State Number
Consecutive Number
Number of Vehicle Forms Submitted for MV In Transport
Vehicle Number
Person Number
Number Of Motor Vehicle Striking Non-Motorist
Crash Date (Day)
Crash Date (Month)
Crash Time (Hour)
Crash Time (Minute)
Land Use
Functional System
First Harmful Event
Manner of Collision
School Bus Related
Vehicle Make
Make Model Combined
Body Type
Vehicle Model Year
Vehicle Trailing
Special Use
Emergency Use
Rollover Type
Areas of Impact - Initial Contact Point
Fire Occurrence
Person Type
Injury Severity
Seating Position
Restraint System/Helmet Use
Any Indication of Mis-Use of Restraint System/Helmet Use
Air Bag Deployed
Ejection Path
Extrication
Police Reported Alcohol Involvement
Method of Alcohol Determination by Police
Alcohol Test- Status
Alcohol Test- Type
Alcohol Test- Result
Police Reported Drug Involvement
Method of Drug Determination by Police
Drug Test -Status
Drug Test -Type (1)
Drug Test -Type (2)
Drug Test -Type (3)
Drug Test- Result (1)
Drug Test- Result (2)
Drug Test- Result (3)
Transported to Medical Facility By
Died at Scene/En Route
Death Date (Day)
Death Date (Month)
Death Date (Year)
Death Time (Hour)
Death Time (Minutes)
Death Time
Crash to Death Time (Hours)
Crash to Death Minutes (Minutes)
Related Factors (1)
Related Factors (2)
Related Factors (3)
Fatal Injury at Work
Hispanic Origin
Non-Motorist Location at Time of Crash