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.
Iowa Accident Report Preview
Form 433002
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
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 |
= |
17 |
= Small school bus (seats |
02 |
= |
10 |
= Tractor/doubles |
18 |
= Other bus (seats > 15) |
03 |
= Van or |
11 |
= Tractor/triples |
19 |
= Other small bus (seats |
04 |
= Sport utility vehicle |
12 |
= Other heavy truck (cannot classify) |
20 |
= Farm vehicle/equipment |
05 |
= |
13 |
= Motor home/recreational vehicle |
21 |
= Maintenance/construction vehicle |
06 |
= |
14 |
= Motorcycle |
22 |
= Train |
07 |
= Truck/trailer |
15 |
= |
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 =
4 = Possible
5 = Uninjured
9 = Unknown
Occupant Protection: |
Airbag Deployment: |
Ejection: |
Type |
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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 |
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unicycle, pedal car) |
4 |
= Shoulder belt only used |
4 |
= Other deployment (explain |
4 |
= Not applicable |
3 |
= Skater |
5 |
= Child safety seat used |
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in narrative |
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(motorcycle, |
8 |
= Other (explain in narrative) |
6 |
= Helmet used |
5 |
= Not deployed |
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bicycle, etc.) |
9 |
= Unknown |
8 |
= Other (explain in narrative) |
6 |
= Not applicable |
9 |
= Unknown |
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9 |
= Unknown |
9 |
= Unknown |
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Motorcycle Seating Position |
Seating |
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01 |
- Motorcycle Driver |
Position |
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04 |
- Motorcycle Passenger |
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88 |
- Other (explain in |
01 |
02 |
03 |
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narrative) |
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06 |
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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
(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
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 |
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2 |
= Shoulder |
5 |
= Grassy Area between |
9 = Unknown |
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3 |
= Median |
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exit ramp and roadway |
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MANNER OF CRASH/COLLISION |
7 = Sideswipe, |
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= Broadside |
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= Sideswipe, |
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opposite direction |
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3 |
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same direction |
9 = Unknown |
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= Angle, oncoming |
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left turn |
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VEHICLE ACTION |
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01 |
= Movement essentially |
06 |
= Changing lanes |
11 |
= Stopped for |
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straight |
07 |
= Entering traffic lane |
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stop sign/signal |
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02 |
= Turning left |
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(merging) |
12 |
= Legally Parked |
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03 |
= Turning right |
08 |
= Leaving traffic lane |
13 |
= Illegally Parked / |
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WEATHER CONDITIONS (up to two)
01 |
= Clear |
06 |
= Rain |
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02 |
= Partly cloudy |
07 |
= Sleet, hail, freezing |
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03 |
= Cloudy |
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rain |
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04 |
= Fog, smoke |
08 |
= Snow |
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= Mist |
09 |
= Severe winds |
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SURFACE CONDITIONS |
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= Dry |
5 |
= Slush |
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= Wet |
6 |
= Sand, mud, dirt, oil, |
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3 |
= Ice |
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gravel |
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4 |
= Snow |
7 |
= Water (standing, |
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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 |
09 |
= Backing |
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Unattended |
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= Overtaking/passing |
10 |
= Slowing/stopping |
88 |
= Other (explain in |
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narrative |
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= Unknown |
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FIRST HARMFUL EVENT |
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24 |
= Railway vehicle/train |
35 |
= Guardrail |
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11 |
= Overturn/rollover |
25 |
= Animal |
36 |
= Concrete barrier |
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= Jackknife |
26 |
= Other |
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(median or right side) |
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= Other |
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(explain in narrative) |
37 |
= Tree |
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(explain in narrative) |
Collision with fixed object: |
38 |
= Poles (utility, light, |
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Collision with: |
30 |
= Bridge/bridge rail/ |
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etc.) |
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20 |
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overpass |
39 |
= Sign post |
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31 |
= Underpass/structure |
40 |
= Mailbox |
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= Vehicle in traffic |
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support |
41 |
= Impact attenuator |
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22 |
= Vehicle in/from other |
32 |
= Culvert |
42 |
= Other fixed object |
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roadway |
33 |
= Ditch/Embankment |
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(explain in narrative) |
23 |
= Parked motor vehicle |
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= Curb/island/raised median |
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01 |
= Not obscured |
08 |
= Moving vehicles |
12 |
= Blowing snow |
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02 |
= Trees/crops |
09 |
= Person/object in or |
13 |
= Fog/smoke/dust |
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03 |
= Buildings |
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on vehicle |
88 |
= Other (explain in |
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= Embankment |
10 |
= Blinded by sun or |
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narrative) |
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= Sign/billboard |
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headlights |
99 |
= Unknown |
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= Hillcrest |
11 |
= Frosted windows/ |
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07 |
= Parked vehicles |
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windshield |
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DRIVER CONDITION |
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= Apparently normal |
4 |
= Illness |
8 = Other (explain in |
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= Physical impairment |
5 |
= Asleep, fainted, |
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narrative) |
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3 |
= Emotional (e.g., |
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fatigued, etc. |
9 = Unknown |
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depressed, angry, |
6 |
= Under the influence of |
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disturbed) |
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alcohol/drugs/ |
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medications |
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CONTRIBUTING CIRCUMSTANCES Driver (up to two)
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TYPE OF ROADWAY JUNCTION/FEATURE |
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= Other |
16 |
= Intersection with ramp |
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01 |
= No special feature |
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(explain in narrative) |
17 |
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= Bridge/overpass/ |
Intersection: |
18 |
= |
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underpass |
11 |
= |
19 |
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03 |
= Railroad crossing |
12 |
= |
20 |
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= Business drive |
13 |
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21 |
= With bike/pedestrian |
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= Farm/residential drive |
14 |
- |
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path |
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= Alley intersection |
15 |
- Offset |
22 |
= Other intersection |
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= Crossover in median |
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intersection |
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(explain in narrative) |
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99 |
= Unknown |
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TRAFFIC CONTROLS |
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01 |
= No controls present |
06 |
= No Passing Zone |
10 |
= Traffic director |
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= Traffic signals |
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(marked) |
11 |
= Workzone signs |
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= Flashing traffic control |
07 |
= Warning sign |
88 |
= Other control (explain |
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signal |
08 |
= School zone signs |
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in narrative) |
04 |
= Stop signs |
09 |
= Railway crossing |
99 |
= Unknown |
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= Yield signs |
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device |
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LIGHT CONDITIONS |
4 = Dark, roadway lighted |
6 = Dark, unknown |
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1 = Daylight |
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2 = Dusk |
5 = Dark, roadway not |
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roadway lighting |
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3 = Dawn |
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lighted |
9 = Unknown |
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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
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
Form 433002 |
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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 |
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AM |
Number of Vehicles |
Total Killed |
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Total Injured |
Total Estimated Damage |
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Step 2. |
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NO. 1 (YOUR VEHICLE) |
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NO. 2 (OTHER VEHICLE) |
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Date of Birth |
Sex |
Dr.Lic. State |
Driver License No. as Printed on License |
D |
Date of Birth |
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Sex |
Dr.Lic. State |
Driver License No. as Printed on License |
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Last Name of Driver 1 |
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First Name |
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Middle Initial |
I |
Last Name of Driver 2 |
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First Name |
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Middle Initial |
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Number and Street |
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City |
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State |
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Zip Code |
E |
Number and Street |
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Last Name of Owner 1 |
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First Name |
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Last Name of Owner 2 |
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Number and Street |
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Zip Code |
N |
Number and Street |
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No. of Occupants |
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State of Registration |
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No. of Occupants |
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V.I.N. |
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Est. Cost of Repairs |
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V.I.N. |
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Est. Cost of Repairs |
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Vehicle Year & Make |
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Step 3. |
Vehicle Type Code |
L |
Vehicle Year & Make |
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Step 3. |
Vehicle Type Code |
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E |
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Step 4. |
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LOCATION OF ACCIDENT |
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County
Accident occurred within corporate limits of (city)
If accident occurred outside of |
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N NE E SE S SW W NW |
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city limits, describe distance to city |
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miles |
of nearest city |
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Name of Road, Street or Highway |
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At Intersection with |
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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
or
N NE E SE S SW W NW |
Feet |
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Miles |
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and |
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N NE E SE S SW W NW
of
Milepost Number |
Definable Intersection, bridge, or railroad crossing |
Or
Step 5. Accident Codes (on page 2) For your own vehicle
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Location of Accident |
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Manner of Crash |
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Vehicle Action |
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Type of Roadway |
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Traffic Controls |
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Light Conditions |
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Junction/Feature |
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Surface Conditions |
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Vision Obscured |
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Driver Condition |
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Identify Damaged Property Other Than Vehicles |
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Owner |
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Step 6. |
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Step 7. Injury Section: Fill Out Space Below For Every Person Injured Or Killed In The Accident (Attach additional sheets if necessary)
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Vehiclen |
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Gender |
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Name & Address |
I Number |
Date of Birth |
Describe Injuries |
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First Harmful Event
Weather Conditions
Contributing Circumstances 
Amount of Damage
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Insert Correct Code |
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(See Step 7 of Instructions) |
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InjuryStatus |
Occupant Protection |
Airbag Deployment |
Ejection |
Type |
Seating Position |
Date of |
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Death |
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(Complete reverse side)´
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 |
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(prior to coded Vehicle Action) |
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N |
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1 |
- North |
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2 |
- East |
W |
E |
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3 |
- South |
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4 |
- West |
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S |
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9 |
- Unknown |
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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 |
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Vehicle 2 |
Street or Highway
Street or Highway
Description
Did Peace Officer investigate? |
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Yes |
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No |
Department |
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If you did not have automobile liability insurance coverage for this accident, please check this box |
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. |
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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. |
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Policy Period: From |
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V.I.N. No. |
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Name of Driver |
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Name of Owner |
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Name of Policyholder |
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Step 10. |
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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.
Document Attributes
| 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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