The Alaska Motor Vehicle Crash Form 12-209 serves as a comprehensive report to document motor vehicle accidents within the state. It meticulously records various details from the incident including the number of vehicles involved, crash time and date, location specifics, and characteristics of the crash scene such as weather, road conditions, and lighting. Designed for official use, it also captures in-depth information about the drivers, vehicles, any injuries sustained, and circumstances that may have contributed to the accident, ensuring a thorough understanding of each collision for investigative and insurance purposes.
In the vast and diverse landscape of Alaska, the occurrence of motor vehicle accidents presents unique challenges and complexities, necessitating a comprehensive and detailed documentation process for effective management and analysis. The Alaska Motor Vehicle Crash Form 12-209 serves as a critical tool in this endeavor, structured to capture an array of crucial data points post-accident. The form encompasses a wide range of information, from basic crash details such as the total number of vehicles involved, the crash date, time and specific location within the city or borough, to more nuanced data like weather conditions, lighting, and specificities of the roadway or junction where the crash occurred. Furthermore, it delves into the nature of the crash with sections dedicated to the first sequence of events, including both collision and non-collision types and the exact location of these events on the road surface. Crucially, it seeks detailed information about the drivers and vehicles involved, including the driver's contact information, vehicle damage assessment, direction of travel, actions leading up to the crash, and any contributing roadway circumstances. Additionally, the form features sections for other drivers' information, vehicle configurations, and specifics about traffic control at the scene. Injury and insurance information play a significant role in the form, ensuring all involved parties' health status and coverage details are accurately recorded. This thorough documentation framework not only facilitates the immediate response and intervention efforts but also aids in long-term crash analysis and prevention strategies. By compiling and analyzing data from the Alaska Motor Vehicle Crash Form 12-209, stakeholders can identify patterns, assess risk factors, and implement targeted measures to enhance road safety across the state.
ALASKA MOTOR VEHICLE CRASH FORM 12-209
SR #
C R A S H I N F O R M A T I O N
(One choice per field unless otherwise noted. Other* should be explained in narrative)
Total # Vehicles
Crash Date
Time of Crash
am Crash Day
01 MON
03 WED
05 FRI
07 SUN
Crash occurred in (City / Borough)
pm
02 TUE
04 THU
06 SAT
Name of Street or Highway
Miles
North of:
South of:
Name of Cross Street, Highway, Bridge, etc.
OFFICIAL USE ONLY
East of:
West of:
Location Control
Reference Point
Feet
At intersection with:
Weather
Lighting
Roadway / Junction
01 Blowing dirt, snow
07 Sleet, hail (freezing rain)
01 Dark - lighted roadway
07 Not reported
01 Crossover
07 Roundabout
13 Other*
02 Clear
08 Severe crosswinds
02 Dark - not lighted
08 Unknown
02 Driveway
08 T - intersection
03 Cloudy
09 Snow
03 Dark - unknown lighting
03 Not a junction
09 Y - intersection
04 Fog/ smoke
10 Other*
04 Daylight
04 On ramp
10 Four way intersection
05 Ice fog
11 Not reported
05 Twilight
05 Off ramp
11 Five point or more
06 Rain
12 Unknown
06 Other*
06 Railway crossing
First Sequence of Events (what was the first thing you crashed into, or what was the first event that resulted in the crash. (CHECKONLY ONE FOR EITHER COLLISION OR NON-COLLISION
COLLISION
NON-COLLISION
01 Aircraft
09 Ditch
17 Median barrier
25 Train
33 Cargo loss / shift
40 Overturn
02 Animal
10 Embankment
18 Moose
26 Tree / shrub
34 Crossed median / centerline
41 Ran off road
03 Bicyclist
11 Fence
19 Parked vehicle
27 Utility pole
35 Downhill runaway
42 Separation of units
04 Bridge / overpass
12 Guard rail face
20 Pedestrian
28 Vehicle in transit
36 Equipment failure
43 Other*
05 Bridge rail
13 Guard rail end
21 Sideswipe
29 Vehicle - rear end
37 Explosion / fire
44 Unknown
06 Crash cushion
14 Light support
22 Sign
30 Vehicle - head on
38 Immersion
07 Culvert
15 Machinery
23 Snowberm
31 Vehicle - angle
39 Jackknife
08 Curb / wall
16 Mail box
24 Traffic signal pole
32 Other fixed object
Location of First Sequence of Events (where did the crash happen first?)
Road Surface
Did police
01 Bike lane
04 Outside of trafficway
07 Roadway
10 Unknown
01 Dry
04 Sand, mud, oil
07 Wet
Yes
investigate
02 Gore
05 Parking lot
08 Shared use paths
02 Ice
05 Slush
08 Other*
No
this crash?
03 Median
06 Roadside
09 Shoulder
03 Water
06 Snow
Y O U R D R I V E R I N F O R M A T I O N
Your Name (Vehicle Driver's Last Name, First Name, Middle Name)
Your Date of Birth
Your Contact Telephone
Your Mailing Address
Your Driver License Number
Your Driver License State
Your Driver License Country
Your City
Your State
Your Zip Code
Your Residence Country
Y O U R V E H I C L E I N F O R M A T I O N
Your Vehicle Damage
No. of Occupants
Your Vehicle Owner's Name (Last, First, Middle Initial)
Vehicle Owner's Telephone
01 None / minor
03 Disabling
05 Unknown
Your Vehicle Owner's Mailing Address
02 Functional
04 Totaled
02
03
04
Your Vehicle Owner's City
Your Vehicle Owner's State
Vehicle Owner's Zip Code
Vehicle Year
Vehicle Make
Vehicle Model
License Plate #
Vehicle License State
01
05
Your Vehicle's Direction of Travel
Damage Estimate
01 North
02 South
03 East
04 West
Over $501
Your Vehicle Driver's Injury Status (vehicle passengers are listed on page 2)
08
07
06
01 Fatal
03 Non-incapacitating
05 None
07 Unknown
CHECK ONLY ONE TO SHOW FIRST AREA OF IMPACT
02 Incapacitating
04 Possible
06 Not reported
Roadway Circumstances (that may have contributed to the crash)
Your Vehicle Action
01 Debris
07 Road surface condition
01 Avoiding objects in road
08 Out of control
15 Straight ahead
02 Inoperative traffic device
08 Ruts, holes, bumps
14 Unknown
02 Backing
09 Passing
16 Turning right
03 Missing traffic device
09 School zone
03 Changing lanes
10 Parked
17 Turning left
04 Obscured traffic device
10 Work zone
04 Entering traffic lane
11 Skidding
18 Other*
05 Obstruction in roadway
11 Worn, polished road surface
05 Leaving traffic lane
12 Slowing
19 Unknown
06 Shoulder
12 None
06 Making U-turn
13 Starting in traffic
07 Merging
14 Stopped
Traffic Control
Vehicle Configuration
01 Flashing signal
05 School zone signs
09 Officer / Flagman / Guard
01 Dog sled
05 Off highway vehicle
09 Other*
02 No traffic controls
06 Stop sign
10 Yield sign
02 Light truck (4 tires)
06 Passenger car
03 Road construction signs
07 Traffic control signal
11 Other*
03 Motorhome
07 Pedalcycle
04 RR crossing device
08 Warning signs
04 Motorcycle
08 Pedestrian
C R A S H D E S C R I P T I O N
(Write a brief narrative describing the crash)
Fairbanks Police Department Rev. 07/05
Crash Form 12-209 - Page 1
O T H E R D R I V E R ' S I N F O R M A T I O N
Other Driver's Name (Last Name, First Name, Middle Name)
Other Driver's Date of Birth
Other Driver's Contact Telephone
Other Driver's Mailing Address
Other Driver's License #
Other Driver's License State
Other Driver's License Country
Other Driver's Mailing Address City
Other Driver's State
Other Driver's Zip Code
Other Driver's Residence Country
O T H E R D R I V E R V E H I C L E I N F O R M A T I O N
Other Vehicle Damage
Other Vehicle No. of Occupants
Other Vehicle Owner's Name (Last, First, Middle Initial)
Other Vehicle Owner's Telephone
Other Vehicle Owner's Mailing Address
Other Vehicle Owner's City
Other Vehicle Owner's State
Other Vehicle Owner's Zip
Other Vehicle's Direction of Travel
Other Vehicle Driver's Injury Status (vehicle passengers are listed below)
Other Driver's Roadway Circumstances (that may have contributed to the crash)
Other Driver's Vehicle Action
Other Driver's Traffic Control (traffic control for the other driver may have been different from yours)
Other Driver's Vehicle Configuration
I N J U R Y S E C T I O N
(Fill in the name of injured person, injury status, telephone number, and which vehicle they occupied when the crash occurred)
Name
Injury Status
Telephone
Vehicle License
YOUR INSURANCE INFORMATION
C E R T I F I C A T E O F
I N S U R A N C E
Failure to complete the Certificate of Insurance could
result in the suspension of your driver's license)
CRASH
Crash Location
INFORMATION
Your Name (Driver's Last Name, First Name, Middle Initial)
Your Driver's License Number
Your Driver's License State
DRIVER
VEHICLE
Vehicle Owner's Name (Last Name, First Name, Middle Initial)
Owner's Date of Birth
Owner's License Number
Owner' License State
OWNER
Vehicle Owner's Mailing Address
Owner's City
Owner's State
Owner's Zip Code
Owner's Contact Telephone
Vehicle year
Vehicle make
Vehicle model
License plate #
Vehicle Identification Number (VIN)
Did you have a current automobile liability policy in effect covering this accident?
YES
NO
Insurance Company or Insurance Carrier Name
Insurance Policy Number
INSURANCE
Address and Telephone Number of Insurance Agent
Insurance Policy
FROM
TO
Period:
SIGNATURE
YOUR SIGNATURE
INSURANCE VERIFICATION: If the motor vehicle liability insurance policy listed above was not in effect for the motor vehicle listed at the time of the crash indicated above, the insurance company is to complete the following and return this form to the Division of Motor Vehicles at the address listed on the bottom right corner on page 2 of this form. If indicated coverage was in effect at the time of the crash, no action is required.
REASON FOR DENIAL:
Policy expired before crash
Driver is not covered on policy
Policy effective after crash
Lapse in policy
Policy number given is incorrect
Other:
Authorized Representative Signature / Date
MAIL THIS FORM TO:
DMV MAIN OFFICE
P.O. BOX 110221
JUNEAU, AK 99811-0221
(907) 465-4361
Crash Form 12-209 - Page 2
Filling out the Alaska Motor Vehicle Crash Form 12-209 is an important step if you've been involved in a vehicle crash in the state. This detailed form helps in documenting the specifics of the incident, which is crucial for insurance claims and legal matters. Let's navigate through this process step-by-step to ensure you complete the form accurately and comprehensively.
Correctly filling out this form is critical for the accurate assessment of any claims or legal issues resulting from the crash. Take your time to provide thorough and accurate information for each section. This meticulousness ensures your interests are well-represented in any subsequent evaluations or investigations.
What is the Alaska Motor Vehicle Crash Form 12-209 used for?
The Alaska Motor Vehicle Crash Form 12-209 is a document used to report a motor vehicle crash in the state of Alaska. It captures essential information about the crash, including details of vehicles involved, driver and occupant information, crash circumstances, and damages incurred. This comprehensive report aids in official documentation and helps in the investigation of the incident.
Who needs to fill out this form?
Any driver involved in a motor vehicle crash in Alaska that results in injury, death, or property damage must complete the Form 12-209. If the police investigate the crash, they might also fill out or assist in completing this document.
Can I fill out the Alaska Motor Vehicle Crash Form 12-209 online?
As of the latest update, the Alaska Motor Vehicle Crash Form 12-209 needs to be filled out on paper. It's recommended to check with the Alaska Department of Motor Vehicles (DMV) for any updates or changes regarding the submission process.
What happens if I don't submit the Alaska Motor Vehicle Crash Form 12-209?
Failing to submit the Form 12-209 after a crash can result in penalties, including the suspension of your driver's license. It is a legal requirement to report crashes involving injury, death, or significant property damage to the Alaska DMV.
How do I submit the completed Alaska Motor Vehicle Crash Form 12-209?
The completed form should be mailed to the DMV MAIN OFFICE at the address provided at the bottom of the form. It is important to ensure that the form is completely and accurately filled out to avoid any delay in processing.
What information do I need to provide in the form?
You need to provide detailed information regarding the crash, including the date, time, and location of the crash, details about the vehicles involved, driver and passenger information, a description of the crash, and any injuries or damages sustained. Additionally, insurance details must also be provided.
Is it mandatory to have police investigate the crash to fill this form?
No, it is not mandatory for the police to investigate the crash for you to fill out this form. However, if the police do investigate, they might complete or assist with the form based on their findings.
What should I do if I wasn't able to gather all the information at the scene of the crash?
If you're unable to gather all the necessary information at the scene, provide as much detail as you can and note the missing information clearly. Contacting the other parties involved to gather additional details or obtaining the police report if available can be helpful.
How can I get a copy of the Alaska Motor Vehicle Crash Form 12-209?
Copies of the form can be obtained through the Alaska Department of Motor Vehicles website or at a local DMV office. It’s advisable to keep a blank copy handy in your vehicle for unforeseen circumstances.
Filling out the Alaska Motor Vehicle Crash Form 12-209 requires careful attention to detail. Several common mistakes can occur during this process, which can potentially complicate the recording and understanding of a vehicular accident. Here are nine mistakes often made:
By ensuring that these common mistakes are avoided, individuals can fill out the form more accurately, aiding both their personal records and any ongoing investigations or insurance claims related to the accident.
When completing or using the Alaska Motor Vehicle Crash Form 12-209, several other documents and forms often come into play, especially when documenting the specifics of a vehicle accident or following up on the event. These additional forms and documents are vital for various reasons such as insurance claims, legal issues, or personal records. Here’s a look at some of those key documents:
Gathering and managing these documents promptly and efficiently can significantly influence the outcomes of insurance claims and legal matters resulting from the accident. It’s also a step toward ensuring all aspects of the accident are thoroughly documented for future reference.
The Alaska Motor Vehicle Crash Form 12-209 is akin to the California Traffic Accident Report (SR1), particularly in its purpose to document details of a vehicle crash. Both forms gather comprehensive information about the accident, including the date, time, location, and weather conditions, as well as details about the drivers, vehicles involved, and the sequence of events leading to the crash. The requirement to provide specific information about road and lighting conditions, vehicle movements, and driver actions emphasizes the forms' roles in assessing accident causes and liabilities.
Similarly to the New York State DMV Accident Report Form (MV-104), the Alaska form collects data not only on the crash circumstances but on specifics such as road surface conditions and traffic controls present. Like the Alaska variant, the MV-104 is designed to capture a nuanced picture of the accident environment, which can be crucial for insurance claims and legal proceedings. Drivers in both states are obligated to detail the physical context of the accident, ensuring a clear understanding of external factors that might have contributed.
The Texas Peace Officer's Crash Report (CR-3) shares objectives with the Alaska form in recording accident specifics for law enforcement purposes. Each form includes fields for detailed narratives of the crash, allowing officers to describe the sequence of events. Both documents are integral to the post-accident investigation process, aiding in the determination of fault and the application of traffic laws.
The Florida Traffic Crash Report (HSMV 90010S) is another document with similarities to Alaska's crash form, particularly in how it captures data on vehicle damage and passenger injuries. Each form makes provisions for documenting the direction of travel, actions preceding the crash, and the nature of impacts. This information is critical for insurance assessment and for improving road safety measures based on crash patterns.
Illinois Motorist Report (SR 1050) shares commonalities with Alaska's form in the detailed personal and vehicle information required from drivers involved in a crash. Both forms necessitate driver, vehicle, and insurance details to ensure accountability and to facilitate the insurance claim process. The emphasis on thorough information collection is key to understanding crash dynamics and legal responsibilities.
The Ohio Traffic Crash Report (OH-1) parallels the Alaska form in its comprehensive approach to documenting crash details, including diagrams and narratives. Both forms allow for the illustration of crash scenes, offering valuable visual context to complement written descriptions. These diagrams can be pivotal in legal evaluations and insurance determinations, aiding in the accurate reconstruction of events.
Michigan Traffic Crash Report (UD-10) aligns with the Alaska form in the granularity of data collection regarding crash circumstances and conditions. The focus on specific crash events, road conditions, and traffic controls serves a similar purpose of aiding in the forensic analysis of traffic accidents, with implications for both legal and insurance outcomes.
The Pennsylvania Police Crash Reporting Form (AA-500) shares similarities in its design to capture a wide array of data points regarding a vehicular accident, much like Alaska's form. This inclusivity in documentation is vital for providing a detailed account of the crash, which is beneficial for investigative, legal, and insurance purposes. Both forms are tools for compiling data that can influence traffic safety policies.
Georgia Motor Vehicle Crash Report (Form SR-13) bears resemblances in its coverage of accident specifics, including driver actions and environmental conditions, similar to the Alaska form. The careful documentation of these elements is crucial for understanding causation and liability in crashes, serving both preventative and legal needs.
Lastly, the Washington State Motor Vehicle Collision Report mirrors Alaska’s form in the emphasis on detailed descriptions of the collision, the involvement of pedestrians or bicycles, and the conditions under which the crash occurred. Both forms require information about the sequence of incidents leading to the crash, underscoring the importance of narrative accounts in comprehending and preventing future accidents.
Filling out Alaska Motor Vehicle Crash Form 12-209 correctly is crucial to ensure the accuracy and completeness of a crash report. Here are five important dos and don'ts to keep in mind.
Things to Do
Things to Avoid
Navigating the intricacies of Alaska's Motor Vehicle Crash Form 12-209 can be a daunting task, with myths and misunderstandings complicating what should be a straightforward process. Let's debunk some of the most common misconceptions surrounding this important document.
This misconception could not be farther from the truth. Regardless of the severity, the form is crucial for documenting any incidents on the road, ensuring all parties have accurately recorded information for insurance and legal matters.
While timely filing is important, accuracy and completeness matter more. It’s essential to collect as much information as possible at the scene, but the form should be filled out carefully and thoughtfully, which might mean taking a bit more time to ensure all details are correct.
On the contrary, the involvement of law enforcement and their findings can be pivotal information that complements the details provided in your report, often affecting fault determinations and insurance claims.
Although thoroughness is encouraged, some sections of the form may not apply to every incident. It's crucial to complete all relevant sections to the best of your ability and knowledge.
This is not the case. Information regarding all parties involved, including other drivers, passengers, and even witnesses, can be vital. The form is designed to capture a comprehensive overview of the crash, not just the perspective of one driver.
Even seemingly minor details can have major implications down the line, especially when it comes to injuries that might not become apparent until after the incident. Reporting all damages and injuries, regardless of their initial assessment, is critical.
While the form is an essential piece of the puzzle, determining fault involves a comprehensive review of all available information, including but not limited to this report, police reports, witness statements, and any other evidence.
Although mailing the form is one option, it’s not the only way to submit it. Checking with local jurisdictions is essential as digital submissions or direct submissions to insurance companies may also be viable options.
No matter what is said at the scene, documenting the incident formally is crucial. Admissions of fault at the scene do not negate the need for official documentation, as circumstances and recollections may change over time.
Understanding the Alaska Motor Vehicle Crash Form 12-209 is imperative for anyone on the roads in Alaska. Dispelling these misconceptions ensures that all parties involved are better prepared to accurately report any unfortunate incidents, aiding in the seamless processing of claims and legal matters.
When filling out the Alaska Motor Vehicle Crash Form 12-209, there are several key takeaways that are essential for ensuring the information you provide is accurate and comprehensive. This can not only aid in the processing of your form but also in any subsequent legal or insurance procedures.
This form plays a crucial role in documenting motor vehicle crashes in Alaska, serving as an official record that can impact legal and insurance outcomes. Whether you're a driver, a vehicle owner, or a witness, providing complete and accurate information is in your best interest and assists in the fair resolution of the aftermath of the crash.
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