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The Iowa Accident Report Form is a critical document used to report accidents that occur within the state, specifically those resulting in death, personal injury, or property damage exceeding $1,500. Timely submission of this form is essential; failure to do so within 72 hours may lead to the suspension of driving privileges. To ensure compliance and protect your rights, it is important to fill out the form accurately and completely by clicking the button below.

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Contents

When a motor vehicle accident occurs in Iowa, it’s crucial to understand the importance of the Iowa Accident Report Form, also known as Form 433002. This document serves as the official record for any accident resulting in death, personal injury, or property damage exceeding $1,500. Failure to submit this form within 72 hours can lead to serious consequences, including the suspension of your driving privileges. The form requires detailed information, starting with the accident's date, time, and location, as well as specifics about the vehicles and drivers involved. You'll need to provide not only the names and license details of all drivers but also the type and registration of the vehicles. Additional sections cover injury details, property damage, and even the weather conditions at the time of the accident. With clear instructions on how to fill it out, including using specific codes for vehicle types and accident circumstances, this form is designed to ensure that all relevant information is captured accurately. Completing the report thoroughly is essential for both legal and insurance purposes, making it a vital part of the post-accident process in Iowa.

Form 433002 08-10

IOWA ACCIDENT REPORT FORM

An accident occurring anywhere within the State of Iowa causing death, personal injury, or total property damage of $1,500.00 or more must be reported on this accident report form. Failure to return this accident report form within 72 hours may result in suspension of your driving privilege. Caution: You must attempt to completely fill out this report.

Instructions

Please print or type all information. Use black or dark blue ink.

Step 1. Begin completing the "Report of Motor Vehicle Accident" form by entering accident date, day of week, time, number of vehicles, total number killed, number injured, and the total amount of damage to all vehicles and any property other than vehicles.

Step 2. Enter the information pertaining to all drivers and vehicles involved in the accident. Important: Be sure to include the driver's name, driver license number, and driver license state. Also include the vehicle owner's name, license plate number, and license plate state. If more than two drivers or two vehicles were involved, use an extra report form or sheet of paper making sure that the extra vehicles and drivers are numbered 3, 4, 5, etc.

If you were involved in an accident with a pedestrian, print PEDESTRIAN in the driver space provided for vehicle No. 2 and complete pedestrian information in Step 7. If you were involved in an accident with a pedalcyclist (bicycle, etc.) print 'Bike' in the driver space provided for Vehicle 2 and complete information for Non-Motorist in Step 7.

If one of the vehicles involved was parked at the time of the accident, print PARKED in the driver space and complete the vehicle owner information.

Step 3. Please use the following codes when completing the box marked "vehicle type code":

01	= Passenger Car	09	= Tractor/semi-trailer	17	= Small school bus (seats 9-15)
02	= Four-tire light truck (pick-up, panel)	10	= Tractor/doubles	18	= Other bus (seats > 15)
03	= Van or mini-van	11	= Tractor/triples	19	= Other small bus (seats 9-15)
04	= Sport utility vehicle	12	= Other heavy truck (cannot classify)	20	= Farm vehicle/equipment
05	= Single-unit truck (2-axle, 6-tire)	13	= Motor home/recreational vehicle	21	= Maintenance/construction vehicle
06	= Single-unit truck (> = 3 axles)	14	= Motorcycle	22	= Train
07	= Truck/trailer	15	= Moped/All-Terrain Vehicle	88	= Other (explain in narrative)
08	= Truck tractor (bobtail)	16	= School bus (seats > 15)	99	= Unknown

Step 4. The location of the accident is very important. Please be as specific as possible.

Step 5. To the best of your ability, complete the Accident Codes section for your own vehicle using codes provided on page 2 of this form.

Step 6. If there is damage to property other than the vehicles involved complete the property damage information.

Step 7. Injury information should be entered in the space provided. Make sure that the vehicle number in which the injured party was riding is complete, describe the nature of the injury, and check the box under the column most appropriate for the injury severity. NOTE: Include all drivers whether injured or not. The codes are:

Injury Status:

1 = Fatal

2 = Incapacitating

3 = Non-incapacitating

4 = Possible

5 = Uninjured

9 = Unknown

Occupant Protection:		Airbag Deployment:		Ejection:		Type Non-Motorist:
1	= None used	1	= Deployed front of person	1	= Not ejected	1	= Pedestrian
2	= Shoulder and lap belt used	2	= Deployed side of person	2	= Partially ejected	2	= Pedalcyclist (bicycle, tricycle,
3	= Lap belt only used	3	= Deployed both front/side	3	= Totally ejected		unicycle, pedal car)
4	= Shoulder belt only used	4	= Other deployment (explain	4	= Not applicable	3	= Skater
5	= Child safety seat used		in narrative		(motorcycle,	8	= Other (explain in narrative)
6	= Helmet used	5	= Not deployed		bicycle, etc.)	9	= Unknown
8	= Other (explain in narrative)	6	= Not applicable	9	= Unknown
9	= Unknown	9	= Unknown

Motorcycle Seating Position		Seating
01	- Motorcycle Driver	Position
04	- Motorcycle Passenger	Position
04	- Motorcycle Passenger
88	- Other (explain in	01	02	03
	narrative)
	narrative)	04	05	06
		04	05	06

		07	08	09

10 - Sleeper Section

11 - Enclosed Cargo Area

12 - Unenclosed Cargo Area

13 - Training Unit

14 - Exterior

15 - Pedestrian

16 - Pedalcyclist

17 - Pedalcyclist, passenger

88 - Other (explain in narrative)

99 - Unknown

(Instructions continued on page 2) Æ

-1-

(Instructions continued from page 1)

Step 8. To the best of your ability, complete the accident diagram and description as briefly as possible. Important: If you are vehicle No. 1 in Step 2, make sure that your vehicle is vehicle No. 1 in the description and diagram. Indicate if there has been a Peace Officer investigation.

Step 9. Complete the insurance information on the back of the report. Failure to complete insurance coverage information may result in a suspension of your driving and registration privileges.

Step 10. Sign the accident report and tear at the perforated line and return accident report to:

Iowa Department of Transportation

Office of Driver Services

P.O. Box 9235

Des Moines, IA 50306-9235

ACCIDENT CODES (See Step 5)

LOCATION OF ACCIDENT (Where did first damage or injury event occur)

1	= On Roadway		4	= Roadside (ditch)		6 = Outside Trafficway
2	= Shoulder		5	= Grassy Area between		9 = Unknown
3	= Median				exit ramp and roadway
		MANNER OF CRASH/COLLISION				7 = Sideswipe,


1	= Non-collision		5	= Broadside
2	= Head-on		6	= Sideswipe,			opposite direction
3	= Rear-end				same direction	9 = Unknown
4	= Angle, oncoming
		left turn
		VEHICLE ACTION
		VEHICLE ACTION
01		= Movement essentially	06		= Changing lanes	11	= Stopped for
		straight	07		= Entering traffic lane		stop sign/signal
02		= Turning left			(merging)	12	= Legally Parked
03		= Turning right	08		= Leaving traffic lane	13	= Illegally Parked /

WEATHER CONDITIONS (up to two)

01		= Clear	06		= Rain
02		= Partly cloudy	07		= Sleet, hail, freezing
03		= Cloudy			rain
04		= Fog, smoke	08		= Snow
05		= Mist	09		= Severe winds
		SURFACE CONDITIONS

1	= Dry		5	= Slush
2	= Wet		6	= Sand, mud, dirt, oil,
3	= Ice				gravel
4	= Snow		7	= Water (standing,
					moving)

VISION OBSCURED

10 = Blowing sand, soil, dirt, snow

88 = Other (explain in narrative)

99 = Unknown

8 = Other (explain in

narrative)

9 = Unknown

04	= Making U-turn	09	= Backing		Unattended
05	= Overtaking/passing	10	= Slowing/stopping	88	= Other (explain in
					narrative
				99	= Unknown
	FIRST HARMFUL EVENT
Non-collision events:		24	= Railway vehicle/train	35	= Guardrail
11	= Overturn/rollover	25	= Animal	36	= Concrete barrier
12	= Jackknife	26	= Other non-fixed object		(median or right side)
13	= Other non-collision		(explain in narrative)	37	= Tree
	(explain in narrative)	Collision with fixed object:		38	= Poles (utility, light,
Collision with:		30	= Bridge/bridge rail/		etc.)
20	= Non-motorist (see		overpass	39	= Sign post
	non-motorist type)	31	= Underpass/structure	40	= Mailbox
21	= Vehicle in traffic		support	41	= Impact attenuator
22	= Vehicle in/from other	32	= Culvert	42	= Other fixed object
	roadway	33	= Ditch/Embankment		(explain in narrative)
23	= Parked motor vehicle	34	= Curb/island/raised median

01		= Not obscured	08		= Moving vehicles	12	= Blowing snow
02		= Trees/crops	09		= Person/object in or	13	= Fog/smoke/dust
03		= Buildings			on vehicle	88	= Other (explain in
04		= Embankment	10		= Blinded by sun or		narrative)
05		= Sign/billboard			headlights	99	= Unknown
06		= Hillcrest	11		= Frosted windows/
07		= Parked vehicles			windshield
		DRIVER CONDITION
		DRIVER CONDITION
1	= Apparently normal		4	= Illness		8 = Other (explain in
2	= Physical impairment		5	= Asleep, fainted,			narrative)
3	= Emotional (e.g.,				fatigued, etc.	9 = Unknown
		depressed, angry,	6	= Under the influence of
		disturbed)			alcohol/drugs/
					medications

CONTRIBUTING CIRCUMSTANCES Driver (up to two)

	TYPE OF ROADWAY JUNCTION/FEATURE
	TYPE OF ROADWAY JUNCTION/FEATURE
Non-intersection::		08	= Other non-intersection	16	= Intersection with ramp
01	= No special feature		(explain in narrative)	17	= On-ramp merge area
02	= Bridge/overpass/	Intersection:		18	= Off-ramp diverge area
	underpass	11	= Four-way intersection	19	= On-ramp
03	= Railroad crossing	12	= T-intersection	20	= Off-ramp
04	= Business drive	13	= Y-intersection	21	= With bike/pedestrian
05	= Farm/residential drive	14	- Five-leg or more		path
06	= Alley intersection	15	- Offset four-way	22	= Other intersection
07	= Crossover in median		intersection		(explain in narrative)
				99	= Unknown
	TRAFFIC CONTROLS
	TRAFFIC CONTROLS
01	= No controls present	06	= No Passing Zone	10	= Traffic director
02	= Traffic signals		(marked)	11	= Workzone signs
03	= Flashing traffic control	07	= Warning sign	88	= Other control (explain
	signal	08	= School zone signs		in narrative)
04	= Stop signs	09	= Railway crossing	99	= Unknown
05	= Yield signs		device
	LIGHT CONDITIONS	4 = Dark, roadway lighted		6 = Dark, unknown
	LIGHT CONDITIONS
1 = Daylight
2 = Dusk		5 = Dark, roadway not			roadway lighting
3 = Dawn			lighted	9 = Unknown

01 = Ran traffic signal

02 = Ran stop sign

03 = Exceeded authorized speed

04 = Driving too fast for conditions

05 = Made improper turn

06 = Traveling wrong way or on wrong side of road

07 = Crossed centerline

08 = Lost Control

09 = Followed too close

10 = Swerved to avoid; vehicle, object, non- motorist, or animal in roadway

11 = Over correcting/over steering

12 = Operating vehicle in erratic, reckless, careless, negligent, or aggressive manner

Failed to yield right-of-way: 13 = From stop sign

14 = From yield sign

15 = Making left turn

16 = Making right turn on red signal

17 = From driveway

18 = From parked position

19 = To pedestrian

20 = At uncontrolled intersection

21 = Other (explain in narrative)

Inattentive/distracted by: 22 = Passenger

23 = Use of phone or other device

24 = Fallen object

25 = Fatigued/asleep

Other

26 = Vision obstructed

27 = Other improper action

28 = No improper action

99 = Unknown

-2-

Form 433002
08-10
	REPORT OF MOTOR VEHICLE ACCIDENT
Step 1.	See Instructions on completing (please print or type)

Did accident occur on	Yes
private property?	No

Accident Date (Mo/Day/Year)

Day of Week

Time

Number of Vehicles

Total Killed

Total Injured

Total Estimated Damage

Step 2.

NO. 1 (YOUR VEHICLE)

NO. 2 (OTHER VEHICLE)

Date of Birth

Sex

Dr.Lic. State

Driver License No. as Printed on License

Date of Birth

Sex

Dr.Lic. State

Driver License No. as Printed on License

Last Name of Driver 1

First Name

Middle Initial

Last Name of Driver 2

First Name

Middle Initial

Number and Street

City

State

Zip Code

Number and Street

City

State

Zip Code

Last Name of Owner 1

First Name

Middle Initial

----

Last Name of Owner 2

First Name

Middle Initial

Number and Street

City

State

Zip Code

Number and Street

City

State

Zip Code

----

No. of Occupants

Plate Number

State of Registration

Year

No. of Occupants

Plate Number

State of Registration

Year

V.I.N.

Est. Cost of Repairs

V.I.N.

Est. Cost of Repairs

Vehicle Year & Make

Step 3.

Vehicle Type Code

Vehicle Year & Make

Step 3.

Vehicle Type Code

----

Step 4.

LOCATION OF ACCIDENT

County

Accident occurred within corporate limits of (city)

If accident occurred outside of		N NE E SE S SW W NW
city limits, describe distance to city	miles	of nearest city

Name of Road, Street or Highway		At Intersection with

Note: Unless accident occurred at an intersection which is completely described above, use the space below to give the exact location from a milepost or definable intersection, bridge or railroad crossing, using two distances and directions if necessary.

Feet Miles

N NE E SE S SW W NW	Feet		Miles
N NE E SE S SW W NW
	and	or
	and	or

N NE E SE S SW W NW

Milepost Number

Definable Intersection, bridge, or railroad crossing

Step 5. Accident Codes (on page 2) For your own vehicle

Location of Accident

Manner of Crash

Vehicle Action

Type of Roadway

Traffic Controls

Light Conditions

Junction/Feature

Surface Conditions

Vision Obscured

Driver Condition

Identify Damaged Property Other Than Vehicles

Owner

Step 6.

Step 7. Injury Section: Fill Out Space Below For Every Person Injured Or Killed In The Accident (Attach additional sheets if necessary)

	Vehiclen		Gender
Name & Address	I Number	Date of Birth	Gender	Describe Injuries

First Harmful Event

Weather Conditions

Contributing Circumstances

Amount of Damage

(Complete reverse side)´

-3-

Step 8.

Indicate On This Diagram What Happened

Use one of these outlines to sketch the scene of your accident, writing in street or highway names or numbers.

Initial Travel Direction
(prior to coded Vehicle Action)			N
1	- North		N
1	- North
2	- East	W	E
3	- South
4	- West		S
9	- Unknown		S
9	- Unknown

INDICATE

NORTH

BY ARROW

Street or Highway

Original Direction of Travel: (Example: Vehicle going north then turning left, code 'N' for Original Direction of Travel)

Vehicle 1

Vehicle 2

Street or Highway

Description

Did Peace Officer investigate?	Yes	No	Department
If you did not have automobile liability insurance coverage for this accident, please check this box				.
				.

If you had automobile liability insurance coverage for this accident, please complete insurance information below:

Failure To Complete Insurance Coverage Information Requested Below May Result In A Suspension Of Your Driving And/Or Registration Privileges.

Step 9.

Name of Insurance Company (Not Agent) Providing Insurance To Cover Your Liability For Damage Or Injury To Others:

Name of Agent Who Sold Policy

Agent Address

Policy No.	Policy Period: From	To
V.I.N. No.
Name of Driver
Name of Owner
Name of Policyholder

Step 10.
Step 10.

Date

Signature of Driver of Vehicle No. 1

If Signed By Person Other Than Driver, Give Reason

IMPORTANT: This accident should also be reported directly to your insurance company. Failure to report may jeopardize your automobile liability insurance.

-4-

⇓ PDF File

Fact Name	Detail
Form Identification	The Iowa Accident Report Form is identified as Form 433002, dated 08-10.
Reporting Requirement	Accidents causing death, personal injury, or property damage exceeding $1,500 must be reported.
Submission Deadline	The report must be submitted within 72 hours to avoid potential suspension of driving privileges.
Filling Instructions	Information should be printed or typed using black or dark blue ink.
Driver Information	All drivers involved must be listed, including their names, license numbers, and states of issuance.
Vehicle Type Codes	A specific code must be used to classify vehicle types, such as passenger cars, trucks, and motorcycles.
Accident Location	Accurate location details are essential; the form requires specific descriptions of where the accident occurred.
Injury Reporting	Injury details must be provided, including the nature of injuries and severity codes.
Insurance Information	Insurance details must be completed; failure to do so may lead to suspension of driving and registration privileges.

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Insert Correct Code

(See Step 7 of Instructions)

InjuryStatus

Occupant Protection

Airbag Deployment

Type Non-Motorist

Seating Position

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