Fill Out a Valid Wisconsin Accident Template Edit Form Online

Fill Out a Valid Wisconsin Accident Template

The Wisconsin Driver Report of Accident is a crucial document that must be completed when certain conditions arise following a vehicle accident. Specifically, this form is necessary if there is damage exceeding $1,000 to any person's property, if anyone is injured, or if government property incurs damage of $200 or more. Filling out this report accurately and promptly is essential for ensuring that all involved parties are properly documented.

To proceed with the filing, please fill out the form by clicking the button below.

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The Wisconsin Driver Report of Accident form serves as an essential tool for individuals involved in motor vehicle accidents within the state. This form must be completed when certain criteria are met, such as when damages exceed $1,000 to any one person's property, when anyone sustains injuries, or when government property incurs damages of $200 or more. It is important to note that if a law enforcement officer has already filed a Wisconsin Motor Vehicle Accident Report, this form should not be completed. The report requires clear and accurate information, including details about all parties involved, vehicle specifics, and a description of the accident itself. Sections of the form allow for a narrative explanation and a diagram to illustrate the accident's circumstances. Incomplete submissions may be returned for additional information, emphasizing the importance of thoroughness. Individuals are encouraged to retain a copy for their records and to seek assistance from their insurance agents or local law enforcement if needed. For convenience, the form is accessible online through the Wisconsin Department of Transportation's website, making it easier for those affected to fulfill their reporting obligations promptly.

Listed Questions and Answers

  1. What is the purpose of the Wisconsin Driver Report of Accident?

    The Wisconsin Driver Report of Accident is used to document details of a motor vehicle accident. It is necessary to complete this form when there is significant property damage, injuries, or damage to government property. Specifically, it must be filled out if there is $1,000 or more damage to any one person’s property, if anyone was injured, or if there is $200 or more damage to government property other than vehicles.

  2. When should I not complete this form?

    You should not complete the Wisconsin Driver Report of Accident if a law enforcement officer has already filled out a Wisconsin Motor Vehicle Accident Report. In such cases, the officer's report will serve as the official documentation of the incident.

  3. What information is required to complete the form?

    The form requires detailed information about the accident, including:

    • Your identification as "Unit 1."
    • Signatures from individuals involved in the accident.
    • Information about other drivers or vehicle owners.
    • A narrative description of how the accident occurred.
    • A diagram illustrating the accident scene.

    Incomplete forms may be returned for missing information, so it is essential to provide all requested details clearly.

  4. How do I submit the completed report?

    After completing the form, retain a copy for your records. Mail the completed report to:

    TRAFFIC ACCIDENT SECTION
    WISCONSIN DEPT OF TRANSPORTATION
    PO BOX 7919
    MADISON WI 53707-7919

    Ensure the address panel is visible on the outside of the envelope. Fold the report so that the address shows and tape the bottom edge closed. Do not staple the report.

Key takeaways

Filling out the Wisconsin Accident form correctly is crucial for ensuring your report is processed smoothly. Here are some key takeaways to keep in mind:

  • Complete the form when necessary: Use this form if there is $1,000 or more in property damage, anyone is injured, or if there is $200 or more damage to government property.
  • Provide accurate information: Ensure all requested details are filled out clearly. Incomplete forms may be returned, delaying the process.
  • Sign the report: An individual involved in the accident must sign the report. This step is essential for validation.
  • Use the Narrative and Diagram sections: Describe how the accident occurred and provide a visual representation. If more space is needed, attach additional pages.
  • Retain a copy: Before mailing the completed report, keep a copy for your records. This is important for future reference.

By following these guidelines, you can help ensure that your accident report is complete and accurate, facilitating a smoother claims process.

Document Overview

Fact Name Details
Form Title Wisconsin Driver Report of Accident
Usage Requirement Complete the form if there is $1,000 or more damage to property, anyone is injured, or there is $200 or more damage to government property.
Governing Law Wisconsin Statutes, Section 346.70(2)
Signature Requirement An individual involved in the accident must sign the report.
Submission Instructions Mail the completed report to the Traffic Accident Section, Wisconsin Department of Transportation, PO Box 7919, Madison, WI 53707-7919.
Contact Information For assistance, contact WisDOT at (608) 266-8753.
Diagram Section Use the diagram section to illustrate the accident's location and details.
Form Availability The form is available online at www.dot.wisconsin.gov/drivers/drivers/traffic/accident.htm.
Record Keeping Retain a copy of the report for personal records before mailing.

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Misconceptions

Misconceptions about the Wisconsin Accident form can lead to confusion and incomplete submissions. Here are some common misunderstandings clarified:

  • Only law enforcement can file an accident report. Many believe that only a police report is sufficient. However, if no officer is present, individuals involved must complete the Wisconsin Driver Report of Accident.
  • All accidents must be reported. Not every incident requires a report. The form is only necessary if property damage exceeds $1,000, someone is injured, or government property damage is $200 or more.
  • Incomplete forms are acceptable. Some think they can submit a form with missing information. Incomplete reports may be returned, causing delays in processing.
  • Only the driver needs to sign the report. It's a common misconception that only the driver’s signature is necessary. Each individual involved in the accident must sign the report.
  • The narrative section is optional. Many assume they can skip the narrative. Providing a clear explanation of the accident is crucial for context and may influence the outcome of claims.
  • Attachments are not allowed. Some people believe they cannot add extra information. If more space is needed, individuals can use plain paper and attach it to the report.
  • The form can be mailed without a copy. Individuals often think they can send the report without retaining a copy. It’s important to keep a copy for personal records before mailing.
  • It’s unnecessary to specify the type of accident. Some think details about the accident type are irrelevant. However, selecting the correct type helps clarify the circumstances and assists in processing the report.

Form Sample

Wisconsin

DRIVER REPORT OF ACCIDENT

DO NOT COMPLETE this Driver Report of Accident if a law enforcement officer completed a Wisconsin Motor Vehicle Accident Report.

COMPLETE this Wisconsin Driver Report of Accident if:

There was $1000 or more damage to any one person’s property

— OR — Anyone was injured

— OR —

There was $200 or more damage to government property, other than vehicles.

MV4002 3/2014 s.346.70(2) Wis. Stats.

Wisconsin Department of Transportation

Please provide all requested information. Print clearly.

1.You are “Unit 1”.

2.An individual involved in the accident must sign the report.

3.Provide all information on the other driver(s)/owner(s) involved. Incomplete reports may be returned requesting missing information. If you need assistance, contact your insurance agent, local law enforcement agency, or Wisconsin Department of Transportation (WisDOT) at: (608) 266-8753.

4.Use the “Narrative” and “Diagram” sections to explain how the accident happened.

5.If more space is needed, use plain paper and attach to this report.

6.This form is available at: www.dot.wisconsin.gov/drivers/drivers/traffic/accident.htm

Retain a copy of this report for your records before mailing.

Mail completed report to address shown below.

(Fold report so that address panel shows to outside – tape bottom edge closed and mail – Do not staple)

Important – Please print your return address:

TRAFFIC ACCIDENT SECTION

WISCONSIN DEPT OF TRANSPORTATION

PO BOX 7919

MADISON WI 53707-7919

______

PLACE STAMP HERE

______

 

Clear Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WISCONSIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER REPORT

CONTINUE ONLY ...if there was $1000 or more damage to any one person’s property,

 

 

 

 

 

 

 

OF ACCIDENT

OR ...if anyone was injured,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OR ...if there was $200 or more damage to government property, other than vehicles.

 

 

 

 

(See instructions on reverse side

 

 

 

before completing – Please Print)

 

 

Hit and Run Accident?

 

 

 

ACCIDENT

County of

 

 

 

 

City, Village or Township of

ACCIDENT Month

Day

 

Year

Day of Week

 

 

Time

 

a.m.

 

 

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

p.m.

 

Total Units Involved

Total Injured *

 

LOCATION

Name and Number of Street(s) or Highway or Parking Lot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE OF

(Please check one)

 

 

Hit another motor

 

 

 

Hit a parked vehicle

Hit a deer

 

Hit a bicyclist

 

 

 

 

Other

 

ACCIDENT

 

 

 

 

 

 

 

 

 

1 vehicle in operation

 

 

 

2

 

 

 

 

 

3

 

 

 

 

4/5 or pedestrian

 

 

 

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

U Driver Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

 

U Driver Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

 

NI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth Date

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth Date

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State

 

 

 

 

 

 

 

 

 

ZIP Code

 

Daytime Telephone Number

 

City, State

 

 

 

 

 

ZIP Code

 

 

Daytime Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Driver License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issuing State

 

 

2 Driver License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issuing State

 

 

Vehicle Legally Parked

 

Operating a commercial vehicle?

 

 

 

 

 

If yes, check

 

 

 

 

Vehicle Legally Parked

 

 

Operating a commercial vehicle?

 

 

If yes, check

 

 

 

 

YES

 

 

 

 

 

YES

 

 

 

 

 

 

appropriate classification

 

 

 

YES

 

 

 

YES

 

 

 

 

 

appropriate classification

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A B C

 

 

 

 

 

 

 

 

 

 

 

 

A B C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Full Name (Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State

 

 

 

 

 

 

 

 

 

ZIP Code

 

Daytime Telephone Number

 

 

 

City, State

 

 

 

 

 

ZIP Code

 

 

Daytime Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

License Plate Number

 

Exp Yr

Issuing State

 

Vehicle Make

 

Year

 

Color

 

 

 

 

License Plate Number

 

 

Exp Yr

Issuing State

Vehicle Make

Year

 

Color

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was a motor vehicle liability insurance policy

 

 

Policy Holder’s Name

 

 

 

 

 

 

 

Was a motor vehicle liability insurance policy

Policy Holder’s Name

 

 

 

 

 

 

 

 

in effect on the day of the accident?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

in effect on the day of the accident?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exact Name of Insurance Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exact Name of Insurance Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*INJURED Important:

Number of injuries reported must equal number entered in “Total Injured” box above.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For additional injuries, provide the information on a separate piece of paper and attach. Injury Codes: A=Severe, B=Moderate, C=Minor

Unit No.

Name (Last, First, MI)

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

City, State

 

 

ZIP Code

 

Sex

 

Birth Date

 

 

Injury Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unit No.

Name (Last, First, MI)

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

City, State

 

 

ZIP Code

 

Sex

 

Birth Date

 

 

Injury Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VEHICLE Unit 1 Important: Circle the numbers closest to the damaged areas.

 

 

Unit 2 Important: Circle the numbers closest to the damaged areas.

 

DAMAGE Damage Estimate

 

 

6

 

 

 

7

8

 

 

 

 

 

 

 

Damage Estimate

 

6

7

8

 

 

 

 

 

 

 

 

 

 

 

 

(Required)

5

REAR

 

 

 

 

 

 

 

 

 

FRONT

 

1

 

 

 

 

 

(If Known)

5

REAR

 

 

 

 

 

 

FRONT

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

3

2

 

 

 

 

 

 

 

4

3

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROPERTY Describe what was damaged. Property damage includes structures, trees, fences, towed items, etc. Do NOT include vehicle damage.

 

 

 

 

 

 

 

 

 

 

 

DAMAGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property Owner Full Name (Last, First, MI)

 

 

Address

 

 

 

 

 

 

 

 

 

City, State

 

 

ZIP Code

 

 

 

 

 

Daytime Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NARRATIVE Print a brief description of the accident.

 

 

 

 

 

 

 

 

 

 

 

DIAGRAM Draw a basic picture of

 

 

Indicate NORTH by putting

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the accident and location.

 

 

an arrow in the circle.

 

 

 

X

(Signature Required)

Print