Sample Form Fr300p - Police Crash Report Page 5
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6Commonwealth of Virginia
Department of Motor Vehicles
FR300P (Rev 1/12)
•
Officer Initials________ Badge # __________
Police Crash Report
Page _______ of _______
Revised Report
CRASH
Crash
MM DD YYYY
MILITARY Time (24 hr clock) County of Crash
Local Case Number
City of
Date
Town of
COMMERCIAL MOTOR VEHICLE SECTION
This form is being completed because the vehicle is:
A Truck or Truck Combination Rating Greater
Any Motor Vehicle That Seats
A Vehicle of Any Type with a Hazardous Materials
Than 10,000 lbs. (GVWR/GCWR)
9 or More People, Including the Driver
Placard Regardless of Weight
AND
The crash resulted in:
A fatality: any person(s) killed in or outside of any
An injury: any person(s) injured as a
A tow-away: any motor vehicle (truck,
bus, car, etc.) disabled as a result of the
vehicle (truck, bus, car, etc.) involved in the crash or
result of the crash who immediately
OR
OR
crash and transported away from the
who dies within 30 days of the crash as a result of
receives medical treatment away from
scene by a tow truck or other vehicle
an injury sustained in the crash
the crash scene
VEHICLE #
Vehicle Configuration
Cargo Body Type
License
Commercial
V10
V11
P8
P9
Class
Endorsement
1. Passenger Car (Only if Vehicle Has Hazardous Materials Placard)
1. Bus (Seats 9-15 People,
10. Grain/Chips/Gravel
Including Driver)
2. Light Truck (Only if Vehicle Has Hazardous Materials Placard)
11. Pole-Trailer
Class A
T–Double Trailer
2. Bus (Seats For 16 People or
3. Bus (Seats 9-15 People, Including Driver)
12. Vehicle Towing Another
Class B
P–Passenger Vehicle
More, Including Driver)
4. Bus (Seats for 16 People or More, Including Driver)
Motor Vehicle
Class C
N–Tank Vehicle
3. Van/Enclosed Box
5. Single Unit Truck (2 Axles, 6 Tires)
13. Intermodel Container
Class DRL
H–Required To Be
4. Cargo Tank
Chassis
6. Single Unit Truck (3 or More Axles)
(regular
Placarded for
5. Flatbed
14. Logging
drivers
7. Truck Trailer(s) [Single-Unit Truck Pulling Trailer(s)]
Hazardous Material s
license)
6. Dump
15. Other Cargo Body
8. Truck Tractor (Bobtail)
X–Combined Tank/HAZMAT
Class M
(Not Listed Above)
7. Concrete Mixer
9. Tractor/Semi-trailer (One Trailer)
O–Other
16. Not Applicable/
8. Auto Transporter
10. Tractor/Doubles (Two Trailers)
GVWR/
V12
No Cargo Body
1. 10,000 lbs. or Less
9. Garbage/Refuse
11. Other Truck Greater Than 10,000 lbs. (Not Listed Above)
GCWR
2. 10,001–26,000 lbs.
Hazardous Material
3. Greater Than 26,000 lbs.
Hazardous Material Placard:
Y
N
HM Cargo Present
HM Cargo Released
HM 4–Digit
HM Placard Name
HM Class
Y
N
Y
N
Carrier Identification
Commercial/Non-Commercial
V13
Commercial Motor Carrier Name
Address (P.O. Box if No Street Address)
1. Interstate Carrier
2. Intrastate Carrier
Carrier’s ID Number
State
City
State
Zip
(Intrastate Only)
3. Not in Commerce-Government (Trucks and Buses)
US DOT#
4. Not in Commerce-Other Truck (Over 10,000 lbs.)
VEHICLE #
Cargo Body Type
Vehicle Configuration
License
Commercial
V10
V11
P8
P9
Class
Endorsement
1. Passenger Car (Only if Vehicle Has Hazardous Materials Placard)
1. Bus (Seats 9-15 People,
10. Grain/Chips/Gravel
Including Driver)
2. Light Truck (Only if Vehicle Has Hazardous Materials Placard)
11. Pole-Trailer
Class A
T–Double Trailer
2. Bus (Seats For 16 People or
3. Bus (Seats 9-15 People, Including Driver)
12. Vehicle Towing Another
Class B
P–Passenger Vehicle
More, Including Driver)
4. Bus (Seats for 16 People or More, Including Driver)
Motor Vehicle
Class C
N–Tank Vehicle
3. Van/Enclosed Box
13. Intermodel Container
5. Single Unit Truck (2 Axles, 6 Tires)
Class DRL
H–Required To Be
4. Cargo Tank
Chassis
6. Single Unit Truck (3 or More Axles)
(regular
Placarded for
5. Flatbed
14. Logging
drivers
7. Truck Trailer(s) [Single-Unit Truck Pulling Trailer(s)]
Hazardous Material s
license)
6. Dump
15. Other Cargo Body
8. Truck Tractor (Bobtail)
X–Combined Tank/HAZMAT
Class M
(Not Listed Above)
7. Concrete Mixer
9. Tractor/Semi-trailer (One Trailer)
O–Other
16. Not Applicable/
8. Auto Transporter
10. Tractor/Doubles (Two Trailers)
GVWR/
V12
No Cargo Body
1. 10,000 lbs. or Less
9. Garbage/Refuse
11. Other Truck Greater Than 10,000 lbs. (Not Listed Above)
GCWR
2. 10,001–26,000 lbs.
Hazardous Material
3. Greater Than 26,000 lbs.
Hazardous Material Placard:
Y
N
HM Cargo Present
HM Cargo Released
HM 4–Digit
HM Placard Name
HM Class
Y
N
Y
N
Carrier Identification
Commercial/Non-Commercial
V13
Commercial Motor Carrier Name
Address (P.O. Box if No Street Address)
1. Interstate Carrier
2. Intrastate Carrier
Carrier’s ID Number
State
City
State
Zip
(Intrastate Only)
3. Not in Commerce-Government (Trucks and Buses)
US DOT#
4. Not in Commerce-Other Truck (Over 10,000 lbs.)
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