________ ____________________________
Vehicle Owner ___________________________ ____________________________
Address ________________________________ ____________________________
Reg. Cert. Nr. & File Nr. ___________________ ____________________________
Estimated Damage ________________________ ____________________________
VI. WHAT DRIVERS WERE DOING:
1 2 (Check appropriate boxes)
1. Going straight 10. Backing
2. Turning right 11. Evading Vehicle
3. Turning left 12. Evading pedestrian
4. Making U-turn 13. Evading animal
5. Slowing 14. Evading object
6. Abrupt stopping 15. Overtaking
7. Stopped 16. Parked
8. Entering parked position 17. Others (specify) ______________
9. Leaving parked position
VII. WHAT PEDESTRAN OR ANIMAL WAS DOING:
1. Crossing between intersection 11. Along roadway outside sidewalk
2. Crossing at intersection 12. Along roadway without sidewalk
3. Crossing upon signal 13. Standing in safety zone/island
4. Crossing against signal 14. Getting on vehicle
5. No signal 15. Getting off vehicle
6. Crossing at pedestrian lane 16. Evading other vehicle
7. Crossing without pedestrian lane 17. Pushing cart/wagon
8. Coming from behind 18. Pulling cart/wagon
9. Coming from park vehicle 19. Vending on road
10. Along roadway or sidewalk 20. Others (specify) ______________
VIII. CONDITION OF MOTOR VEHICLE:
1 2 (Check appropriate boxes)
1. No defects noted 9. Tail lights out
2. Brakes defective 10. Brake lights defective
3. Headlights glaring 11. Signal lights defective
4. Both headlight insufficient 12. Steering mechanism defective
5. Both headlight is out 13. Windshield wipers defective
6. One headlight insufficient 14. Defective tires
7. One headlight is out 15. Others (specify) ______________
8. Tail light/s insufficient
IX. VIOLATION INDICATED:
1 2 (Check appropriate boxes)
1. Disregarding traffic signs and signal 9. On wrong side of road
2. Weaving in-and-out of traffic 10. Right of way
3. Exceeding lawful speed 11. Dangerous loaded
4. Unsafe passing between intersection 12. Under the influence of intoxicants
5. Unsafe passing in hill/curve 13. No valid driver’s license
6. Operating defective vehicle 14. No driver’s license
7. Failure to signal 15. Others (specify) ______________
8. Hit-and-run
X. CONDITION:
1 2 (Check appropriate boxes)
1. Absolutely normal 5. Had been drinking liquor
2. Physically defective (eye sight…) 6. Absolutely drunk
3. Sick or ill 7. Others (specify) ______________
4. Apparently sleepy
XI. VIOLATION INDICATED:
1 2 (Check appropriate boxes)
1. Trees, plants, crops, etc. 6. Moving vehicle
2. Building, house fence, etc. 7. Its own cargo
3. Hillcrest, embankment 8. Rain
4. Signboards 9. Falling objects
5. Parked vehicle 10. Others (specify) ______________
XII. ROAD CHARACTER SURFACE: XIII. WEATHER CONDITION AND DAYLIGHT
CONDITION:
1. Straight road 1. Concreate 1. Fair 1. Sunny
2. Curve 2. Asphalt 2. Cloudy 2. Dim (cloudy)
3. Level road 3. Gravel 3. Foggy 3. Dark-moonlight
4. Dip 4. Sand 4. Stormy 4. Dark-artificial light good
5. Hillcrest 5. Earth 5. Rainy 5. Dark-artificial light poor
6. Upgrade 6. Coral 6. Smoky 6. Darkness
7. Downgrade 7. Windy
XIV. ROAD CONDITION, WIDTH, LANES
1. No defects noted 1. Dry
2. Lanes Marked 2. Wet
3. Defective Shoulder 3. Muddy
4. Loose Material 4. Dusty
5. Holes, deep ruts 5. Under Construc.
6. Lanes separated 6. Others (specify) _______
XV. ROAD CONDITION, WIDTH, LANES
1 2 (Check appropriate boxes)
1. Front end 7. Front left side
2. Right front 8. Center left side
3. Left Front 9. Rear left side
4. Front right side 10. Rear end
5. Center right side 11. Right rear
6. Rear right side 12. Left rear
XVI. SKETCH OF ACCIDENT:
Use separate sheet if necessary and indicate (File Number)
INSTRUCTIONS:
1. Number each vehicle and show the 4. Show pedestrian or animal by Circle.
direction by arrow. 1 & 2
2. Use solid line to show direction before 5. Show North by arrow.
impact.
3. Show dotted lines after impact. 6. Draw out roadway in solid lines
XVII. BRIEF NARRATION:
XVIII. CASUALTY LIST:
Legend: K-killed; SI-serious injury; SPI-slight physical injury; D-driver; Pd-pedestrian; Ps-passenger
Hospital taken
Name Symbol Address Age Sex
1. _____________________ ______ ____________________ ____ ______
2. _____________________ ______ ____________________ ____ ______
3. _____________________ ______ ____________________ ____ ______
4. _____________________ ______ ____________________ ____ ______
5. _____________________ ______ ____________________ ____ ______
XIX. WITNESSES:
Name: Address
1. ________________________________ ____________________________________
2. ________________________________ ____________________________________
3. ________________________________ ____________________________________
XX. ACTION TAKEN: ________________________________________________________
XXI. RECOMMENDATION: ___________________________________________________
XXII. STATUS OF THE CASE: _________________________________________________
XXIII. REPORTED BY: ________________________________________________________
XXIV. INSURANCE COVERAGE DATA:
Vehicle 1 Vehicle 2
Insurance Company and Policy Nr. And sticker Nr. ________________ _________________
________________________________ ____________________________________
________________________________ ____________________________________
Certificate of cover Nr. _________________________________________________________
Date of Issued/Period Covered ___________________________________________________
XXV. INCLUSURES:__________________________________________________________
XXVI. INVESTIGATED OR PREPARED BY: __________ ________________________
Office Print Name and Sign
