STATE OF MICHIGAN TRAFFIC CRASH REPORT Crash Type (First Impact) ‘Special Vehicles Vehicle Use Single Moor vehice 4 Poice 4 Ambulance 1 Private om ‘eno 2 Fre” 8 Famequament || 2 Conmorca Soe Head on ta Tam Ane ear End 3 bee 8 ee lla E a P i“ eo | |® 5 SchooV/education Seger | | > > rol > 1 [es <|[se|[% TS Daa] | Satta Temi Rewinding Saeenpe eto gia wien pate San 1 Brakes 4 Treswwheels || 8 Other government a F en Pee 2 Lights) 5 Windows. 9 Uilty (gas, cable, etc.) ST Si] PSH] [Phere] | etecos €or 40 Road construction! > x 3. Steering ‘oad maintenance 41 Other ‘Area Position 0 Steeper section —<———— } Freeway oc ‘11 Other enclosed passenger Private Trailer Type 01 Enirance/ext ramp related P Pedestian 12 Oawrurcecioed| 1 Usity (02. Median crossing related E Engineer (railroaditrain) escergoarea || 2 Taveltraler 3 aneton seas avait nee 13. Ring Fon Cling unit 3 Gonna hoes cee ‘See epresernion Blow 14 Riding on vehicie exterior ned oD 05. Scalaiwoigh station related M4 Ridin 5 Towed a 06 Allotner trooway arcas = oe 6 Recreation double Motorcycles, snowmobiles, ot. et intersection C7 8 (6) (8) "urine seating) 7 Om 07 Within intersection (5) (8) + on ———r 8 Driveway related (within 150 feet 4. Passenger one ‘Sequence of Events/ of intersection Qe WO 7_ Passenger two Most Harmful Event 09 Intersecton rlated-ther ; Wemecseeon p Other Non-Freeway Areas Restraint Use Action Prior To Crash || o1 Loss of control w aan ram 01 No belts available > Driver Action 02. Cross centerline/median 11 Curved eaaway 3 Lapbot ony une | | Of Song stmt ead Of an of rodney fo Not related to other selectons 04 Shoulder & lap belt used 05 Re-enter roadway 12 Driveway relates 03 Turing right maton 13 Parking related (lagal roadside) | | 05 No,bettuses 04 Stopped on roadway lari sacanaton cl unis) a eaten ae OF Ghidrestait ret used, | | °° levobed i por erash at 0 Froerioson 18. Mecian crossing related rot available or improper ro 08. Immersion 46 Rail cossing related 96 Changing lanes 36 Rall crossing relat 08 Restraint failure 07 Backing 10 Jackknite 18 Scale/weigh station related os | Resalnt we union) 08. Slowing/stopping on roadway | | 11 Downhill runaway 19 Nonsratfe aea ie eeknet wort 09 Slowing/stopping ther area’ | | 12 Cargo loss/shit Aetone: 11 Helmet not worn {0 Sougup enone: 413 Individual fel rom vehicle Eee 12 Holmet use unknown sifcumaceoneraea 44 Other noncolision “increase Gecrease in the numberof ravel lanes, a Caan > Had a Collision With ving parking om Tay Code of Injury 44 Entering ready Non-Fixed Objects Fatal injury Ary injury 415 Leaving reaaway 15 Pedestrian OF Nt aly ied wich resufs death 48 Making Utorn a way Tatiowa ‘AAincapacitating Injury 17 Overtaking or pass vehicle in anspor (82 Dnided highway, median stip, | | “Anynury otter than fatal which | | 18 Avoring Sbject 18 Parked motor vehicle without traffic barrier prevents normal activities and 19 Avoiding pedestrian 19 Engineer (ralroaditrain) 09, Divisedrighway. masan sp, ‘generally requires hospitalization. | | 20 Avoiding vehicle (frontback) | | 20 Animal ee eee -Non-Incapacttating Injury | | 21. Avoiting vehicle (angle) 21 Other norsfxed object sd ad ‘Any injury not incapacitating but | | 22 Driverless moving Fixed Objects everwhere athe scone || 23 Parked ae ‘Access Control ‘c-Possible injury No visible wong animal 23 Bridge parapet end ot No access cont! unimited access) || Hrsry but complamt of pan or | » Pedestrian Action 24 Bridge ral (02 Full acess contol camp enty & ext cniy)| | ™omentary unconsciousness. 24 Crossing at intersection 25 Guardrail face 03 Other (partial access control) O-No injury No indication of 25 Crossing not at intersection 26 Guardrail end injury. 28 Getting on/ott vehicle at eer oe Eo Sloe cs Hazardous Action Driver Condition 28 In roadway against traffic 29. Highway signal post 00 None 29 Standingilying in roadway 30 Luminairefight support 01 Speed too fast 01 Appeared normal 30. Pushing/working on vehicle 31 Uitlty pole 02 Speed too siow (02. Had been drinking 31. Other working in roadway 32 Other pole 03 Failed to yield 03 Wegal drug use 32 Playing in roadway 33 Culvert 04 Disregard tratfic controi 04 Sick ‘33 In roadway other reason 34 Curb 05. Drove wrong way 05 Fatigue 34 Notin roadway 35 Ditch 06 Drove let of conter 05 Asleep 35 Oher 36 Embankment 07 Improper passing 97 Medication 36. Unknown 37 Fence (08 Improper lane use 08. Driver Distracted 38 Maltbox 9 Improper turn (09. Driver Using Cellular Phone 39 Tree 10 Improperino signal 99. Unknown 40 Ralroad crossing signal 11 improper backing 41 Buiding 12 Unable to stop in assured Unit Type 42 Trafic island clear distance 43 Fire ydrant 13 Other MV Motor Vehicle 444 Impact atenuator 44 Unkrown B Beyoists (all pedakycists) 45. Other fixed object 15. Reckess Driving P Pedestrian “ieaper eae ara ie 16 Careless Negligent Driving E Engineer (raitoadtrain) ira ona echCommercial Motor Vehicle Type & Commercial Driver License Endorsement Group “A"'is any vehicle thats towing a vehicle or trailer that has a {gross vehicle weight rating (GVWR) over 10,000 Ibs. a i. 2 Vehicle Ty Driver's COL SP ne ererener naga . th 1 Seba tata rcs a Rie Mose ate rea an AD 1 Gib A via, Pectnge a At 1 Goupavenise: Gouiottpe a Ax 1 GieupA vet: Fans Haus x ay 1 GepAveuae: Tena pecs te ae A 1 Gepavense;vocsone poets ANT AL 1 GepAvetde Marsoos tone Bouter AK Group “B” is any single vehicie (including buses) with a GVWR of £26,001 Ibs. of more. This would include a combination of vehicles with a ‘combined GVWR over 26,000 lbs. when towing a taller that has a GVWR. (of 10,000 lbs. or less: i inn ow BB = Group B vehicle 8 BH = Group B vehicie, Hazardous BH BN = Group 8 vehicle, Tank BN BP = Group B vehicle, Passenger BP BX = Group B vehicle, Tank & Hazardous Bx Group “C” is any single vehicle with a GVWR of less than 26,001 pounds (ra combination of vehicles having a combined GVWR under 26,001 ‘pounds when the vehicle is required to dsplay placards for hazardous ‘material or designed to carry 16 passengers (Including driver). Group °C" is also any vehicle carrying 15 oF less people (including driver) transport- ing children to or from school and home on a regular basis for compensa- tion aa ws ee CH = Group C vehicle, Hazardous cH CP = Group C vehicle, Passenger oP CX = Group C vehicle, Tank & Hazardous ox Location of Greatest Damage/First Impact @ Qo @ Undercarriage ~ Multiple a (@)Roliover (5) GD Other/Unknown| @None Vehicle Type (No CDL or Endorsement Required) PA = Passenger Car and Station Wagon VA = Van & Motor Home PU = Pickup ST = Small Truck (10,000 lbs. or less GVWR) CY = Cycle MO = Moped GC = GoCan SM = Snowmobile OR = Off Road Vehicle (ATV Type) MD = Medium Truck over 10,000 fas. GVWR (Non CDL) with or without trailer (Athough not specifically isted on the UD-10, an “MD" vehicle should be reported by marking “Truck/Bus" inthe Vehicle Type box in the Unit Section, and by marking “Other” as the Vehicle “Type in the Truck Bus Section) Truck or Bus Definition The truckious information box located on the back ofthe form must be completed for each of these veticies. 1. Any tuck or truck vacterthat as ateast ‘wo axes and sietres onthe power unt. [ Gargo Body Type Inclucing sx whee! pickups. Pave 2. Any vehicle at displays a hazardous eicatsane alia paced, aomosies an as sichonaee ‘3. Any bus designed to transport 18 or more ae ° ‘passengers, including he arver Concrete mixer 4. Any yellow and black school bus. eines (Go not report motorhomes or agerofuse Implements ot hasbaner,) 8 Other/unknowr Type and Axles Per Unit Enter the total number of axles for the truck or busin the first box. Always} Include the steering axle. There will alvays be at least two axles. Include all axles whether they are on the ground or raised. Place the letter “T” before the number of axles if the truck isa truck tractor (equipped with a {ith wheel for towing semi-railers and there is no cargo body mounted on| the tuck.) Next, enter the total numberof axis for each trailer. List one taller per box. Include al axles whether they are on the ground or raised. Place an *S* before the number of axles it the aler isa semitrailer (designed so that a portion ofthe load is supported by the towing unit. examples lll 2 t2|| s1 st and ard ath ist nd Grd ath r2|{ st] ] 2 2 st nd Sed ain iat nad Select the degree of severty. 1” being the least severe and "7" most severe, for each vehicle. ita vehicle sustained no damage, 20" (ze70) rating is used. In cases in which vehicles are damaged in more than one area, consider all damage when selecting the appropriate code. i ‘Questions about the UD-10? Call the Central Records Division (517/322-1150) 5 aaa] irfomanon fing on he Wo porn, ‘sstance may be avalableby contacting the Michigan State Police, Motor Carrier Division (517/396-6195)