aconrnmann Accident Report (AR Form = % iL PEE EEE EET | w 10 type! 1D number ‘Country of erigin of 10. ‘Sumame Residentialhome address n Bu if 8 i i Zz i Fit » Ry iE i = > o 2 ° 8 our / 4. Kiled 2 Sereur 3 Sight 4, Noinjy Severity of injury 4. Killed «2. Sartus 3, Sight 4. No inury Breahdonn ta ———prenenamber etre |1 Grom Gat tere 2 me kom — 1 Oe 4 Cate 2 Bry nent A Pete kOe 1 Bewie New Owe a 1 om WA 2 mae) 2 tebe et . 1 oncmenent fH 2 Semerbonetctone |? oy 1 ate a tl a ‘ee ac eee MOH, B,C, AWA On pe 2 gene open Ou ta gt (5 Sate 8 ct OF ttt OF Ltt am ote ie soe me 2 tem = = see 2 Woon ~ ti ee ace vec BE na er em ee ll 3 Sexe a eee 8 * a] SeeInitiaks 223aeouo gité 2 a6. a Serious eReE itt Slight 4, Novinjury 6. o a, ao 1D typed ID number / Country of origin of 1D ‘Sumame Age Ihitiats Hometcontact addross a ow Telephone number HW Cellphonaiother number 3. Coloured How would you | Asian 00, Unknown describe the person? 4. white 0. Unknown Gender 1. Male Sigh 4 Nolnjury ——Severityofinury 1. Kites ‘Ambulance service, driver, case reference number 8 hospital Unknown Seatbelt fited/heimet present Unknown Seatbelvhelmet definitely used Liquor/drug use suspected *Liquoridrug use: evidentiary tested ID type/ ID number f ‘Country of origin of 1 Sumame Age Initials: Homelcontact address H (Celiphoneiother number 2. Colourea How would you 00, Unknown describe the person? 0. Unknown Gender Severity of injury ’ Ambulance service, driver, case reference number & hospital ‘unknown Seatbelt fitied’helmat present Unknown Seatbellinelmet definitely used Liquoridrug use suspected “Liquoridrug use: evidentiary tested Asian’ white Male Killed HW Telaphonefcantact number } w RRR (ESSA, latin ot PAGE 3| ae ee Wh) WITNESSES | 4 potentiats oteniatn auhoinnd peraun ini make anaemia witwase oan acide ‘This it particularly important in respect of independent oyewitnesses, Byeindas al sone of ar seldom ale chased mre Color a good stare i eds byw ofc find ot wor anos winesed (Saw) the scoident, and{or can give valuable information about crcumstances relating to the accident, andior can assist with the identification of deceased or seriously injured persons involved in the accident, Inthe event ofa rllable witness ( peat alg veg fa eter fia wa A ew 1 posed, bs akan fom hinibar hora te scnne or at tne poice tatontste peice departmant (Thi mi the vant ofS CRICAS police case docket being registered.) Indopenciont ayewitnass Passongor of vehicie Independent eyewnness Passenger of vehicle Surname & initials Workicontact address Code Code ( y coat mie ) ‘Telephone number Position Dangerous goods carried inion vehicla 4 feel eget ered A eee 1 Dangerous pod cared ‘Winn marked 2 Whiin Smt crossing. Not at crsing 5 eae coer a) 3 Vapour emission oosered 4. Facing tic Backtotratic «=. Crossingroad |W dangerous goods were carried Pedestrian Action i jestann cy) i poe eer ee eee es i rao 5 Siting 6 Lying down 7, Working 8 Other. | Drew placard and whe the Code/SiN Colour of 1 ght 2 Dank 3. LMA Can 4 Retecto | on the dager A Omer (Speci) ‘Tyre appears to have burst 1. No 2 Yes 0, Unknown metres YN 1, Good 2. Faultyinot visible ‘Good 2.__ Fauityinot visite | Particulars of notice lo discontinue use of vehicle issued by officerGPS.0103 v2 ‘811149020 Accident Report (AR) Form ae GENERAL INFORMATION 4. In terms of the National Road Traffic Act, Act No 93 of 1996, a driver must report her/his involvement in an accident in person within 24 hours ofits occurrence to the nearest Metro, Municipal, Traffic Police (MMTP) office or South African Police Services (SAPS) station, This is only applicable if a police/traffic officer did not attend the accident due to the apparent minar nature thereof. However, the hours of operation of these offices must be taken into consideration. A driver must present her/his driving licence when the accident is reported. ‘2. Thisformmust be completed for all accidents which occur on a public road and where a vehicle was involved, i.@. allroads where the public or part of the public has right of access, This could include private property. 3. This form can/may be completed personally by a driver of a vehicle involved in an accident where no criminal case docket has been openediregistered (such as 'damage only’ accidents), only if s/he is in acondition to do so, A police official, traffic officer or other authorised person must be prepared to help the driver complete the form. 4. At the prescribed fee, a photocopy of this form may only be furnished in response to.a written request from an involved party (/.@. driver, passenger, pedestrian, cyclist or owner of damaged property), if they can prave that they were the invoived party; and/or to @ person who is not an involved party, anly if they have the written permission or authority of the involved party. if a case docket has been opened/registered for a criminal investigation of an accident by the SAPS and the matter is stilt under investigation, any written request for a photocopy of a completed accident report form must be submitted to the Senior Public Prosecutor (SPP) of that particular magisterial district via the relevant SAPS station commissioner. S/he will determina whether a photocopy may be furnished ornot. 5. Thename of the SAPS station in which area the accident occurred must be supplied on Page 1 of the form, even ifthe accidentis reported and/or the form completed atby an MMTP office/officer. 6. NB: Every effort must be made to specify the exact ‘LOCATION ' of the accident on Page 1 of the form. Always specify the Province and Street or Road (by name or number, e.g. N4) before proceeding to complete the appropriate section for accidents in town or on ruratroadsifreeways. Be sure to complete the box with Speed Limit, Road Typeand Junction Typein allcases. INSTRUCTIONS FOR COMPLETION OF THE FORM T. tis essentialthat the information recorded an this form is an accuraterefiection of the circumstances af the accident 8. When completing this form, please use BLOCK/CAPITAL LETTERS only. 9. Mark the relevant blocks with a cross (X), and notthe pictureiilustration. However, to identify a particular vehicle (2.9. on Page 2), write the reference letter allocatedto each vehicle (A, B, C. etc.)in the relevantblocks. Refer topedesinans andsyaistsasP, QR, ete. and passengers as1.2, 3, et 10. When correcting a mistake, the person completing the form must initial and date against the correction, without interfering with any of the white blocks. No correction fluid/tapemay beused. 11. Pages 1 and'2 must be completed in all instances. If there were any passengers in any vehicle (even if they were not injured), their particulars mustbe entered on Page’3. The particulars of the person completing the form must be entered in the'‘Completed By’ section in the bottom right-hand comer of Page 4 12. All four pages of this form must be completed if# driver or passenger was killed or injured in the accident, orpedasirians oreyollsts were involved. 413. All four pages of this form must also be completed if a vehicle carrying dangerous goods or hazardous materials is involved inan accident. ‘14. Once a driver has reported an accident at an MMTP office or SAPS station, and this form has been completed, an-entry ‘must be made in the Occurrence Book (08). Accident Register. etc. The driver must then be fumished with reference number (OBor AR) as proof thal the accident has been reported. PAGE taOPERATIONAL PROCEDURES FOR MMTP AND SAPS OFFICERS 18. This Accident Report (AR) form replaces the OfficersAccident Report (OAR) form. 16. AMAR form must be completed for each driverfpedestrian reporting an accident atan MMTPoffice or SAPS station, 47, Apadastrian may iso report an accident within 24 hours ofits occurenceto his/her nearest MMTP office or SAPS station. Slhemust [Present proof afidentification. 18. Aperson wanting to report his/her involvementin an accident must notbe referred unnecessanly from one department to ancther, one ‘office (another, or from one SAPS station fo another, 49. Tho TratficAccident Registor Number{TARN) in the 'For official use only’ section on Page 1 ofthe form must be supplied by the MMTP ‘office where the completed AR forms.are kept The Capturing Authonty Number (CAN) in the ‘For official so only’ section on Page 1 of the form must be supplied, by the data capturing authority, rom the aceiden number generaled by the computer systeman which the form is captured. 21..ifthereis not sufficient space on the form forfurther particulars of witnesses, passengers, casualties or the description althe accident, ‘etc, relevant sections of additional forms must be completed and attachedio the original. 22..ilthere are more than two parties (e.g. more than two wehicles} involved in the accident, additional forms must be completed. Eact form musi be numbered in sequence onthe spaces provided (at Form-oF) &.g., Form { of 2. Or Form 2of2. 23. When a person, who reports an accident, prefers to write the description, and/or draw an accident skeIch. s/he should sign nextto the relevantitem, 24. A policaliraffic officer who attonds ant accident must completo this form immediately. Thereafter. an entry in the Occurrence Book (08) oF Accident Register mus! be made. This must be done before oing off uty. Acckdent victims mustnot be told to report an accident at an MMTP office or SAPS station unless they are mentally composed and their vehicte is in a driveable and roadworthy condition. A polica/tratic officer who attends an accident must ensure that the particulars of all passengers, pedestrians and cyclists (even If they are notinjured) are recorded, since names cannat be added to a completed AR form onca ithas been processed. When this fonm is completed at an MMTP office, it must not be registered at the SAPS station (SAPS 176 Accident Repister process), unless .a case docket has to be opened registered forthe accident lobe criminally investigated. (In this instance must be presumed thatan MMTP officer attended the accident and conducted a crime scene investigation. S/he must opem/registera case docket atthe ‘SAPS station in which area the accident occurred before s/he gaes off duty. For such a crime scene Investigation function to be performed by an MMTP officer, there must be a formalised writen co-operation/protocol agreement between the SAPS and the rolovant MTP), When this form is complated at an SAPS station, the SAPS 176 Accident Register process must be followod. If nocase docket has to ‘be openedirogistered fora criminal investigation of an accident, the eriginal completed form must be collected by the relevant |MMTP or other autherised person, under cover of the SAPS 506 Delivery Note, within the prescribed period. Itis not necessary for a [Photocopy to be made andkept inthe SAPS station manthly accidenttfile. 28. Wen a member of the SAPS attands an accidont of a serious nature (where a criminal case docket has to be openediregistored), -ghe must conduct a erime scene investigation and open!Tegister @ case docket immediately after the accident has been attended, oF before sine goes off duty. This must be done at he SAPS stationin whose area the accident occurred. ignatures* and ‘initials’ of persons who complete and check the form, and the official date stamp, must be entered in therelevant spaces. 30, When this form is completed for an accident in which a.case docket is openedinegistered, 2 photocopies of the completed form must be made. Both copies must be centiied as tue coples of the original form. One copy must be filedin the “A” clip of the case docket. The second copy must be collected by the relevant MMTP or oliver authorised person under cover of the SAPS 506 Delivery Note. The original completed form must be filed in the SAPS station monthly accident file. The CAS/CR reference number must be ‘enteredon ail documents joniginal and photocopies). 34. {the form is. completed at.an SAPS station, but the accident occurred in another SAPS station area, an Ocourrence Book (OB) ‘number must be allocated. Aphotocopy musi then be made, and certified as a true copy of the original form. The original completed form, togethor with a covering leier, must be posted by registered mail or transferred by police vehicle to the SAPS station in which ‘area the accident occurred. For record purposes the photocopy must be fledin the accident fle of the SAPS station where the form was completed. 32, It any of the injured persons dies within six-(6) days of the accident, the particulars on Page 1 and 3 of the form must be changed accordingly by the office at which the form was completed before the form is collacled by the relevant MMTP olfcer oF acy other ‘authorised person, 33. All culpable homicide motor vehicle accidents (in which a person is killed), must be reported to the National Arrive Alive Fatal ‘Accident Information Centre immediately after such an accident, or before the policetraffic officer goes off duty, Tel: 0800005 619 (oll free} or (012) 308.3668. Fax 0800 111 301 (tol free) oF (012) 309 3655. The ‘Fatal Accident Report’ form must be used for this Purpose. PAGE tb