DR 2447 (02/01/06)

COLORADO DEPARTMENT OF REVENUE

MAIL TO: STATE OF COLORADO

MOTOR VEHICLE
TRAFFIC RECORDS
DENVER, CO 80261-0016

STATE OF COLORADO TRAFFIC ACCIDENT REPORT

AMENDED/SUPPL.

UNDER $1,000

CDOT Code

Case #
Date of Accident
Officer Number

Number Killed

Number Injured

Agency Code
Traffic Unit #
1 or _______

County #

Signature

Detail

______ Miles ______ Feet

N
S
E
W
OF:
___________________________________ At: ___________________________________
Latitude _________ _________ _________ Longitude _________ _________ ________

Investigated Total Vehicles District Number Public Property/ Photos Taken Railroad Crossing Const. Zone Highway
Interchg.
@ Scene
Employee
Related
Related
Veh.

Location Route, Street, Road

Parked

Bicycle

Pedestrian

Traffic Unit #
Non-Contact Veh. 2 or _______

Non-Vehicle

First

MI

Street Address

Personal Phone

(
City

State

Driver License Number

ZIP
CDL

Parked

Bicycle

Last Name

Pedestrian

Non-Vehicle

Sex

DOB

Non-Contact Veh.

M
M

MI
Personal Phone

Bridge
Related

First

Street Address

Bus. Phone
State

Veh.

)
City

State

Driver License Number

ZIP
CDL State

)
N

Bus. Phone

Sex

DOB

Primary Violation

Primary Violation

DUI

DUI

Violation Code
Year

County

Officer Name

Last Name

K
K

Agency

Date of Report
B

PAGE ______ OF ______ PAGES

DOR Code

MILEPOINT

City

Time (24 Hr.)

PRIVATE PROPERTY

HWY NUMBER

INTERSTATE HWY
STATE HWY
CITY ST/CNTY RD

COUNTER REPORT

Citation Number

Make

Model

Common Code

Violation Code

Body Type

Year

Citation Number

Make

Common Code

Model

Body Type

State or Country

Color

P
D

License Plate Number

State or Country

License Plate Number

Color

Vehicle Identification Number

Vehicle Identification Number

Vehicle Owner Last Name
E

Address

Same

First

Same

Towed Due to Damage

To:

MI

City

State ZIP

Vehicle Owner Last Name

Address

First

Same

Towed Due to Damage

To:

By:

Same

City

MI
State ZIP

By:

Q
Q

Trailer VIN#___________________________

____ Undercarriage

_____ Undercarriage
Insurance Company

None

No Proof

Trailer VIN#___________________________

1- Slight
2- Moderate
3- Severe
Exp. Date

_____ Undercarriage
Insurance Company

Policy Number

None

____ Undercarriage
No Proof

1- Slight
2- Moderate
3- Severe
Exp. Date

R
R

Policy Number

Owner Damaged Prop. Last Name

First

MI

Address

City

State ZIP

Owner Damaged Prop. Last Name

First

MI

Address

City

State ZIP

T.U. POS. REST.ENDO.

#

SAFETY
EQUIP.

AIR BAG

SUSPECTED INJ.
EJECT ALCO DRUG SEV. AGE SEX NAME / ADDRESS

S
S

T
T

Approved By

I.D. #

Date

PAGE ______ OF ______ PAGES

AA

Case #

DOR CODE

Accident Date

Agency
HH

Describe Accident
AA

HH

BB

BB

JJ

CC

JJ

CC
KK

DD
KK

DD

EE

LL

EE

LL

FF

MM

FF

MM

GG

NN

Carrier Name

GG

T.U. #

GG

Address

T.U. #

Carrier Name
GG

Address

NN

US DOT

ICC

State DOT

Carrier Identification #

US DOT

ICC

Carrier Identification #

NN

State DOT

NN

COLORADO INVESTIGATORS FATAL TRAFFIC ACCIDENT SUPPLEMENTAL REPORT

PAGE ______ OF ______ PAGES

Case #

DOR CODE

Accident Date

Agency

EMERGENCY MEDICAL SERVICES

(Record all time using 24 Hr. time)
Time Notified

ACCIDENT AVOIDANCE MANEUVER

Time Arrived @ Scene Time Arrived @ Hospital

00.
01.
02.
03.
04.
05.
06.

If times are unknown provide name of responding services

Traffic
Unit #1
or ___

Traffic
Unit #2
or ___

Traffic
Unit #3
or ___

Traffic
Unit #4
or ___

Traffic
Unit #1
or ___

Traffic
Unit #2
or ___

Traffic
Unit #3
or ___

Traffic
Unit #4
or ___

FIRE/HAZARDOUS MATERIALS INVOLVEMENT

TRAFFICWAY FLOW
01.
02.
03.
04.

No Avoidance Maneuver
Braking (Skid marks evident)
Braking (Per driver, no skid marks evident)
Braking (Per witness, no skid marks evident)
Steering (Evidence or stated)
Steering & Braking (Evidence or stated)
Other Avoidance Maneuver

00.
01.
02.
03.
04.
05.

Not Divided (Two Way)

Divided, Median W/O Barrier
Divided, Median W/Barrier
One Way

NUMBER OF TRAVEL LANES

No Fire/No Haz-Mat Cargo

No Fire/Haz-Mat Cargo Not Involved
No Fire/Haz-Mat Incident
Vehicle Fire/No Haz-Mat Cargo
Vehicle Fire/Haz-Mat Cargo Not Involved
Vehicle Fire/Haz-Mat Incident

If the accident is totally contained on half of a divided

highway (physical barrier not painted median), only
count the number of travel lanes on that half.

TRAFFIC CONTROL DEVICE

FUNCTIONING

01.
02.
03.
04.
05.

List the Most Significant Types of Traffic Control Devices

No Controls
Not Functioning
Functioning Improperly
Functioning Properly
Unknown

MUST BE COMPLETED FOR ALL PERSONS INVOLVED EXCEPT UNINJURED BUS/RAILWAY PASSENGERS.
(A) Traffic Unit Number (list Traffic Unit Number as on DR 2447)
(B) Position in Vehicle

14

03

06

09

02

05

08

01

04

07

10/11
12

(C) Ejection Path 00. Not Ejected/ Not applicable

01. Through Side Door Opening
02. Through Side Window
03. Through Windshield

(D) Alcohol Suspected

(Officer Opinion Only)

13

04.
05.
06.
07.

Driver
Passengers
Other ENCLOSED passenger/cargo area
Other UN-ENCLOSED passenger/cargo area
Sleeper Section of Truck
Trailer
Riding/Hanging on to Exterior of Vehicle or Trailer
Pedestrian

Through Back Window

Through Back Door/Tailgate Opening
Through Roof Opening (sun roof/convertible top down)
Through Roof (convertible top up)

Yes > 01. Preliminary Breath Test

02. SFST
03. Observed

(E) Tested for Alcohol 00. Not Tested 03. Urine

01. Blood
02. Breath

01.
02-09.
10.
11.
12.
13.
14.
15.

04. Passive Alcohol Sensor

05. Other method

08. Other Path (e.g. back of pickup truck)

09. Unknown

No > 06. Preliminary Breath Test

07. SFST
08. Observed

09. Passive Alcohol Sensor

10. Other method

06. By Coroner

04. Other
05. Refusal

(F) Other Drug/Impairment Suspected

(Officer Opinion Only)

(G) Tested for Other Drugs

Yes > 01.

02.
03.
04.

00. Not Tested

01. Blood

Drug Recognition Expert

SFST
Observed
Other
02. Breath 04. Other
03. Urine 05. Refusal

No > 05.
06.
07.
08.

Drug Recognition Expert

SFST
Observed
Other Method

06. By Coroner

(H) Dead at Scene 00. No

01. Yes

Name

Taken to

Date

Expired

Time