Crash Report Sampling System Form

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OMB Control No. 2127-0714
Expiration Date 12/31/2022

2022 Crash Report Sampling System
CRASH LEVEL
Full disclaimer text: This collection of information is voluntary and will be used for informative purposes only. The collection of information will allow NHTSA to develop and
evaluate programs designed to reduce the number of motor vehicle-related injuries and deaths. NHTSA will not collect any personal information that would allow anyone to
identify persons involved in the motor vehicle traffic crash. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information
displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0714. Public reporting for this collection of information is
estimated to be approximately 30 minutes per response, including the time for reviewing instructions, completing, and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer,
National Highway Traffic Safety Administration, W51-316, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Original Strata :

Final Strata :

PSU #

PAR ID

PAR #

**Number of Forms Submitted for Persons Not in Motor Vehicles

**Number of Vehicle Submitted

**Number of Motor Vehicle Occupant Forms Submitted

Crash Date

Crash Time
/

/

:

2022

Relation To Junction: Within Interchange Area

Relation To Junction: Specific Location

0 - No

01 - Non-Junction

1 - Yes

02 - Intersection

8 - Not Reported

03 - Intersection-Related

9 - Reported as Unknown

04 - Driveway Access
05 - Entrance/Exit Ramp Related
06 - Railway Grade Crossing
07 - Crossover-Related
08 - Driveway Access Related
16 - Shared-Use Path Crossing
17 - Acceleration/Deceleration Lane
18 - Through Roadway
19 - Other location within interchange area
20 - Entrance/Exit Ramp
98 - Not Reported
99 - Reported as Unknown

Type of Intersection

Relation to Trafficway

01 - Not an Intersection

01 - On Roadway
02 - On Shoulder

NHTSA Form 1696

02
Intersection
03 -- Four-Way
T-Intersection

03 - On Median

04 - Y-Intersection

04 - On Roadside

05 - Traffic Circle

05 - Outside Trafficway

06 - Roundabout

06 - Off Roadway-Location Unknown

07 - Five Point, or More

07 - In Parking Lane/Zone

10 - L-Intersection

08 - Gore

11 - Other Intersection Type

10 - Separator

98 - Not Reported

11 - Continuous Left - Turn Lane

99 - Reported as Unknown

12 - Pedestrian Refuge Island or Traffic Island
98 - Not Reported
99 - Reported as Unknown

Work Zone

Light Condition

0 - None

1 - Daylight

1 - Construction

2 - Dark - Not Lighted

2 - Maintenance

3 - Dark - Lighted

3 - Utility

4 - Dawn

4 - Work Zone, Type Unknown

5 - Dusk
6 - Dark - Unknown Lighting
7 - Other
8 - Not Reported
9 - Reported as Unknown

Atmospheric Conditions

School Bus Related

01 - Clear
02 - Rain
03 - Sleet or Hail
04 - Snow
05 - Fog, Smog, Smoke
06 - Severe Crosswinds
07 - Blowing Sand, Soil, Dirt
08 - Other
10 - Cloudy
11 - Blowing Snow
12 - Freezing Rain or Drizzle
98 - Not Reported
99 - Reported as Unknown

Crash Related Factors

Interstate Highway
NHTSA Form 1696

County

Global Position
Deg

Min

Sec

Latitude:

Longitude:

NHTSA Form 1696

2022 Crash Report Sampling System
CRASH LEVEL - CRASH EVENTS

Click here to open Clock Point Diagrams
First Harmful Event

Manner of Collision of the First Harmful Event

Vehicle No.
(This)

Area of Impact (AOI) (This)

Sequence Of Events (SOE)

Vehicle No.

Area of Impact (AOI) (Other)

(Other)

NHTSA Form 1696

OMB Control No. 2127-0714
Expiration Date 12/31/2022

2022 Crash Report Sampling System
VEHICLE LEVEL # 1
PSU #

Number of Occupants

PAR ID

**Vehicle Number

**Number Of Occupants

Unit Type

1 - Motor Vehicle In-Transport (Inside or Outside the
Trafficway)
2 - Motor Vehicle Not In-Transport Within the Trafficway
3 - Motor Vehicle Not In-Transport Outside the
Trafficway
4 - Working Motor Vehicle (Highway Construction,
Maintenance, Utility only)
Hit and Run

Registration State

0 - No
1 - Yes

Travel Speed

Vehicle Underride/Override

0 - No Underride or Override
1 - Underride
2 - Override
7 - Not Applicable
8 - Not Reported
9 - Reported as Unknown
Rollover

Location of Rollover

0 - No Rollover

0 - No Rollover

3 - Rollover

1 - On Roadway

8 - Not Applicable

2 - On Shoulder
3 - On Median/Separator
4 - In Gore
5 - On Roadside
6 - Outside of Trafficway
7 - In Parking Lane/Zone
8 - Not Applicable
9 - Unknown

Areas of Impact-Initial

NHTSA Form 1696

00 - Non-Collision
01 - 1 Clock Point
02 - 2 Clock Point
03 - 3 Clock Point
04 - 4 Clock Point
05 - 5 Clock Point
06 - 6 Clock Point
07 - 7 Clock Point
08 - 8 Clock Point
09 - 9 Clock Point
10 - 10 Clock Point
11 - 11 Clock Point
12 - 12 Clock Point
13 - Top
14 - Undercarriage
18 - Cargo/Vehicle Parts Set-In-Motion
19 - Other Objects or Person Set-In-Motion
20 - Object Set in Motion, Unknown if Cargo/Vehicle
Parts or Other
61 - Left
62 - Left-Front Side
63 - Left-Back Side
81 - Right
82 - Right-Front Side
83 - Right-Back Side
98 - Not Reported
99 - Reported as Unknown

Extent of Damage

Vehicle Towed

0 - No Damage

5 - Not Towed

2 - Minor Damage

6 - Towed

4 - Functional Damage

8 - Not Reported

6 - Disabling Damage

9 - Reported as Unknown

7 - Damage Reported, Extent Unknown
8 - Not Reported
9 - Reported as Unknown

Vehicle Sequence of Events

Most Harmful Event

Vehicle License Plate Number
NHTSA Form 1696

NHTSA Form 1696

DAMAGED AREAS FOR VEHICLE# 1
01-1 Clock Value
02-2 Clock Value

Damaged Areas
Left

12

03-3 Clock Value
04-4 Clock Value
05-5 Clock Value
06-6 Clock Value
07-7 Clock Value

Top
13

11

1

10

2

9

3

8

4

7

5

08-8 Clock Value
09-9 Clock Value
10-10 Clock Value
11-11 Clock Value
12-12 Clock Value
13-Top
14-Undercarriage
15-No Damage
99-Damage Areas Unknown

14
Under

6

Right

VIN INFORMATION FOR VEHICLE# 1
Vehicle Model Year

VIN
00000000000000000 - No VIN Required, Not a Vehicle
for Road Use
88888888888888888 - Not Reported
99999999999999999 - Reported as Unknown

vPIC Make

vPIC Model

vPIC Body Class

Final Stage Body Class

NCSA Make

NCSA Model

NCSA Body Type

Power Unit GVWR From

Power Unit GVWR To

Automation System(s) in Vehicle

NHTSA Form 1696

Highest Automation System Level Present in Vehicle

Highest Automation System Level Engaged at Time of
Crash

NHTSA Form 1696

DETAILS FOR VEHICLE# 1
Motor Carrier ID Issuing Authority

Motor Carrier Identification Number

Vehicle Configuration

00 - Not Applicable
01 - Single-Unit Truck (2- axle and GVWR more than
10,000 lbs)
02 - Single-Unit Truck (3 or more axles)
04 - Truck Pulling Trailer(s)
05 - Truck Tractor (Bobtail)
06 - Truck Tractor/Semi-Trailer
07 - Truck Tractor/Double
08 - Truck Tractor/Triple
10 - Vehicle 10,000 pounds or less placarded for
hazardous materials
19 - Vehicle More Than 10,000 lbs., Other
20 - Bus/Large Van (seats for 9-15 occupants, including
driver)
21 - Bus (seats for more than 15 occupants, including
driver)
88 - Qualifying Vehicle, Unknown Configuration
99 - Unknown

Cargo Body Type

HM1: Hazardous Material Involvement

00 - Not Applicable (N/A)

1 - No

01 - Van/Enclosed Box

2 - Yes

02 - Cargo Tank
03 - Flatbed

HM2: Placard

04 - Dump
05 - Concrete Mixer

0 - Not Applicable

06 - Auto Transporter

1 - No

07 - Garbage/Refuse

2 - Yes

08 - Grain/ Chips/ Gravel

8 - Not Reported

09 - Pole-Trailer
10 - Log
11 - Intermodal Container Chassis
12 - Vehicle Towing Another Motor Vehicle

HM3: Hazardous Material ID Number

0000 - Not Applicable

22 - Bus

8888 - Not Reported

96 - No Cargo Body Type

HM4: Hazardous Material Class Number

97 - Other
98 - Unknown Cargo Body Type
99 - Unknown

00 - Not Applicable
01 - 01
02 - 02
03 - 03

NHTSA Form 1696

04
05 -- 04
05
06 - 06
07 - 07
08 - 08
09 - 09
88 - Not Reported
HM5: Release of Hazardous Material from the Cargo
Compartment

0 - Not Applicable
1 - No
2 - Yes
8 - Not Reported

NHTSA Form 1696

OTHER INFORMATION FOR VEHICLE# 1
Vehicle Trailing

Jackknife

0 - No Trailers

0 - Not an Articulated Vehicle

1 - One Trailer

1 - No

2 - Two Trailers

2 - Yes - First Event

3 - Three or More Trailers

3 - Yes - Subsequent Event

4 - Yes, Number of Trailers Unknown
5 - Vehicle Towing Another Motor Vehicle - Fixed
Linkage
6 - Vehicle Towing Another Motor Vehicle - Non-Fixed
Linkage
7 - Trailing Unit Other than a Trailer or Another Motor
Vehicle
9 - Unknown
Bus Use

Special Use

00 - Not a Bus

00 - No Special Use Noted

01 - School

01 - Taxi

04 - Intercity

02 - Vehicle Used for School Transport

05 - Charter/Tour

03 - Vehicle Used as Other Bus

06 - Transit/ Commuter

04 - Military

07 - Shuttle

05 - Police

08 - Modified for Personal/Private Use

06 - Ambulance

97 - Bus, Unknown Use

07 - Fire Truck

98 - Not Reported

08 - Non-Transport Emergency Services Vehicle

99 - Reported as Unknown

10 - Safety Service Patrols – Incident Response
11 - Other Incident Response
12 - Towing – Incident Response
19 - Motor Vehicle Used for Vehicle Sharing Mobility
20 - Motor Vehicle Used for Electronic Ride-hailing
21 - Mail Carrier
22 - Public Utility
23 - Rental Truck over 10,000 lbs.
24 - Truck Operating with Crash Attenuator Equipment
99 - Reported as Unknown

Emergency Motor Vehicle Use

Vehicle Related Factors

0 - Not Applicable
2 - Non-Emergency, Non-Transport
3 - Non-Emergency Transport
4 - Emergency Operation, Emergency Warning
Equipment Not in Use

NHTSA Form 1696

5 - Emergency Operation, Emergency Warning
Equipment in Use
6 - Emergency Operation, Emergency Warning
Equipment in Use Unknown
8 - Not Reported
9 - Reported as Unknown
Fire Occurrence

0 - No or Not Reported
1 - Yes

NHTSA Form 1696

TRAILER INFORMATION FOR VEHICLE# 1

Trailer VIN (1)

vPIC Make
vPIC Body Class

00000000000000000 - No VIN Required, Not a Vehicle for
Road Use
77777777777777777 - No Trailing Units
88888888888888888 - Not Reported

vPIC Trailer Body Type
vPIC Model
vPIC Model Year

99999999999999999 - Reported as Unknown
Trailer GVWR

Trailer VIN (2)

vPIC Make
vPIC Body Class

00000000000000000 - No VIN Required, Not a Vehicle for
Road Use
77777777777777777 - No Trailing Units
88888888888888888 - Not Reported

vPIC Body Type
vPIC Model
vPIC Year

99999999999999999 - Reported as Unknown
Trailer GVWR

Trailer VIN (3)

vPIC Make
vPIC Body Class

00000000000000000 - No VIN Required, Not a Vehicle for
Road Use

vPIC Trailer Body Type

77777777777777777 - No Trailing Units

vPIC Year

88888888888888888 - Not Reported

vPIC Model

99999999999999999 - Reported as Unknown
Trailer GVWR

NHTSA Form 1696

2022 Crash Report Sampling System
PRECRASH LEVEL (VEHICLE/DRIVER) FOR VEHICLE# 1
PSU #

PAR ID

Contributing Circumstances, Motor Vehicle

00 - None Noted
01 - Tires
02 - Brake System
03 - Steering

**Vehicle Number

Trafficway Description
0 - Non-Trafficway or Driveway Access
1 - Two-Way, Not Divided
2 - Two-Way, Divided, Unprotected Median
3 - Two-Way, Divided, Positive Median Barrier
4 - One-Way Trafficway

04 - Suspension

5 - Two-Way, Not Divided With a Continuous Left-Turn
Lane

05 - Power Train

6 - Entrance/Exit Ramp

06 - Exhaust System

7 - Two-Way Divided, Unknown if Unprotected Median
or Positive Median Barrier

07 - Head Lights

8 - Not Reported

08 - Signal Lights

9 - Reported as Unknown

09 - Other Lights
10 - Wipers
11 - Wheels
12 - Mirrors
13 - Windows/Windshield
14 - Body, Doors
15 - Truck Coupling/Trailer Hitch/Safety Chains
16 - Safety Systems
17 - Vehicle Contributing Factors - No Details
97 - Other
99 - Reported as Unknown
Total Lanes in Roadway

Speed Limit

0 - Non-Trafficway or Driveway Access
1 - One lane
2 - Two lanes
3 - Three lanes
4 - Four lanes
5 - Five lanes
6 - Six lanes
7 - Seven or more lanes

NHTSA Form 1696

8 - Not Reported
9 - Reported as Unknown

Roadway Alignment

Roadway Grade

0 - Non-Trafficway or Driveway Access

0 - Non-Trafficway or Driveway Access

1 - Straight

1 - Level

2 - Curve Right

2 - Grade, Unknown Slope

3 - Curve Left

3 - Hillcrest

4 - Curve - Unknown Direction

4 - Sag (Bottom)

8 - Not Reported

5 - Uphill

9 - Reported as Unknown

6 - Downhill
8 - Not Reported
9 - Reported as Unknown

Roadway Surface Conditions

Traffic Control Device

00 - Non-Trafficway or Driveway Access

00 - No Controls

01 - Dry

01 - Traffic control signal (on colors) without Pedestrian
Signal

02 - Wet
03 - Snow
04 - Ice/Frost

02 - Traffic control signal (on colors) with Pedestrian
Signal

06 - Water (Standing or Moving)

03 - Traffic control signal(on colors) not known whether
or not Pedestrian Signal

07 - Oil

04 - Flashing Traffic Control Signal

08 - Other

07 - Lane Use Control Signal

10 - Slush

08 - Other Highway Traffic Signal

11 - Mud, Dirt or Gravel

09 - Unknown Highway Traffic Signal

98 - Not Reported

20 - Stop Sign

99 - Reported as Unknown

21 - Yield Sign

05 - Sand

23 - School Zone Sign/Device
28 - Other Regulatory Sign
29 - Unknown Regulatory Sign
40 - Warning Sign
50 - Person
65 - Railway Crossing Device
97 - Not Reported
98 - Other
99 - Reported as Unknown

NHTSA Form 1696

Device Functioning

0 - No Controls
1 - Device Not Functioning
2 - Device Functioning-Functioning Improperly
3 - Device Functioning Properly
4 - Device Not Functioning or Device Functioning
Improperly, Specifics Unknown
8 - Not Reported
9 - Reported as Unknown

Driver's Vision Obscured By

Driver Maneuvered to Avoid

Driver Distracted By

Pre-Event Movement(Prior to Recognition of Critical
Event)

Critical Event-Precrash (Category)

Critical Event -Precrash (Event)

1 - This Vehicle Loss of Control Due To:

10 - Over the lane line on left side of travel lane

2 - This Vehicle Traveling

11 - Over the lane line on right side of travel lane

3 - Other Motor Vehicle in Lane

12 - Off the edge of the road on the left side

4 - Other Motor Vehicle Encroaching into Lane

13 - Off the edge of the road on the right side

5 - Pedestrian or Pedalcyclist or Other Non-Motorist

14 - End departure

6 - Object or Animal

15 - Turning Left

7 - Other

16 - Turning Right

9 - Unknown

17 - Crossing Over (Passing Through) Junction
18 - This vehicle decelerating
19 - Unknown travel direction
20 - Backing
21 - Making a U-Turn

Attempted Avoidance Maneuver

Pre-Impact Stability

00 - No Driver Present / Unknown if Driver Present

0 - No Driver Present / Unknown if Driver Present

01 - No Avoidance Maneuver

1 - Tracking

05 - Releasing brakes

2 - Skidding longitudinally rotation less than 30 degrees

06 - Steering left

3 - Skidding laterally clockwise rotation

NHTSA Form 1696

07
rightsteering left
08 -- Steering
Braking and

4
rotation
5 -- Skidding
Skidding laterally
Laterally,counterclockwise
Rotation Direction
Unknown

09 - Braking and steering right

7 - Other vehicle loss-of-control (specify:)

10 - Accelerating

9 - Precrash stability unknown

11 - Accelerating and steering left
12 - Accelerating and steering right
15 - Braking and Unknown Steering Direction
16 - Braking
98 - Other actions (specify:)
99 - Unknown/Not Reported
Pre-Impact Location

Crash Type

0 - No Driver Present / Unknown if Driver Present
1 - Stayed in original travel lane
2 - Stayed on roadway, but left original travel lane
3 - Stayed on roadway, not known if left original travel
lane
4 - Departed roadway
5 - Remained off roadway
6 - Returned to roadway
7 - Entered roadway
9 - Unknown

NHTSA Form 1696

2022 Crash Report Sampling System
DRIVER LEVEL FOR VEHICLE# 1
PSU #

PAR ID

**Vehicle Number

Driver Presence

Driver Zip Code

0 - No Driver Present/Not Applicable

00000 - Not resident of U.S. or Territories

1 - Yes

99998 - Not Reported

9 - Unknown

99999 - Reported as Unknown

Violations Charged

Speeding Related

0 - No
2 - Yes, Racing
3 - Yes, Exceeded Speed Limit
4 - Yes, Too Fast for Conditions
5 - Yes, Specifics Unknown
9 - Reported as Unknown

Condition (Impairment) At Time of Crash

00 - None/Apparently Normal
01 - Ill, Blackout
02 - Asleep or Fatigued
03 - Walking with a Cane or Crutches, etc.
04 - Paraplegic or in a Wheelchair
05 - Impaired Due to Previous Injury
06 - Deaf/Hard of Hearing
07 - Blind/Low Vision
08 - Emotional (depressed, angry, disturbed, etc.)
09 - Under the Influence of Alcohol, Drugs or
Medication
10 - Physical Impairment - No Details
96 - Other Physical Impairment
98 - Not Reported
99 - Reported as Unknown if Impaired

Driver Related Factors
NHTSA Form 1696

NHTSA Form 1696

2022 Crash Report Sampling System
PERSON LEVEL (MV OCCUPANT) FOR VEHICLE# 1 AND PERSON# 1
PSU #

PAR ID

Age

**Vehicle Number

**Person Number

Sex/Gender

1 - Male
2 - Female
3 - Other (e.g., "X", Non-Binary, Not Specified, etc.)
8 - Not Reported
9 - Reported as Unknown
Person Type

Injury Severity

01 - Driver of a Motor Vehicle In-Transport

0 - No Apparent Injury (O)

02 - Passenger of a Motor Vehicle In-Transport

1 - Possible Injury (C)

03 - Occupant of a Motor Vehicle Not In- Transport

2 - Suspected Minor Injury (B)

09 - Unknown Occupant Type in a Motor Vehicle InTransport

3 - Suspected Serious Injury (A)
4 - Fatal Injury (K)
5 - Injured, Severity Unknown
6 - Died Prior to Crash*
9 - Unknown/Not Reported

Seating Position

Transported to First Medical Facility By

11 - Front Seat, Left Side

0 - Not Transported for Treatment

12 - Front Seat, Middle

1 - EMS Air

13 - Front Seat, Right Side

2 - Law Enforcement

18 - Front Seat, Other

3 - EMS Unknown Mode

19 - Front Seat, Unknown

4 - Transported Unknown Source

21 - Second Seat, Left Side

5 - EMS Ground

22 - Second Seat, Middle

6 - Other

23 - Second Seat, Right Side

8 - Not Reported

28 - Second Seat, Other

9 - Reported as Unknown

29 - Second Seat, Unknown
31 - Third Seat, Left Side
32 - Third Seat, Middle
33 - Third Seat, Right Side
38 - Third Seat, Other
39 - Third Seat, Unknown
41 - Fourth Seat, Left Side
42 - Fourth Seat, Middle
43 - Fourth Seat, Right Side
48 - Fourth Seat, Other
49 - Fourth Seat, Unknown

NHTSA Form 1696

50 - Sleeper Section of Cab (Truck)
51 - Other Passenger in enclosed passenger or cargo
area
52 - Other Passenger in unenclosed passenger or cargo
area
53 - Other Passenger in passenger or cargo area,
unknown whether or not enclosed
54 - Trailing Unit
55 - Riding on Exterior of Vehicle
56 - Appended to a Motor Vehicle for Motion
98 - Not Reported
99 - Reported as Unknown

Person Related Factors

SAFETY DEVICES FOR VEHICLE# 1 AND PERSON# 1
Helmet Use

Restraint System Use
Type of Restraint System in Use

Helmet Use

01 - Shoulder Belt Only Used

05 - DOT-Compliant Motorcycle Helmet

02 - Lap Belt Only Used
03 - Shoulder and Lap Belt Used

16 - Helmet, Other than DOT-Compliant Motorcycle
Helmet

04 - Child Restraint Type Unknown

17 - No Helmet

06 - Racing-Style Harness Used

19 - Helmet, Unknown if DOT-Compliant

08 - Restraint Used - Type Unknown

20 - Not Applicable

10 - Child Restraint System - Forward Facing

98 - Not Reported

11 - Child Restraint System - Rear Facing

99 - Reported as Unknown if Helmet Worn

12 - Booster Seat
20 - None Used/Not Applicable

Indication of Helmet Misuse?

97 - Other
98 - Not Reported

0 - No Indication of Misuse

99 - Reported as Unknown

1 - Yes, Indication of Misuse

Indication of Restraint System Misuse?

7 - None Used/Not Applicable

0 - No Indication of Misuse
1 - Yes, Indication of Misuse
7 - None Used/Not Applicable
Air Bag Deployed

01 - Deployed- Front
02 - Deployed- Side (door, seatback)
03 - Deployed- Curtain (roof)
07 - Deployed- Other (Knee, air belt, etc.)

Ejection

0 - Not Ejected
1 - Totally Ejected
2 - Partially Ejected
3 - Ejected - Unknown Degree
7 - Not Reported

NHTSA Form 1696

08 - DeploymentDeployed- Combination
09
Unknown Location
20 - Not Deployed

8 - Not Applicable
9 - Reported as Unknown if Ejected

98 - Not Reported
99 - Reported as Deployment Unknown

NHTSA Form 1696

2022 Crash Report Sampling System
ALCOHOL FOR VEHICLE# 1 AND PERSON# 1
Police-Reported Alcohol Involvement

Alcohol Test Status

0 - No (Alcohol Not Involved)

0 - Test Not Given

1 - Yes (Alcohol Involved)

2 - Test Given

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown if Tested

Alcohol Test Type

Alcohol Test Result

00 - Test Not Given
01 - Blood
02 - Breath Test (AC)
03 - Urine
08 - Other Test Type
10 - Preliminary Breath Test (PBT)
11 - Breath Test, Unknown Type
95 - Not Reported
98 - Unknown Test Type
99 - Reported as Unknown if Tested
Police Reported Drug Involvement

NHTSA Form 1696