Recreational Vehicle Equipment Release Form

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Recreational Vehicle Equipment Release Form Powered By Docstoc
					                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


ID       Element                           Element Name
   10   C01        Crash Case Identifier
10.01   C01.01     Crash Case Identifier
   20   C02        Crash Date and Time
20.01   C02.01     Crash Date and Time
   30   C03        Crash County
30.01   C03.01     Crash County
   40   C04        Crash City/Place
40.01   C04.01     Crash City/Place
   50   C05        Crash Location
50.01   C05.1      Crash Location
50.02   C05.2      Crash Location
50.03   C05.3      Crash Location
   60   C06        First Harmful Event
60.01   C06.01     First Harmful Event
60.02   C06.02     First Harmful Event
60.03   C06.03     First Harmful Event
60.04   C06.04     First Harmful Event
60.05   C06.05     First Harmful Event
60.06   C06.06     First Harmful Event
60.07   C06.07     First Harmful Event
60.08   C06.08     First Harmful Event
60.09   C06.09     First Harmful Event
 60.1   C06.10     First Harmful Event
60.11   C06.11     First Harmful Event
60.12   C06.12     First Harmful Event
60.13   C06.13     First Harmful Event
60.14   C06.14     First Harmful Event
60.15   C06.15     First Harmful Event
60.16   C06.16     First Harmful Event
60.17   C06.17     First Harmful Event
60.18   C06.18     First Harmful Event
60.19   C06.19     First Harmful Event
 60.2   C06.20     First Harmful Event
60.21   C06.21     First Harmful Event
60.22   C06.22     First Harmful Event
60.23   C06.23     First Harmful Event
60.24   C06.24     First Harmful Event
60.25   C06.25     First Harmful Event
60.26   C06.26     First Harmful Event
60.27   C06.27     First Harmful Event
60.28   C06.28     First Harmful Event
60.29   C06.29     First Harmful Event
 60.3   C06.30     First Harmful Event
60.31   C06.31     First Harmful Event
60.32   C06.32     First Harmful Event
60.33   C06.33     First Harmful Event
60.34   C06.34     First Harmful Event
60.35   C06.35     First Harmful Event

60.36 C06.36       First Harmful Event
60.37 C06.37       First Harmful Event


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    70   C07      Location of First Harmful Event
 70.01   C07.01   Location of First Harmful Event
 70.02   C07.02   Location of First Harmful Event
 70.03   C07.03   Location of First Harmful Event
 70.04   C07.04   Location of First Harmful Event
 70.05   C07.05   Location of First Harmful Event
 70.06   C07.06   Location of First Harmful Event
 70.07   C07.07   Location of First Harmful Event
 70.08   C07.08   Location of First Harmful Event
 70.09   C07.09   Location of First Harmful Event
  70.1   C07.10   Location of First Harmful Event
    80   C08      Manner of Crash/Collision Impact
 80.01   C08.01   Manner of Crash/Collision Impact
 80.02   C08.02   Manner of Crash/Collision Impact
 80.03   C08.03   Manner of Crash/Collision Impact
 80.04   C08.04   Manner of Crash/Collision Impact
 80.05   C08.05   Manner of Crash/Collision Impact
 80.06   C08.06   Manner of Crash/Collision Impact
 80.07   C08.07   Manner of Crash/Collision Impact
 80.08   C08.08   Manner of Crash/Collision Impact
 80.09   C08.09   Manner of Crash/Collision Impact
  80.1   C08.10   Manner of Crash/Collision Impact
 80.11   C08.11   Manner of Crash/Collision Impact
 80.12   C08.12   Manner of Crash/Collision Impact
 80.13   C08.13   Manner of Crash/Collision Impact
    90   C09      Source of Information
 90.01   C09.01   Source of Information
 90.02   C09.02   Source of Information
 91.03   C09.03   Source of Information

  100 C10         Date and Time Crash Reported to Law Enforcement Agency

100.01 C10.01     Date and Time Crash Reported to Law Enforcement Agency

100.02   C10.02   Date and Time Crash Reported to Law Enforcement Agency
   110   C11      Weather Conditions
110.01   C11.01   Weather Conditions
110.02   C11.02   Weather Conditions
110.04   C11.04   Weather Conditions
110.05   C11.05   Weather Conditions
110.06   C11.06   Weather Conditions
110.07   C11.07   Weather Conditions
110.08   C11.08   Weather Conditions
110.09   C11.09   Weather Conditions
 110.1   C11.10   Weather Conditions
110.11   C11.11   Weather Conditions
110.12   C11.12   Weather Conditions
   120   C12      Light Condition
   121   C12.1    Light Condition
   122   C12.2    Light Condition
   123   C12.3    Light Condition
   124   C12.4    Light Condition


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                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


   125   C12.5    Light Condition
   126   C12.6    Light Condition
   127   C12.7    Light Condition
   128   C12.8    Light Condition
   130   C13      Roadway Surface Condition
130.01   C13.01   Roadway Surface Condition
130.02   C13.02   Roadway Surface Condition
130.03   C13.03   Roadway Surface Condition
130.04   C13.04   Roadway Surface Condition
130.05   C13.05   Roadway Surface Condition
130.06   C13.06   Roadway Surface Condition
130.07   C13.07   Roadway Surface Condition
130.08   C13.08   Roadway Surface Condition
130.09   C13.09   Roadway Surface Condition
 130.1   C13.10   Roadway Surface Condition
130.11   C13.11   Roadway Surface Condition
   140   C14      Contributing Circumstances-Environment
140.01   C14.01   Contributing Circumstances-Environment
140.02   C14.02   Contributing Circumstances-Environment
140.03   C14.03   Contributing Circumstances-Environment
140.04   C14.04   Contributing Circumstances-Environment
140.05   C14.05   Contributing Circumstances-Environment
140.06   C14.06   Contributing Circumstances-Environment
140.07   C14.07   Contributing Circumstances-Environment
   150   C15      Contributing Circumstances-Road
150.01   C15.01   Contributing Circumstances-Road
150.02   C15.02   Contributing Circumstances-Road
150.03   C15.03   Contributing Circumstances-Road
150.04   C15.04   Contributing Circumstances-Road
150.05   C15.05   Contributing Circumstances-Road
150.06   C15.06   Contributing Circumstances-Road
150.07   C15.07   Contributing Circumstances-Road
150.08   C15.08   Contributing Circumstances-Road
150.09   C15.09   Contributing Circumstances-Road
 150.1   C15.10   Contributing Circumstances-Road
150.11   C15.11   Contributing Circumstances-Road
150.12   C15.12   Contributing Circumstances-Road
   160   C16      Relation to Junction
160.01   C16.01   Relation to Junction
160.02   C16.02   Relation to Junction
160.03   C16.03   Relation to Junction
160.04   C16.04   Relation to Junction
160.05   C16.05   Relation to Junction
160.06   C16.06   Relation to Junction
160.07   C16.07   Relation to Junction
160.08   C16.08   Relation to Junction

160.09   C16.09   Relation to Junction
 160.1   C16.10   Relation to Junction
160.18   C16.18   Relation to Junction
160.19   C16.19   Relation to Junction
 160.2   C16.20   Relation to Junction


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                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


160.21   C16.21   Relation to Junction
160.22   C16.22   Relation to Junction
160.23   C16.23   Relation to Junction
160.24   C16.24   Relation to Junction
   170   C17      Type of Intersection
170.01   C17.01   Type of Intersection
170.02   C17.02   Type of Intersection
170.03   C17.03   Type of Intersection
170.04   C17.04   Type of Intersection
170.05   C17.05   Type of Intersection
170.06   C17.06   Type of Intersection
170.07   C17.07   Type of Intersection
170.08   C17.08   Type of Intersection
170.09   C17.09   Type of Intersection
   180   C18      School Bus Related
180.01   C18.01   School Bus Related
180.02   C18.02   School Bus Related
180.03   C18.03   School Bus Related
180.04   C18.04   School Bus Related
   190   C19      Work Zone Related
190.01   C19.01   Work Zone Related
190.02   C19.02   Work Zone Related

190.03   C19.03   Work Zone Related
190.04   C19.04   Work Zone Related
190.05   C19.05   Work Zone Related
190.06   C19.06   Work Zone Related
190.07   C19.07   Work Zone Related
190.08   C19.08   Work Zone Related
190.09   C19.09   Work Zone Related
 190.1   C19.10   Work Zone Related
190.11   C19.11   Work Zone Related
190.12   C19.12   Work Zone Related
190.13   C19.13   Work Zone Related
190.14   C19.14   Work Zone Related
190.15   C19.15   Work Zone Related
190.16   C19.16   Work Zone Related
   200   CD1      Crash Severity
200.01   CD1.01   Crash Severity
200.02   CD1.02   Crash Severity
200.03   CD1.03   Crash Severity
200.04   CD1.04   Crash Severity
200.05   CD1.05   Crash Severity
200.06   CD1.06   Crash Severity
   210   CD2      Number of Motor Vehicles Involved
   220   CD3      Number of Motorists
   230   CD4      Number of Non- Motorists
   240   CD5      Number of Non-Fatality Injured Persons
   250   CD6      Number of Fatalities
   260   CD7      Alcohol Involvement
260.01   CD7.01   Alcohol Involvement
260.02   CD7.02   Alcohol Involvement


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                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


260.03   CD7.03   Alcohol Involvement
   270   CD8      Drug Involvement
271.01   CD8.01   Drug Involvement
271.02   CD8.02   Drug Involvement
271.03   CD8.03   Drug Involvement
   280   CD9      Day of Week
280.01   CD9.01   Day of Week
280.02   CD9.02   Day of Week
280.03   CD9.03   Day of Week
280.04   CD9.04   Day of Week
280.05   CD9.05   Day of Week
280.06   CD9.06   Day of Week
280.07   CD9.07   Day of Week
   590   P01      Date of Birth
590.01   P01.01   Date of Birth
590.02   P01.02   Date of Birth
590.03   P01.03   Date of Birth
   600   P02      Sex
600.01   P02.01   Sex
600.02   P02.02   Sex
600.03   P02.03   Sex
   610   P03      Person Type
610.01   P03.01   Person Type
610.02   P03.02   Person Type
610.03   P03.03   Person Type

610.04 P03.04     Person Type
610.05 P03.05     Person Type
610.06 P03.06     Person Type

610.07 P03.07     Person Type

610.08   P03.08   Person Type
610.09   P03.09   Person Type
 610.1   P03.10   Person Type
   620   P04      Injury Status
620.01   P04.01   Injury Status
620.02   P04.02   Injury Status
620.03   P04.03   Injury Status
620.04   P04.04   Injury Status
620.05   P04.05   Injury Status
620.06   P04.06   Injury Status
   630   P05      Occupant's Motor Vehicle Unit Number
   640   P06      Seating Position
640.01   P06.01   Seating Position
640.02   P06.02   Seating Position
640.03   P06.03   Seating Position
640.04   P06.04   Seating Position
640.05   P06.05   Seating Position
640.06   P06.06   Seating Position

640.07 P06.07     Seating Position


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                            011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


640.08   P06.08   Seating Position
640.09   P06.09   Seating Position
 640.1   P06.10   Seating Position
640.11   P06.11   Seating Position
640.12   P06.12   Seating Position
640.13   P06.13   Seating Position
640.14   P06.14   Seating Position
640.15   P06.15   Seating Position
640.16   P06.16   Seating Position
640.17   P06.17   Seating Position
640.18   P06.18   Seating Position
   650   P07      Occupant Protection System Use
650.01   P07.01   Occupant Protection System Use
650.02   P07.02   Occupant Protection System Use
650.03   P07.03   Occupant Protection System Use
650.04   P07.04   Occupant Protection System Use
650.05   P07.05   Occupant Protection System Use
650.06   P07.06   Occupant Protection System Use
650.07   P07.07   Occupant Protection System Use
650.08   P07.08   Occupant Protection System Use
650.09   P07.09   Occupant Protection System Use
 650.1   P07.10   Occupant Protection System Use
650.11   P07.11   Occupant Protection System Use
650.12   P07.12   Occupant Protection System Use
650.13   P07.13   Occupant Protection System Use
   660   P08      Air Bag Deployed
660.01   P08.01   Air Bag Deployed
660.02   P08.02   Air Bag Deployed
660.03   P08.03   Air Bag Deployed
660.04   P08.04   Air Bag Deployed
660.05   P08.05   Air Bag Deployed
660.06   P08.06   Air Bag Deployed
660.07   P08.07   Air Bag Deployed
   670   P09      Ejection
670.01   P09.01   Ejection
670.02   P09.02   Ejection
670.03   P09.03   Ejection
670.04   P09.04   Ejection
670.05   P09.05   Ejection
   680   P10      Driver License Jurisdiction
680.01   P10.01   Driver License Jurisdiction
680.02   P10.02   Driver License Jurisdiction
680.03   P10.03   Driver License Jurisdiction
680.04   P10.04   Driver License Jurisdiction
680.05   P10.05   Driver License Jurisdiction
680.06   P10.06   Driver License Jurisdiction
680.07   P10.07   Driver License Jurisdiction
680.08   P10.08   Driver License Jurisdiction
680.09   P10.09   Driver License Jurisdiction
   690   P11      Driver License Number and Class

690.01 P11.01     Driver License Number and Class


                                             Page 6
                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


690.02   P11.02   Driver License Number and Class
690.03   P11.03   Driver License Number and Class
690.04   P11.04   Driver License Number and Class
690.05   P11.05   Driver License Number and Class
690.06   P11.06   Driver License Number and Class
690.07   P11.07   Driver License Number and Class
   700   P12      Driver Name
700.01   P12.01   Driver Name
   710   P13      Driver Actions at Time of Crash
710.01   P13.01   Driver Actions at Time of Crash
710.02   P13.02   Driver Actions at Time of Crash
710.03   P13.03   Driver Actions at Time of Crash
710.04   P13.04   Driver Actions at Time of Crash
710.05   P13.05   Driver Actions at Time of Crash
710.06   P13.06   Driver Actions at Time of Crash
710.07   P13.07   Driver Actions at Time of Crash
710.08   P13.08   Driver Actions at Time of Crash
710.09   P13.09   Driver Actions at Time of Crash
 710.1   P13.10   Driver Actions at Time of Crash
710.11   P13.11   Driver Actions at Time of Crash
710.12   P13.12   Driver Actions at Time of Crash
710.13   P13.13   Driver Actions at Time of Crash
710.14   P13.14   Driver Actions at Time of Crash

710.15 P13.15     Driver Actions at Time of Crash

710.16   P13.16   Driver Actions at Time of Crash
710.17   P13.17   Driver Actions at Time of Crash
710.18   P13.18   Driver Actions at Time of Crash
710.19   P13.19   Driver Actions at Time of Crash
   720   P14      Driver Condition at Time of Crash
720.01   P14.01   Driver Condition at Time of Crash
720.02   P14.02   Driver Condition at Time of Crash
720.03   P14.03   Driver Condition at Time of Crash
720.04   P14.04   Driver Condition at Time of Crash
720.05   P14.05   Driver Condition at Time of Crash
720.06   P14.06   Driver Condition at Time of Crash
720.07   P14.07   Driver Condition at Time of Crash
   730   P15      Violation Codes
730.01   P15.01   Violation Codes
730.02   P15.02   Violation Codes
730.03   P15.03   Violation Codes
   740   P16      Driver Distracted By
740.01   P16.01   Driver Distracted By
740.02   P16.02   Driver Distracted By
740.03   P16.03   Driver Distracted By
740.04   P16.04   Driver Distracted By
740.05   P16.05   Driver Distracted By
740.06   P16.06   Driver Distracted By
   750   P17      Law Enforcement Suspects Alcohol Use
750.01   P17.01   Law Enforcement Suspects Alcohol Use
750.02   P17.02   Law Enforcement Suspects Alcohol Use


                                               Page 7
                            011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


750.03   P17.03   Law Enforcement Suspects Alcohol Use
   760   P18      Alcohol Test
760.01   P18.01   Alcohol Test
760.02   P18.02   Alcohol Test
760.03   P18.03   Alcohol Test
760.04   P18.04   Alcohol Test
760.05   P18.05   Alcohol Test
760.06   P18.06   Alcohol Test
760.07   P18.07   Alcohol Test
760.08   P18.08   Alcohol Test
760.09   P18.09   Alcohol Test
 760.1   P18.10   Alcohol Test
760.11   P18.11   Alcohol Test
   770   P19      Law Enforcement Suspects Drug Use
770.01   P19.01   Law Enforcement Suspects Drug Use
770.02   P19.02   Law Enforcement Suspects Drug Use
770.03   P19.03   Law Enforcement Suspects Drug Use
   780   P20      Drug Test
780.01   P20.01   Drug Test
780.02   P20.02   Drug Test
780.03   P20.03   Drug Test
780.04   P20.04   Drug Test
780.05   P20.05   Drug Test
780.06   P20.06   Drug Test
780.07   P20.07   Drug Test
780.08   P20.08   Drug Test
780.09   P20.09   Drug Test
 780.1   P20.10   Drug Test
780.11   P20.11   Drug Test
   790   P21      Non-Motorist Number

790.01   P21.01   Non-Motorist Number
   800   P22      Non-Motorist Action Prior to Crash
800.01   P22.01   Non-Motorist Action Prior to Crash
800.02   P22.02   Non-Motorist Action Prior to Crash
800.03   P22.03   Non-Motorist Action Prior to Crash
800.04   P22.04   Non-Motorist Action Prior to Crash
800.05   P22.05   Non-Motorist Action Prior to Crash
800.06   P22.06   Non-Motorist Action Prior to Crash
800.07   P22.07   Non-Motorist Action Prior to Crash
800.08   P22.08   Non-Motorist Action Prior to Crash
800.09   P22.09   Non-Motorist Action Prior to Crash
 800.1   P22.10   Non-Motorist Action Prior to Crash
800.11   P22.11   Non-Motorist Action Prior to Crash
   810   P23      Non-Motorist Actions at Time of Crash
810.01   P23.01   Non-Motorist Actions at Time of Crash
810.02   P23.02   Non-Motorist Actions at Time of Crash
810.03   P23.04   Non-Motorist Actions at Time of Crash
810.04   P23.05   Non-Motorist Actions at Time of Crash
810.05   P23.06   Non-Motorist Actions at Time of Crash
810.06   P23.07   Non-Motorist Actions at Time of Crash
810.07   P23.08   Non-Motorist Actions at Time of Crash


                                              Page 8
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 810.08   P23.09   Non-Motorist Actions at Time of Crash
 810.09   P23.10   Non-Motorist Actions at Time of Crash
  810.1   P23.11   Non-Motorist Actions at Time of Crash
    820   P24      Non-Motorist Condition at Time of Crash
 820.01   P24.01   Non-Motorist Condition at Time of Crash
 820.02   P24.02   Non-Motorist Condition at Time of Crash
 820.03   P24.03   Non-Motorist Condition at Time of Crash
 820.04   P24.04   Non-Motorist Condition at Time of Crash
 820.05   P24.05   Non-Motorist Condition at Time of Crash
 820.06   P24.06   Non-Motorist Condition at Time of Crash
 820.07   P24.07   Non-Motorist Condition at Time of Crash
 820.08   P24.08   Non-Motorist Condition at Time of Crash
    830   P25      Non-Motorist Location at Time of Crash
 830.01   P25.01   Non-Motorist Location at Time of Crash
 830.02   P25.02   Non-Motorist Location at Time of Crash
 830.03   P25.03   Non-Motorist Location at Time of Crash
 830.04   P25.04   Non-Motorist Location at Time of Crash
 830.05   P25.05   Non-Motorist Location at Time of Crash
 830.06   P25.06   Non-Motorist Location at Time of Crash
 830.07   P25.07   Non-Motorist Location at Time of Crash
 830.08   P25.08   Non-Motorist Location at Time of Crash
 830.09   P25.09   Non-Motorist Location at Time of Crash
  830.1   P25.10   Non-Motorist Location at Time of Crash
 830.11   P25.11   Non-Motorist Location at Time of Crash
 830.12   P25.12   Non-Motorist Location at Time of Crash
 830.13   P25.13   Non-Motorist Location at Time of Crash
 830.14   P25.14   Non-Motorist Location at Time of Crash
 830.15   P25.15   Non-Motorist Location at Time of Crash
 830.16   P25.16   Non-Motorist Location at Time of Crash
    840   P26      Non-Motorist Safety Equipment
 840.01   P26.01   Non-Motorist Safety Equipment
 840.02   P26.02   Non-Motorist Safety Equipment

 840.03 P26.03     Non-Motorist Safety Equipment

 840.04   P26.04   Non-Motorist Safety Equipment
 840.05   P26.05   Non-Motorist Safety Equipment
 840.06   P26.06   Non-Motorist Safety Equipment
 840.07   P26.07   Non-Motorist Safety Equipment
 840.08   P26.08   Non-Motorist Safety Equipment
    850   P27      Unit Number of Motor Vehicle Striking Non-Motorist
    860   P28      Transported to Medical Facility By
 860.01   P28.01   Transported to Medical Facility By
 860.02   P28.02   Transported to Medical Facility By
 860.03   P28.03   Transported to Medical Facility By
 860.04   P28.04   Transported to Medical Facility By
 860.05   P28.05   Transported to Medical Facility By
 860.06   P28.06   Transported to Medical Facility By
 860.07   P28.07   Transported to Medical Facility By
 860.08   P28.08   Transported to Medical Facility By
   1200   PD1      Age
1200.01   PD1.01   Age


                                                Page 9
                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


   870 PL1        Driver License Restriction
870.01 PL1.01     Driver License Restriction
870.02 PL1.02     Driver License Restriction

870.03   PL1.03   Driver License Restriction
870.04   PL1.04   Driver License Restriction
870.05   PL1.05   Driver License Restriction
870.06   PL1.06   Driver License Restriction
870.07   PL1.07   Driver License Restriction
870.08   PL1.08   Driver License Restriction
870.09   PL1.09   Driver License Restriction
 870.1   PL1.10   Driver License Restriction
870.11   PL1.11   Driver License Restriction
870.12   PL1.12   Driver License Restriction
870.13   PL1.13   Driver License Restriction
870.14   PL1.14   Driver License Restriction
870.15   PL1.15   Driver License Restriction
870.16   PL1.16   Driver License Restriction
870.17   PL1.17   Driver License Restriction
870.18   PL1.18   Driver License Restriction
   880   PL2      Commercial Motor Vehicle Endorsements
880.01   PL2.01   Commercial Motor Vehicle Endorsements
880.02   PL2.02   Commercial Motor Vehicle Endorsements
880.03   PL2.03   Commercial Motor Vehicle Endorsements
880.04   PL2.04   Commercial Motor Vehicle Endorsements
880.05   PL2.05   Commercial Motor Vehicle Endorsements
880.06   PL2.06   Commercial Motor Vehicle Endorsements
   890   PL3      Driver License Status
890.01   PL3.01   Driver License Status

890.02   PL3.02   Driver License Status
890.03   PL3.03   Driver License Status
890.04   PL3.04   Driver License Status
890.05   PL3.05   Driver License Status
890.06   PL3.06   Driver License Status
890.07   PL3.07   Driver License Status
890.08   PL3.08   Driver License Status
890.09   PL3.09   Driver License Status
 890.1   PL3.10   Driver License Status
890.11   PL3.11   Driver License Status
   900   PL4      Drug Test Result
900.01   PL4.01   Drug Test Result
900.02   PL4.02   Drug Test Result
900.03   PL4.03   Drug Test Result
900.04   PL4.04   Drug Test Result
900.05   PL4.05   Drug Test Result
900.06   PL4.06   Drug Test Result
900.07   PL4.07   Drug Test Result
   910   PL5      Injury Area
910.01   PL5.01   Injury Area
910.02   PL5.02   Injury Area
910.03   PL5.03   Injury Area


                                               Page 10
                               011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


 910.04   PL5.04    Injury Area
 910.05   PL5.05    Injury Area
 910.06   PL5.06    Injury Area
 910.07   PL5.07    Injury Area
 910.08   PL5.08    Injury Area
 910.09   PL5.09    Injury Area
    920   PL6       Injury Description
    930   RL01      Bridge/Structure Identification Number
    940   RL02      Roadway Curvature
 940.01   RL02.01   Roadway Curvature
 940.02   RL02.02   Roadway Curvature
 940.03   RL02.03   Roadway Curvature
 940.04   RL02.04   Roadway Curvature
 940.05   RL02.05   Roadway Curvature
    950   RL03      Grade
 950.01   RL03.01   Grade
 950.02   RL03.02   Grade
    960   RL04      Part of National Highway System
 960.01   RL04.01   Part of National Highway System
 960.02   RL04.02   Part of National Highway System
 960.03   RL04.03   Part of National Highway System
    970   RL05      Roadway Functional Class
 970.01   RL05.01   Roadway Functional Class
 970.02   RL05.02   Roadway Functional Class
 970.03   RL05.03   Roadway Functional Class
 970.04   RL05.04   Roadway Functional Class
 970.05   RL05.05   Roadway Functional Class
 970.06   RL05.06   Roadway Functional Class
 970.07   RL05.07   Roadway Functional Class
 970.09   RL05.09   Roadway Functional Class
  970.1   RL05.10   Roadway Functional Class
 970.11   RL05.11   Roadway Functional Class
 970.12   RL05.12   Roadway Functional Class
 970.13   RL05.13   Roadway Functional Class
 970.14   RL05.14   Roadway Functional Class
 970.15   RL05.15   Roadway Functional Class
    980   RL06      Annual Average Daily Traffic
 980.01   RL06.01   Annual Average Daily Traffic
 980.02   RL06.02   Annual Average Daily Traffic
    990   RL07      Widths of Lane(s) and shoulder(s)
 990.01   RL07.01   Widths of Lane(s) and shoulder(s)
 990.02   RL07.02   Widths of Lane(s) and shoulder(s)
   1000   RL08      Width of Median
1000.01   RL08.01   Width of Median
   1010   RL09      Access Control
1010.01   RL09.01   Access Control
1010.02   RL09.02   Access Control
1010.03   RL09.03   Access Control
   1020   RL10      Railway Crossing ID
   1030   RL11      Roadway Lighting
1030.01   RL11.01   Roadway Lighting
1030.02   RL11.02   Roadway Lighting


                                                 Page 11
                               011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


1030.03   RL11.03   Roadway Lighting
   1040   RL12      Pavement Markings, Longitudinal
1040.01   RL12.01   Pavement Markings, Longitudinal
1040.02   RL12.02   Pavement Markings, Longitudinal
1040.03   RL12.03   Pavement Markings, Longitudinal
1040.04   RL12.04   Pavement Markings, Longitudinal
1040.05   RL12.05   Pavement Markings, Longitudinal
1040.06   RL12.06   Pavement Markings, Longitudinal
1040.07   RL12.07   Pavement Markings, Longitudinal
1040.08   RL12.08   Pavement Markings, Longitudinal

1040.09 RL12.09     Pavement Markings, Longitudinal

 1040.1   RL12.10   Pavement Markings, Longitudinal
1040.11   RL12.11   Pavement Markings, Longitudinal
1040.12   RL12.12   Pavement Markings, Longitudinal
1040.13   RL12.13   Pavement Markings, Longitudinal
1040.14   RL12.14   Pavement Markings, Longitudinal
1040.15   RL12.15   Pavement Markings, Longitudinal
1040.16   RL12.16   Pavement Markings, Longitudinal
1040.17   RL12.17   Pavement Markings, Longitudinal
1040.18   RL12.18   Pavement Markings, Longitudinal
   1050   RL13      Bikeway
1050.01   RL13.01   Bikeway
1050.02   RL13.02   Bikeway
1050.03   RL13.03   Bikeway
1050.04   RL13.04   Bikeway
1050.05   RL13.05   Bikeway
1050.06   RL13.06   Bikeway
1050.07   RL13.07   Bikeway
   1060   RL14      Delineator Presence
1060.01   RL14.01   Delineator Presence
1060.02   RL14.02   Delineator Presence
1060.03   RL14.03   Delineator Presence
1060.04   RL14.04   Delineator Presence
1060.05   RL14.05   Delineator Presence
   1070   RL15      Traffic Control Type at Intersection
1070.01   RL15.01   Traffic Control Type at Intersection
1070.02   RL15.02   Traffic Control Type at Intersection
1070.03   RL15.03   Traffic Control Type at Intersection
1070.04   RL15.04   Traffic Control Type at Intersection
1070.05   RL15.05   Traffic Control Type at Intersection
1070.06   RL15.06   Traffic Control Type at Intersection
1070.07   RL15.07   Traffic Control Type at Intersection
1070.08   RL15.08   Traffic Control Type at Intersection
1070.09   RL15.09   Traffic Control Type at Intersection
 1070.1   RL15.10   Traffic Control Type at Intersection
1070.11   RL15.11   Traffic Control Type at Intersection
1070.12   RL15.12   Traffic Control Type at Intersection
1070.13   RL15.13   Traffic Control Type at Intersection
1070.17   RL15.17   Traffic Control Type at Intersection
1070.18   RL15.18   Traffic Control Type at Intersection


                                                  Page 12
                               011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


1070.19   RL15.19   Traffic Control Type at Intersection
1070.21   RL15.21   Traffic Control Type at Intersection
   1080   RL16      Mainline Number of Lanes at Intersection
1080.01   RL16.01   Mainline Number of Lanes at Intersection
1080.02   RL16.02   Mainline Number of Lanes at Intersection
1080.03   RL16.03   Mainline Number of Lanes at Intersection
1080.04   RL16.04   Mainline Number of Lanes at Intersection
1080.05   RL16.05   Mainline Number of Lanes at Intersection
1080.06   RL16.06   Mainline Number of Lanes at Intersection
   1090   RL17      Side-Road Number of Lanes at Intersection
1090.01   RL17.01   Side-Road Number of Lanes at Intersection
1090.02   RL17.02   Side-Road Number of Lanes at Intersection
1090.03   RL17.03   Side-Road Number of Lanes at Intersection
1090.04   RL17.04   Side-Road Number of Lanes at Intersection
1090.05   RL17.05   Side-Road Number of Lanes at Intersection
1090.06   RL17.06   Side-Road Number of Lanes at Intersection
   1100   RL18      Total Volume of Entering Vehicles
    290   V01       Motor Vehicle Identification Number
    300   V02       Motor Vehicle Unit Type and Number
 300.01   V02.01    Motor Vehicle Unit Type and Number
 300.02   V02.02    Motor Vehicle Unit Type and Number
 300.03   V02.03    Motor Vehicle Unit Type and Number
 300.04   V02.04    Motor Vehicle Unit Type and Number
    310   V03       Motor Vehicle Registration State and Year
 310.01   V03.01    Motor Vehicle Registration State and Year
 310.02   V03.02    Motor Vehicle Registration State and Year
    320   V04       Motor Vehicle License Plate Number
    330   V05       Motor Vehicle Make
    340   V06       Motor Vehicle Model Year
    350   V07       Motor Vehicle Model
    360   V08       Motor Vehicle Body Type Category
 360.01   V08.01    Motor Vehicle Body Type Category
 360.02   V08.02    Motor Vehicle Body Type Category
 360.03   V08.03    Motor Vehicle Body Type Category
 360.04   V08.04    Motor Vehicle Body Type Category
 360.05   V08.05    Motor Vehicle Body Type Category
 360.06   V08.06    Motor Vehicle Body Type Category
 360.07   V08.07    Motor Vehicle Body Type Category
 360.08   V08.08    Motor Vehicle Body Type Category
 360.09   V08.09    Motor Vehicle Body Type Category
  360.1   V08.10    Motor Vehicle Body Type Category
 360.11   V08.11    Motor Vehicle Body Type Category
 360.12   V08.12    Motor Vehicle Body Type Category
 360.13   V08.13    Motor Vehicle Body Type Category
 360.14   V08.14    Motor Vehicle Body Type Category
 360.15   V08.15    Motor Vehicle Body Type Category
 360.16   V08.16    Motor Vehicle Body Type Category
    370   V09       Total Occupants in Motor Vehicle
    380   V10       Special Function of Motor Vehicle in Transport
 380.01   V10.01    Special Function of Motor Vehicle in Transport
 380.02   V10.02    Special Function of Motor Vehicle in Transport
 380.03   V10.03    Special Function of Motor Vehicle in Transport


                                                 Page 13
                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


380.04   V10.04   Special Function of Motor Vehicle in Transport
380.05   V10.05   Special Function of Motor Vehicle in Transport
380.06   V10.06   Special Function of Motor Vehicle in Transport
380.07   V10.07   Special Function of Motor Vehicle in Transport
380.08   V10.08   Special Function of Motor Vehicle in Transport
380.09   V10.09   Special Function of Motor Vehicle in Transport
   390   V11      Emergency Motor Vehicle Use
390.01   V11.01   Emergency Motor Vehicle Use
390.02   V11.02   Emergency Motor Vehicle Use
390.03   V11.03   Emergency Motor Vehicle Use
   400   V12      Motor Vehicle Authorized Speed Limit
400.01   V12.01   Motor Vehicle Authorized Speed Limit
400.02   V12.02   Motor Vehicle Authorized Speed Limit
400.03   V12.03   Motor Vehicle Authorized Speed Limit
   410   V13      Direction of Travel Before Crash
410.01   V13.01   Direction of Travel Before Crash
410.02   V13.02   Direction of Travel Before Crash
410.03   V13.03   Direction of Travel Before Crash
410.04   V13.04   Direction of Travel Before Crash
410.05   V13.05   Direction of Travel Before Crash
410.06   V13.06   Direction of Travel Before Crash
   420   V14      Traffic Way Description
420.01   V14.01   Traffic Way Description
420.02   V14.02   Traffic Way Description
420.03   V14.03   Traffic Way Description
420.04   V14.04   Traffic Way Description
420.05   V14.05   Traffic Way Description
420.06   V14.06   Traffic Way Description
   430   V15      Total Lanes in Roadway
   440   V16      Roadway Alignment and Grade
440.01   V16.01   Roadway Alignment and Grade
440.02   V16.02   Roadway Alignment and Grade
440.03   V16.03   Roadway Alignment and Grade
440.04   V16.04   Roadway Alignment and Grade
440.05   V16.05   Roadway Alignment and Grade
440.06   V16.06   Roadway Alignment and Grade
440.07   V16.07   Roadway Alignment and Grade
440.08   V16.08   Roadway Alignment and Grade
   450   V17      Traffic Control Device Type
450.01   V17.01   Traffic Control Device Type

450.02   V17.02   Traffic Control Device Type
450.03   V17.03   Traffic Control Device Type
450.04   V17.04   Traffic Control Device Type
450.05   V17.05   Traffic Control Device Type
450.06   V17.06   Traffic Control Device Type
450.07   V17.07   Traffic Control Device Type
450.08   V17.08   Traffic Control Device Type
450.09   V17.09   Traffic Control Device Type
 450.1   V17.10   Traffic Control Device Type
450.11   V17.11   Traffic Control Device Type
450.12   V17.12   Traffic Control Device Type


                                                Page 14
                            011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


450.13   V17.13   Traffic Control Device Type
   460   V18      Motor Vehicle Maneuver/Action
460.01   V18.01   Motor Vehicle Maneuver/Action
460.02   V18.02   Motor Vehicle Maneuver/Action
460.03   V18.03   Motor Vehicle Maneuver/Action
460.04   V18.04   Motor Vehicle Maneuver/Action
460.05   V18.05   Motor Vehicle Maneuver/Action
460.06   V18.06   Motor Vehicle Maneuver/Action
460.07   V18.07   Motor Vehicle Maneuver/Action
460.08   V18.08   Motor Vehicle Maneuver/Action
460.09   V18.09   Motor Vehicle Maneuver/Action
 460.1   V18.10   Motor Vehicle Maneuver/Action
460.11   V18.11   Motor Vehicle Maneuver/Action
460.12   V18.12   Motor Vehicle Maneuver/Action
460.13   V18.13   Motor Vehicle Maneuver/Action
460.14   V18.14   Motor Vehicle Maneuver/Action
460.15   V18.15   Motor Vehicle Maneuver/Action
   470   V19      Area(s) of Impact
470.01   V19.01   Area(s) of Impact
470.02   V19.02   Area(s) of Impact
470.03   V19.03   Area(s) of Impact
470.04   V19.04   Area(s) of Impact
470.05   V19.05   Area(s) of Impact
470.06   V19.06   Area(s) of Impact
470.07   V19.07   Area(s) of Impact
470.08   V19.08   Area(s) of Impact
470.09   V19.09   Area(s) of Impact
 470.1   V19.10   Area(s) of Impact
   480   V20      Sequence of Events
480.01   V20.01   Sequence of Events
480.02   V20.02   Sequence of Events
480.03   V20.03   Sequence of Events
480.04   V20.04   Sequence of Events
480.05   V20.05   Sequence of Events
480.06   V20.06   Sequence of Events
480.07   V20.07   Sequence of Events
480.08   V20.08   Sequence of Events
480.09   V20.09   Sequence of Events
 480.1   V20.10   Sequence of Events
480.11   V20.11   Sequence of Events
480.12   V20.12   Sequence of Events
480.13   V20.13   Sequence of Events
480.14   V20.14   Sequence of Events
480.15   V20.15   Sequence of Events
480.16   V20.16   Sequence of Events

480.17 V20.17     Sequence of Events
480.18 V20.18     Sequence of Events

480.19 V20.19     Sequence of Events
 480.2 V20.20     Sequence of Events




                                             Page 15
                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls



480.21 V20.21     Sequence of Events

480.22   V20.22   Sequence of Events
480.23   V20.23   Sequence of Events
480.24   V20.24   Sequence of Events
480.25   V20.25   Sequence of Events
480.26   V20.26   Sequence of Events
480.27   V20.27   Sequence of Events
480.28   V20.28   Sequence of Events
480.29   V20.29   Sequence of Events
 480.3   V20.30   Sequence of Events
480.31   V20.31   Sequence of Events
480.32   V20.32   Sequence of Events
480.33   V20.33   Sequence of Events
480.34   V20.34   Sequence of Events
480.35   V20.35   Sequence of Events
480.36   V20.36   Sequence of Events
480.37   V20.37   Sequence of Events
480.38   V20.38   Sequence of Events
480.39   V20.39   Sequence of Events
 480.4   V20.40   Sequence of Events
480.41   V20.41   Sequence of Events
480.42   V20.42   Sequence of Events
480.43   V20.43   Sequence of Events
   490   V21      Most Harmful Event for this Motor Vehicle
490.01   V21.01   Most Harmful Event for this Motor Vehicle
490.02   V21.02   Most Harmful Event for this Motor Vehicle
490.03   V21.03   Most Harmful Event for this Motor Vehicle
490.04   V21.04   Most Harmful Event for this Motor Vehicle
490.05   V21.05   Most Harmful Event for this Motor Vehicle
490.06   V21.06   Most Harmful Event for this Motor Vehicle
490.07   V21.07   Most Harmful Event for this Motor Vehicle
490.08   V21.08   Most Harmful Event for this Motor Vehicle
490.09   V21.09   Most Harmful Event for this Motor Vehicle

 490.1 V21.10     Most Harmful Event for this Motor Vehicle
490.11 V21.11     Most Harmful Event for this Motor Vehicle

490.12 V21.12     Most Harmful Event for this Motor Vehicle
490.13 V21.13     Most Harmful Event for this Motor Vehicle

490.14   V21.14   Most Harmful Event for this Motor Vehicle
490.15   V21.15   Most Harmful Event for this Motor Vehicle
490.16   V21.16   Most Harmful Event for this Motor Vehicle
490.17   V21.17   Most Harmful Event for this Motor Vehicle
490.18   V21.18   Most Harmful Event for this Motor Vehicle
490.19   V21.19   Most Harmful Event for this Motor Vehicle
 490.2   V21.20   Most Harmful Event for this Motor Vehicle
490.21   V21.21   Most Harmful Event for this Motor Vehicle
490.22   V21.22   Most Harmful Event for this Motor Vehicle
490.23   V21.23   Most Harmful Event for this Motor Vehicle


                                              Page 16
                             011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


490.24   V21.24   Most Harmful Event for this Motor Vehicle
490.25   V21.25   Most Harmful Event for this Motor Vehicle
490.26   V21.26   Most Harmful Event for this Motor Vehicle
490.27   V21.27   Most Harmful Event for this Motor Vehicle
490.28   V21.28   Most Harmful Event for this Motor Vehicle
490.29   V21.29   Most Harmful Event for this Motor Vehicle
 490.3   V21.30   Most Harmful Event for this Motor Vehicle
490.31   V21.31   Most Harmful Event for this Motor Vehicle
490.32   V21.32   Most Harmful Event for this Motor Vehicle
490.33   V21.33   Most Harmful Event for this Motor Vehicle
490.34   V21.34   Most Harmful Event for this Motor Vehicle

490.35   V21.35   Most Harmful Event for this Motor Vehicle
490.36   V21.36   Most Harmful Event for this Motor Vehicle
   500   V22      Underride/Override
500.01   V22.01   Underride/Override
500.02   V22.02   Underride/Override
500.03   V22.03   Underride/Override
500.04   V22.04   Underride/Override
500.05   V22.05   Underride/Override
500.06   V22.06   Underride/Override
500.07   V22.07   Underride/Override
   510   V23      Hit and Run
510.01   V23.01   Hit and Run
510.02   V23.02   Hit and Run
510.03   V23.03   Hit and Run
   520   V24      Extent of Damage
520.01   V24.01   Extent of Damage
520.02   V24.02   Extent of Damage
520.03   V24.03   Extent of Damage
520.04   V24.04   Extent of Damage
520.05   V24.05   Extent of Damage
   530   V25      Contributing Circumstances, Motor Vehicle
530.01   V25.01   Contributing Circumstances, Motor Vehicle
530.02   V25.02   Contributing Circumstances, Motor Vehicle
530.03   V25.03   Contributing Circumstances, Motor Vehicle
530.04   V25.04   Contributing Circumstances, Motor Vehicle
530.05   V25.05   Contributing Circumstances, Motor Vehicle
530.06   V25.06   Contributing Circumstances, Motor Vehicle
530.07   V25.07   Contributing Circumstances, Motor Vehicle
530.08   V25.08   Contributing Circumstances, Motor Vehicle
530.09   V25.09   Contributing Circumstances, Motor Vehicle
 530.1   V25.1    Contributing Circumstances, Motor Vehicle
530.11   V25.11   Contributing Circumstances, Motor Vehicle
530.12   V25.12   Contributing Circumstances, Motor Vehicle
530.13   V25.13   Contributing Circumstances, Motor Vehicle
530.14   V25.14   Contributing Circumstances, Motor Vehicle
   540   V26      Motor Carrier Identification
540.01   V26.01   Motor Carrier Identification
540.02   V26.02   Motor Carrier Identification
540.03   V26.03   Motor Carrier Identification
540.04   V26.04   Motor Carrier Identification


                                              Page 17
                            011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


540.05   V26.05   Motor Carrier Identification
540.06   V26.06   Motor Carrier Identification
540.07   V26.07   Motor Carrier Identification
540.08   V26.08   Motor Carrier Identification
   550   V27      Gross Vehicle Weight Rating
550.01   V27.01   Gross Vehicle Weight Rating
550.02   V27.02   Gross Vehicle Weight Rating
550.03   V27.03   Gross Vehicle Weight Rating
   560   V28      Commercial Motor Vehicle Configuration
560.01   V28.01   Commercial Motor Vehicle Configuration
560.02   V28.02   Commercial Motor Vehicle Configuration
560.03   V28.03   Commercial Motor Vehicle Configuration
560.04   V28.04   Commercial Motor Vehicle Configuration
560.05   V28.05   Commercial Motor Vehicle Configuration
560.06   V28.06   Commercial Motor Vehicle Configuration
560.07   V28.07   Commercial Motor Vehicle Configuration
560.08   V28.08   Commercial Motor Vehicle Configuration
560.09   V28.09   Commercial Motor Vehicle Configuration
 560.1   V28.10   Commercial Motor Vehicle Configuration
560.11   V28.11   Commercial Motor Vehicle Configuration
560.12   V28.12   Commercial Motor Vehicle Configuration
   570   V29      Commercial Cargo Body Type
570.01   V29.01   Commercial Cargo Body Type
570.02   V29.02   Commercial Cargo Body Type
570.03   V29.03   Commercial Cargo Body Type
570.04   V29.04   Commercial Cargo Body Type
570.05   V29.05   Commercial Cargo Body Type
570.06   V29.06   Commercial Cargo Body Type
570.07   V29.07   Commercial Cargo Body Type
570.08   V29.08   Commercial Cargo Body Type
570.09   V29.09   Commercial Cargo Body Type
 570.1   V29.10   Commercial Cargo Body Type
570.11   V29.11   Commercial Cargo Body Type
570.12   V29.12   Commercial Cargo Body Type
570.13   V29.13   Commercial Cargo Body Type
570.14   V29.14   Commercial Cargo Body Type
   580   V30      Hazardous Materials Placard (Cargo Only)
580.01   V30.01   Hazardous Materials Placard (Cargo Only)
580.02   V30.02   Hazardous Materials Placard (Cargo Only)
580.03   V30.03   Hazardous Materials Placard (Cargo Only)
580.04   V30.04   Hazardous Materials Placard (Cargo Only)
580.05   V30.05   Hazardous Materials Placard (Cargo Only)
580.06   V30.06   Hazardous Materials Placard (Cargo Only)
580.07   V30.07   Hazardous Materials Placard (Cargo Only)
580.08   V30.08   Hazardous Materials Placard (Cargo Only)




                                             Page 18
                                       011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


                                      Attribute Name                               On_Form
--------------------------------------------------------------------------------
State Specific Identifier
--------------------------------------------------------------------------------
Date and Time (YYYYMMDDHHMM)
--------------------------------------------------------------------------------
Name of the County
--------------------------------------------------------------------------------
Name of the Political Jurisdiction
--------------------------------------------------------------------------------
Latitude/Longitude Coordinates
Linear Referencing System
Link Node System
--------------------------------------------------------------------------------
Non-Collision: Overturn / Rollover
Non-Collision: Fire / Explosion
Non-Collision: Immersion
Non-Collision: Jackknife
Non-Collision: Cargo / Equipment Loss or Shift
Non-Collision: Fell / Jumped from Motor Vehicle
Non-Collision: Thrown or Falling Object
Non-Collision: Other Non-Collision
Collision with P, MV, Non-FO: Pedestrian
Collision with P, MV, Non-FO: Pedalcycle
Collision with P, MV, Non-FO: Railway Vehicle (train, engine)
Collision with P, MV, Non-FO: Animal
Collision with P, MV, Non-FO: Motor Vehicle in Transport
Collision with P, MV, Non-FO: Parked Motor Vehicle
Collision with P, MV, Non-FO: Work Zone / Maintenance Equipment
Collision with P, MV, Non-FO: Other Non-Fixed Object
Collision with Fixed Object: Impact Attenuator / Crash Cushion
Collision with Fixed Object: Bridge Overhead Structure
Collision with Fixed Object: Bridge Pier or Support
Collision with Fixed Object: Bridge Rail
Collision with Fixed Object: Culvert
Collision with Fixed Object: Curb
Collision with Fixed Object: Ditch
Collision with Fixed Object: Embankment
Collision with Fixed Object: Guardrail Face
Collision with Fixed Object: Guardrail End
Collision with Fixed Object: Concrete Traffic Barrier
Collision with Fixed Object: Other Traffic Barrier
Collision with Fixed Object: Tree (standing)
Collision with Fixed Object: Utility Pole / Light Support
Collision with Fixed Object: Traffic Sign Support
Collision with Fixed Object: Traffic Signal Support
Collision with Fixed Object: Other Post, Pole or Support
Collision with Fixed Object: Fence
Collision with Fixed Object: Mailbox
Collision with Fixed Object: Other Fixed Object (wall, building, tunnel,
etc.)
Unknown


                                                            Page 19
                                            011b605c-cf5b-43f2-89d3-e4bf6a0eb178.xls


--------------------------------------------------------------------------------
On Roadway
Shoulder
Median
Roadside
Gore
Separator
In Parking Lane or Zone
Off Roadway, Location Unknown
Outside Right-of-Way (trafficway)
Unknown
--------------------------------------------------------------------------------
Non-Collision Between Two Motor Vehicles in Transport
Rear End (front-to-rear)
Head-On (front-to-front)
Angle (front-to-side) Same Direction
Angle (front-to-side) Opposite Direction
Angle (front-to-side) Right Angle (includes broadside)
Angle-Direction Not Specified
Sideswipe - Same Direction
Sideswipe - Opposite Direction
Rear-to-Side
Rear-to-Rear
Other
Unknown
--------------------------------------------------------------------------------
Law Enforcement Agency
Motorist
Law Enforcement Reporting Agency Identifier (ORI Codes)

--------------------------------------------------------------------------------

YYYYMMDDHHMM

Unknown
--------------------------------------------------------------------------------
Clear
Cloudy
Fog, Smog, Smoke
Rain
Sleet, Hail (freezing rain or drizzle)
Snow
Blowing Snow
Severe Crosswinds
Blowing Sand, Soil, Dirt
Other
Unknown
--------------------------------------------------------------------------------
Daylight
Dawn
Dusk
Dark - Lighted


                                                                    Page 20
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Dark - Not Lighted
Dark - Unknown Lighting
Other
Unknown
--------------------------------------------------------------------------------
Dry
Wet
Snow
Slush
Ice / Frost
Water (standing, moving)
Sand
Mud, Dirt, Gravel
Oil
Other
Unknown
--------------------------------------------------------------------------------
None
Weather Conditions
Physical Obstruction(s)
Glare
Animal(s) in Roadway
Other
Unknown
--------------------------------------------------------------------------------
None
Road Surface Condition (wet, icy, snow, slush, etc.)
Debris
Rut, Holes, Bumps
Work Zone (construction/maintenance/utility)
Worn, Travel-Polished Surface
Obstruction in Roadway
Traffic Control Device Inoperative, Missing or Obscured
Shoulders (none, low, soft, high)
Non-Highway Work
Other
Unknown
--------------------------------------------------------------------------------
Non-Junction
Junction Non-Interchange Area: Intersection
Junction Non-Interchange Area: Unknown Non-Interchange
Junction Non-Interchange Area: Intersection-Related
Junction Non-Interchange Area: Crossover-Related
Junction Non-Interchange Area: Entrance/Exit Ramp
Junction Non-Interchange Area: Railway Grade Crossing
Junction Non-Interchange Area: Driveway, Alley-Access-Related

Other Non-Interchange (crossings for bikes, snowmobile, school, etc.)
Junction Non-Interchange Area: Unknown Non-Interchange
Junction Interchange Area: Thru Roadway
Junction Interchange Area: Intersection
Junction Interchange Area: Intersection-Related


                                                                 Page 21
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Junction Interchange Area: Entrance / Exit Ramp
Junction Interchange Area: Other part of Interchange
Junction Interchange Area: Unknown Interchange
Junction Interchange Area: Unknown Junction
--------------------------------------------------------------------------------
Not at Intersection
Four-Way Intersection
T-Intersection
Y-Intersection
Intersection as Part of Interchange
Traffic Circle
Roundabout
Five-Point, or More
Unknown
--------------------------------------------------------------------------------
No
Yes, School Bus Directly Involved
Yes, School Bus Indirectly Involved
Unknown
--------------------------------------------------------------------------------
In or near a construction, maintenance or utility work zone? Yes
In or near a construction, maintenance or utility work zone? No

In or near a construction, maintenance or utility work zone? Unknown
Location of the Crash: Before the First Work Zone Warning Sign
Location of the Crash: Advance Warning Area
Location of the Crash: Transition Area
Location of the Crash: Activity Area
Location of the Crash: Termination Area
Type of Work Zone: Lane Closure
Type of Work Zone: Lane Shift / Crossover
Type of Work Zone: Work on Shoulder or Median
Type of Work Zone: Intermittent or Moving Vehicle
Type of Work Zone: Other
Workers Present? Yes
Workers Present? No
Workers Present? Unknown
--------------------------------------------------------------------------------
Fatal Injury (K)
Incapacitating Injury (A)
Non-Incapacitating Injury (B)
Possible Injury (C )
Property Damage Only (O)
Unknown
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
No
Yes


                                                                 Page 22
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Unknown
--------------------------------------------------------------------------------
No
Yes
Unknown
--------------------------------------------------------------------------------
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
--------------------------------------------------------------------------------
Date of Birth: YYYYMMDD
Date of Birth: Unknown
Age: AAA
--------------------------------------------------------------------------------
Male
Female
Unknown
--------------------------------------------------------------------------------
Driver
Passenger
Non-Motorist (non-occupant of vehicle in transport): Pedestrian
Non-Motorist (non-occupant of vehicle in transport): Other Pedest.
(wheelchair)
Non-Motorist (non-occupant of vehicle in transport): Bicyclist
Non-Motorist (non-occupant of vehicle in transport): Other Cyclist
Non-Motorist (non-occupant of vehicle in transport): Occupant of Motor
Vehicle N
Non-Motorist (non-occupant of vehicle in transport): Occupant of a Non-
Motor Veh
Unknown Type of Non-Motorist
Unknown
--------------------------------------------------------------------------------
Fatal Injury (K)
Nonfatal Injury: Incapacitating (A)
Nonfatal Injury: Non-Incapacitating (B)
Nonfatal Injury: Possible (C )
No Injury (O)
Unknown
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Row: Front
Row: Second
Row: Third
Row: Fourth
Row: Other Row (bus, 15 passenger van, etc.)
Row: Unknown
Seat: Left (usually the motor vehicle or motorcycle driver except for postal
veh


                                                        Page 23
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Seat: Middle
Seat: Right
Seat: Other
Seat: Unknown
Other Location: Not Applicable
Other Location: Sleeper Section of Cab (truck)
Other Location: Other Enclosed Cargo Area
Other Location: Unenclosed Cargo Area
Other Location: Trailing Unit
Other Location: Riding on Motor Vehicle Exterior (non-trailing unit)
Other Location: Unknown
--------------------------------------------------------------------------------
Not Applicable (non-motorist)
None Used-Motor Vehicle Occupant
Shoulder and Lap Belt Used
Shoulder Belt Only Used
Lap Belt Only Used
Restraint Used-Type Unknown
Child Restraint System--Forward Facing
Child Restraint System--Rear Facing
Booster Seat
Child Restraint Type Unknown
Helmet Used
Other
Unknown
--------------------------------------------------------------------------------
Not Applicable
Not Deployed
Deployed-Front
Deployed-Side
Deployed-Other (knee, air belt, etc.)
Deployed-Combination
Deployment Unknown
--------------------------------------------------------------------------------
Not Ejected
Ejected, Partially
Ejected, Totally
Not Applicable
Unknown
--------------------------------------------------------------------------------
Not Applicable
Not Licensed
State (see Appendix G)
Indian Nation
U.S. Government
Canadian Province
Mexican State
International License (other than Mexico, Canada)
Unknown
--------------------------------------------------------------------------------
Alphanumeric identifier assigned by the jurisdiction (state, foreign
country, U.


                                                               Page 24
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Class: None
Class: Not Applicable
Class: Class A
Class: Class B
Class: Class C
Class: Class M
--------------------------------------------------------------------------------
Name
--------------------------------------------------------------------------------
No Improper Driving
Ran Off Road
Failed to Yield Right-of-Way
Disregarded Traffic Signs
Ran Red Light (not included in violation codes)
Disregarded Other Road Markings
Exceeded Posted Speed Limit
Drove Too Fast For Conditions
Improper Turn
Improper Backing
Improper Passing
Wrong Side or Wrong Way
Followed Too Closely
Failed to Keep in Proper Lane
Operated Motor Vehicle in Erratic, Reckless, Careless, Negligent or
Aggressive
Swerved or Avoided Due to Wind, Slippery Surface, Motor Vehicle,
Object, Non-Mot
Over-Correcting / Over-Steering
Other Improper Action
Unknown
--------------------------------------------------------------------------------
Apparently Normal
Emotional (depressed, angry, disturbed, etc.)
Ill (sick)
Fell Asleep, Fainted, Fatigued, etc.
Under the Influence of medications/Drugs/Alcohol
Other
Unknown
--------------------------------------------------------------------------------
No Violation
(Violation Code)
Unknown
--------------------------------------------------------------------------------
Not Distracted
Electronic Communication Devices (cell phone, pager, etc.)
Other Electronic Device (navigation device, palm pilot, etc.)
Other Inside the Vehicle
Other Outside the Vehicle
Unknown
--------------------------------------------------------------------------------
No
Yes


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Unknown
--------------------------------------------------------------------------------
Test Status: None Given
Test Status: Test Refused
Test Status: Test Given
Type of Test: Blood
Type of Test: Serum
Type of Test: Breath
Type of Test: Urine
Type of Test: Other
BAC Test Result: Value
BAC Test Result: Pending
BAC Test Result: Unknown
--------------------------------------------------------------------------------
No
Yes
Unknown
--------------------------------------------------------------------------------
Test Status: Test Not Given
Test Status: Test Refused
Test Status: Test Given
Test Status: Unknown if Tested
Type of Test: Blood
Type of Test: Urine
Type of Test: Serum
Type of Test: Other
Drug Test Result: Positive
Drug Test Result: Negative
Drug Test Result: Unknown
--------------------------------------------------------------------------------
Sequential Number (uniquely identifying the non-motorist involved in the
crash)
--------------------------------------------------------------------------------
Entering or Crossing
Recreational Pursuit (walking, running, jogging, playing, etc.)
Walking To/From School
Cycling
Working
Pushing Motor Vehicle
Approaching or Leaving Motor Vehicle
Playing or Working on Motor Vehicle
Standing
Other
Unknown
--------------------------------------------------------------------------------
Improper Crossing
Darting
In Roadway (standing, on knees, lying, etc.)
Failure to Yield Right-of-Way
Not Visible (dark clothing)
Inattentive (talking, eating, etc.)
Failure to Obey Traffic Signs, Signals, or Officer


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Wrong Side of Road
Other
Unknown
--------------------------------------------------------------------------------
Apparently Normal
Physically Impaired
Emotional (depression, angry, disturbed, etc.)
Ill (sick)
Asleep, Fainted, Fatigued, etc.
Under the Influence of Medications/Drugs/Alcohol
Other
Unknown
--------------------------------------------------------------------------------
Marked Crosswalk at Intersection
At Intersection But No Crosswalk
Non-Intersection Crosswalk
Driveway Access Crosswalk
In Roadway (not in crosswalk or intersection)
Median (but not on shoulder)
Island
Shoulder
Sidewalk
Roadside
Outside Trafficway
Dedicated Bike Lane
Shared-Use Path or Trails
Inside Building
Other
Unknown
--------------------------------------------------------------------------------
Safety Equipment Used by Non-Motorist: None
Safety Equipment Used by Non-Motorist: Helmet
Safety Equipment Used by Non-Motorist: Protective Pads Used (elbows,
knees, shin
Safety Equipment Used by Non-Motorist: Reflective Clothing (jacket,
backpack, et
Safety Equipment Used by Non-Motorist: Lighting
Safety Equipment Used by Non-Motorist: Other
Safety Equipment Used by Non-Motorist: Not Applicable
Safety Equipment Used by Non-Motorist: Unknown
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Source of Transport: Not Transported
Source of Transport: EMS
Source of Transport: Law Enforcement
Source of Transport: Other
Source of Transport: Unknown
EMS Response Agency Identifier ID or EMS Agency That Responds
EMS Response Run Number
Name of medical facility receiving patient
--------------------------------------------------------------------------------
Age in Years


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--------------------------------------------------------------------------------
None
Corrective Lenses
Mechanical Devices (special brakes, hand controls, or other adaptive
device)
Prosthetic Aid
Automatic Transmission
Outside Mirror
Limit to Daylight Only
Limit to Employment Only
Must Be Accompanied By an Adult
Limited - Other
CDL Intrastate Only
Motor Vehicles without Air Brakes
Military Vehicles Only
Except Class A Bus
Except Class A and Class B Bus
Except Tractor-Trailer
Farm Waiver
Other
--------------------------------------------------------------------------------
T-Double/Triple Trailer
P-Passenger Vehicle
N-Tank Vehicle
H-Required To be Placarded For Hazardous Materials
X-Combined Tank/HAZ-MAT
Other
--------------------------------------------------------------------------------
Type Applicable For This Person: Non-CDL Driver's License
Type Applicable For This Person: Non-CDL Restricted Driver's License
(Learner's
Type Applicable For This Person: Commercial Driver License (CDL)
Status: Not Licensed
Status: Valid License
Status: Suspended
Status: Revoked
Status: Expired
Status: Cancelled or Denied
Status: Disqualified (CDL)
Status: Unknown
--------------------------------------------------------------------------------
Marijuana
Cocaine
Opiate
Amphetamine
PCP
Other Controlled Substance
Other Drug (excludes post crash drugs and nicotine, Aspirin, etc.)
--------------------------------------------------------------------------------
Head
Face
Neck


                                                           Page 28
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Thorax (Chest)
Abdomen and Pelvis
Spine
Upper Extremity
Lower Extremity
Unspecified
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Curve: Radius
Length
Superelevation
Unit of Measure (feet or meters)
Not Applicable
--------------------------------------------------------------------------------
Direction or Slope: Up (+) or Down (-)
Percent of Slope (Nearest Percent of Slope)
--------------------------------------------------------------------------------
Yes
No
Unknown
--------------------------------------------------------------------------------
Rural: Principal Arterial - Interstate
Rural: Principal Arterial - Other
Rural: Minor Arterial
Rural: Major Collector
Rural: Minor Collector
Rural: Local
Rural: Unknown Rural
Urban: Principal - Interstate
Urban: Principal Arterial - Other Freeway or Expressway
Urban: Principal Arterial - Other
Urban: Minor Arterial
Urban: Collector
Urban: Local
Urban: Unknown Urban
--------------------------------------------------------------------------------
Calendar Year
Motor Vehicles Per Day (ADT)
--------------------------------------------------------------------------------
Lane Width (in feet or meters)
Shoulder Width (in feet or meters)
--------------------------------------------------------------------------------
Width of Median (in feet or meters)
--------------------------------------------------------------------------------
Full Access Control
Partial Access Control
No Access Control
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
No Lighting
Spot Illumination


                                                                    Page 29
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Continuous Lighting
--------------------------------------------------------------------------------
Function and Color: Centerline, Skip-Dash, Yellow
Function and Color: Centerline, Solid, Yellow
Function and Color: Centerline, Solid Double, Yellow
Function and Color: No Passing Barrier, Right or Left, Yellow
Function and Color: Lane Line, Skip-Dash, White
Function and Color: Lane Line, Solid, White
Function and Color: Edge Line, Left, Yellow
Function and Color: Edge Line, Right, White
Function and Color: Left Turn Lane Lines, Combination of Solid and Skip-
Dash, Ye
Function and Color: Turn Arrow Symbols, Right, Thru, Left, or
Combination of Two
Function and Color: Unknown
Material: Paint
Material: Thermoplastic
Material: Raised Markers
Material: Permanent Inlay
Material: Tape
Material: Other
Material: Unknown
--------------------------------------------------------------------------------
No Bikeway
Bicycle Route (signed)
Bicycle Lane (striped) - Right Only
Bicycle Lane (striped) - Both Sides
Bicycle Lane (striped) - Left Only
Separate Bicycle Path / Trail
Unknown
--------------------------------------------------------------------------------
None
Delineators, Right
Delineators, Left
Delineators, Both Sides
Unknown
--------------------------------------------------------------------------------
No Control
Stop Sign on Cross Street Only
Stop Signs on Mainline Only
Four-Way Stops
Four-Way Flasher (red on cross street)
Four-Way Flasher (red on mainline)
Four-Way Flasher (red on all legs)
Yield Signs on Cross Street Only
Yield Signs on Mainline Only
Signals Pre-Timed (two phase)
Signals Semi-Actuated (two-phase)
Signals Semi-Actuated (multi-phase)
Signals Fully-Actuated (two-phase)
Signals Fully-Actuated (multi-phase)
Other


                                                         Page 30
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Unknown
Signals Pre-Timed (multi-phase)
--------------------------------------------------------------------------------
One Lane
Two Lanes
Three Lanes
Four to Six Lanes
Seven or More Lanes
Unknown
--------------------------------------------------------------------------------
One Lane
Two Lanes
Three Lanes
Four to Six Lanes
Seven or More Lanes
Unknown
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Type: Motor Vehicle in Transport
Type: Parked Motor Vehicle
Type: Working Vehicle / Equipment
Number
--------------------------------------------------------------------------------
State Identifier
Year of Motor Vehicle Registration (YYYY)
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Passenger Car
(Sport) Utility Vehicle
Passenger Van
Cargo Van (10,000 lbs (4536 kg) or less)
Pickup
Motor Home
School Bus
Transit Bus
Motor Coach
Other Bus
Motorcycle
Moped
Low Speed Vehicle
Other Light Trucks (10,000 lbs (4536 kg) or less)
Medium / Heavy Duty Trucks (more than 10,000 lbs (4536 kg))
Other
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
No Special Function
Taxi
Vehicle used as School Bus


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Vehicle used as Other Bus
Military
Police
Ambulance
Fire Truck
Unknown
--------------------------------------------------------------------------------
No
Yes
Unknown
--------------------------------------------------------------------------------
Authorized Value (miles per hour)
Not Applicable
Unknown
--------------------------------------------------------------------------------
Northbound
Southbound
Eastbound
Westbound
Not on Roadway
Unknown
--------------------------------------------------------------------------------
Two-Way, Not Divided
Two-Way, Not Divided with a Continuous Left Turn Lane
Two-Way, Divided, Unprotected (painted >4 feet) Median
Two-Way, Divided, Positive Median Barrier
One-Way Trafficway
Unknown
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Horizontal Alignment: Straight
Horizontal Alignment: Curve Left
Horizontal Alignment: Curve Right
Grade: Level
Grade: Hillcrest
Grade: Uphill
Grade: Downhill
Sag (bottom)
--------------------------------------------------------------------------------
Type TCD: No Controls
Type TCD: Person (including flagger, law enforcement, crossing guard,
etc.)
Type TCD: Traffic control Signal
Type TCD: Flashing Traffic Control Signal
Type TCD: School Zone Signs
Type TCD: Stop Signs
Type TCD: Yield Signs
Type TCD: Warning Signs
Type TCD: Railway Crossing Signs
Type TCD: Other
Type TCD: Unknown
Working Properly? Yes


                                                          Page 32
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Working Properly? No
--------------------------------------------------------------------------------
Movements Essentially Straight Ahead
Backing
Changing Lanes
Overtaking / Passing
Turning Right
Turning Left
Making U-Turn
Leaving Traffic Lane
Entering Traffic Lane
Slowing
Negotiating a Curve
Parked
Stopped in Traffic
Other
Unknown
--------------------------------------------------------------------------------
Area of Initial Impact: Non-Collision
Area of Initial Impact: 12-point Clock Diagram
Area of Initial Impact: Top (roof)
Area of Initial Impact: Undercarriage
Area of Initial Impact: Unknown
Most Damaged Area: Non-Collision
Most Damaged Area: 12-point Clock Diagram
Most Damaged Area: Top (roof)
Most Damaged Area: Undercarriage
Most Damaged Area: Unknown
--------------------------------------------------------------------------------
Non-Collision: Overturn / Rollover
Non-Collision: Fire / Explosion
Non-Collision: Immersion
Non-Collision: Jackknife
Non-Collision: Cargo / Equipment Loss or Shift
Non-Collision: Equipment Failure (blown tire, brake failure, etc.)
Non-Collision: Separation of Units
Non-Collision: Ran Off Road Right
Non-Collision: Ran Off Road Left
Non-Collision: Cross Median / Centerline
Non-Collision: Downhill Runaway
Non-Collision: Fell / Jumped from Motor Vehicle
Non-Collision: Thrown or Falling Object
Non-Collision: Other Non-Collision
Collision with P, MV, or Non-Fixed Object: Pedestrian
Collision with P, MV, or Non-Fixed Object: Pedalcycle

Collision with P, MV, or Non-Fixed Object: Railway Vehicle (train, engine)
Collision with P, MV, or Non-Fixed Object: Animal

Collision with P, MV, or Non-Fixed Object: Motor Vehicle in Transport
Collision with P, MV, or Non-Fixed Object: Parked Motor Vehicle




                                                                  Page 33
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Collision with P, MV, or Non-Fixed Object: Strck by Falling, Shifting Cargo
or A
Collision with P, MV, or Non-Fixed Object: Work Zone / Maintenance
Equipment
Collision with P, MV, or Non-Fixed Object: Other Non-Fixed Object
Collision with Fixed Object: Impact Attenuator / Crash Cushion
Collision with Fixed Object: Bridge Overhead Structure
Collision with Fixed Object: Bridge Pier of Support
Collision with Fixed Object: Bridge Rail
Collision with Fixed Object: Culvert
Collision with Fixed Object: Curb
Collision with Fixed Object: Ditch
Collision with Fixed Object: Embankment
Collision with Fixed Object: Guardrail Face
Collision with Fixed Object: Guardrail End
Concrete Traffic Barrier
Other Traffic Barrier
Tree (standing)
Utility Pole / Light Support
Traffic Sign Support
Traffic Signal Support
Other Post, Pole, Support
Fence
Mailbox
Other Fixed Object (wall, building, tunnel, etc.)
--------------------------------------------------------------------------------
Non-Collision: Overturn / Rollover
Non-Collision: Fire / Explosion
Non-Collision: Immersion
Non-Collision: Jackknife
Non-Collision: Cargo / Equipment Loss or Shift
Non-Collision: Fell / Jumped from Motor Vehicle
Non-Collision: Thrown or Falling Object
Collision with P, MV, or Non-Fixed Object: Pedestrian
Collision with P, MV, or Non-Fixed Object: Pedalcycle

Collision with P, MV, or Non-Fixed Object: Railway Vehicle (train, engine)
Collision with P, MV, or Non-Fixed Object: Animal

Collision with P, MV, or Non-Fixed Object: Motor Vehicle in Transport
Collision with P, MV, or Non-Fixed Object: Parked Motor Vehicle
Collision with P, MV, or Non-Fixed Object: Work Zone / Maintenance
Equipment
Collision with P, MV, or Non-Fixed Object: Other Non-Fixed Object
Collision with Fixed Object: Impact Attenuator / Crash Cushion
Collision with Fixed Object: Bridge Overhead Structure
Collision with Fixed Object: Bridge Pier of Support
Collision with Fixed Object: Bridge Rail
Collision with Fixed Object: Culvert
Collision with Fixed Object: Curb
Collision with Fixed Object: Ditch
Collision with Fixed Object: Embankment


                                                        Page 34
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Collision with Fixed Object: Guardrail Face
Collision with Fixed Object: Guardrail End
Collision with Fixed Object: Concrete Traffic Barrier
Collision with Fixed Object: Other Traffic Barrier
Collision with Fixed Object: Tree (standing)
Collision with Fixed Object: Utility Pole / Light Support
Collision with Fixed Object: Traffic Sign Support
Collision with Fixed Object: Traffic Signal Support
Collision with Fixed Object: Other Post, Pole, or Support
Collision with Fixed Object: Fence
Collision with Fixed Object: Mailbox
Collision with Fixed Object: Other Fixed Object (wall, building, tunnel,
etc.)
Collision with Fixed Object: Unknown
--------------------------------------------------------------------------------
No Underride or Override
Underride, Compartment Intrusion
Underride, No Compartment Intrusion
Underride, Compartment Intrusion Unknown
Override, Motor Vehicle in Transport
Override, Other Motor Vehicle
Unknown if Underride or Override
--------------------------------------------------------------------------------
No, Did Not Leave Scene
Yes, Driver or Car and Driver Left Scene
Unknown
--------------------------------------------------------------------------------
No Damage
Minor Damage
Functional Damage
Disabling Damage
Unknown
--------------------------------------------------------------------------------
Brakes
Steering
Power Train
Suspension
Tires
Wheels
Lights (head, signal, tail)
Windows / Windshield
Mirrors
Wipers
Truck Coupling / Trailer Hitch / Safety Chains
Other
Unknown
None
--------------------------------------------------------------------------------
7 digit US DOT Number
If no US DOT Number, State issued ID Name and Number
Name
Street or PO Box


                                                            Page 35
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City
State (two-letter code)
Zip Code
Country
--------------------------------------------------------------------------------
GVWR: 10,000 lbs (4,536 kg) or less
GVWR: 10,001 - 26,000 lbs (4,536 0 11,793 kg)
GVWR: More than 26,000 lbs (11,793 kg)
--------------------------------------------------------------------------------
Passenger Vehicles Carrying Hazardous Material
Single-Unit Truck (2 axles)
Single-Unit Truck (3 or more axles)
Truck Pulling Trailer(s)
Truck Tractor (bobtail)
Truck Tractor / Semi-Trailer
Truck Tractor / Double
Truck Tractor / Triple
Truck More Than 10,000 lbs (4,536 kg), Cannot Classify
Bus / Large Van (seats for 9 - 15 occupants, including driver)
Bus (seats for more than 15 occupants, including driver)
Unknown
--------------------------------------------------------------------------------
No Cargo Body
Bus
Van / Enclosed Box
Hopper (grain / chips / gravel)
Pole
Cargo Tank
Flatbed
Dump
Concrete Mixer
Auto Transporter
Garbage / Refuse
Other
Not Applicable (motor vehicle less than 10,000 lbs)
Unknown
--------------------------------------------------------------------------------
Yes
No
Unknown
4-digit placard number (from middle of diamond)
1-digit placard number (from bottom of diamond)
Release of hazardous materials: Yes
Release of hazardous materials: No
Release of hazardous materials: Unknown




                                                                    Page 36
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Form_Comment          In_Database              DB_Comment




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posted:8/2/2011
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Description: Recreational Vehicle Equipment Release Form document sample