Form CR-3A "Texas Peace Officer's Crash Report Form" - Texas

What Is Form CR-3A?

This is a legal form that was released by the Texas Department of Transportation - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2015;
  • The latest edition provided by the Texas Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CR-3A by clicking the link below or browse more documents and templates provided by the Texas Department of Transportation.

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Download Form CR-3A "Texas Peace Officer's Crash Report Form" - Texas

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Rate (4.8 / 5) 27 votes
Law Enforcement and TxDOT Use ONLY
Total Num.
Total Num.
FATAL
CMV
SCHOOL BUS
RAILROAD
MEDICAL ADVISORY BOARD
Units
Prsns.
SUPPLEMENT
ACTIVE SCHOOL ZONE
ON PRIVATE DRIVE OR ROAD/PRIVATE PROPERTY/PARKING LOT
Texas Peace Officer's Crash Report (Form CR-3 ALTERNATE 1/1/2015)
Mail to: Texas Department of Transportation, Crash Data & Analysis, P.O. Box 149349, Austin, TX 78714. Questions? Call 844/274-7457
*These fields are required on all additional sheets submitted for this crash (ex.: additional vehicles, occupants, injured, etc.).
Page
of
i
*Crash Date
*Crash Time
Case
Local
(MM/DD/YYYY)
(24HRMM)
ID
Use
*County
*City
Name
Name
Speed
Roadway
Limit
Part
Construction
Latitude
Longtitude
.
.
Zone
(Decimal)
(Decimal)
*Address
If No, Distance from Intersection/
Direction from Intersection/
Crash at
Intersection
Reference Marker
Reference Marker
Railroad
Crossing Num.
Unit Number
Parked Vehicle
Did this unit "Hit and Run"?
Unit Description
LP State
LP Number
VIN
Vehicle
Vehicle
Vehicle
Vehicle
Year
Make
Model
Color
Body
Style
DL/ID
Type
DL/ID
DL/ID
DL
DOB
CDL
DL
State
Number
Class
(MM/DD/YYYY)
Endorse.
Restrict.
Address
(Street, City, State, Zip)
Owner/Lessee
Proof of
Name & Address
Insurance
Insurance
Policy
Ins. Company
Company
Number
Phone Number
Vehicle
Towed By
Towed To
Inventoried
1. Person Type
2. Seat Position
3. Injury Severity
4. Ethnicity
5. Ejected
6. Restraint Used
7. Airbag
8. Helmet Use
1 = Driver
1 = Front Left
10 = Cargo Area
A = Incapacitating Injury
W = White
1 = No
1 = Shoulder & Lap Belt
1 = Not Deployed
1 = Not Worn
2 = Passenger/Occupant
2 = Front Center
11 = Outside Vehicle
B = Non-Incapacitating
B = Black
2 = Yes
2 = Shoulder Belt Only
2 = Deployed, Front
2 = Worn, Damaged
3 = Pedalcyclist
3 = Front Right
13 = Other in Vehicle
Injury
H = Hispanic
3 = Yes, Partial
3 = Lap Belt Only
3 = Deployed, Side
3 = Worn, Not Damaged
4 = Pedestrian
4 = 2nd Seat Left
14 = Passenger in Bus
C = Possible Injury
A = Asian
97 = Not Applicable
4 = Child Seat, Facing Forward
4 = Deployed, Rear
4 = Worn, Unknown
5 =
5 = 2nd Seat Center
16 = Pedestrian,
K = Killed
I =
99 = Unknown
5 = Child Seat, Facing Rear
5 = Deployed, Multiple
Damage
6 = Motorcycle Passenger
6 = 2nd Seat Right
Pedalcyclist, or Motorized
N = Not Injured
6 = Child Seat, Unknown
97 = Not Applicable
97 = Not Applicable
98 = Other (Narrative)
7 = 3rd Seat Left
Conveyance
99 = Unknown
98 = Other
7 = Child Booster Seat
99 = Unknown
99 = Unknown if Worn
99 = Unknown
8 = 3rd Seat Center
98 = Other (Narrative)
99 = Unknown
96 = None
9 = 3rd Seat Right
99 = Unknown
97 = Not Applicable
98 = Other (Narrative)
99 = Unknown
1.
2.
3.
4.
5.
6.
7.
8.
Person
Person
Seat
Injury
Age
Ethnicity
Sex
Ejected
Restraint
Airbag
Helmet
Sol.
Num.
Type
Position
Severity
(Y or N)
Driver / Primary Person:
.
Alcohol Test Result
Alcohol Specimen
Drug
Drug Test
Specimen
Result
Drug
Category
Law Enforcement and TxDOT Use ONLY
Total Num.
Total Num.
FATAL
CMV
SCHOOL BUS
RAILROAD
MEDICAL ADVISORY BOARD
Units
Prsns.
SUPPLEMENT
ACTIVE SCHOOL ZONE
ON PRIVATE DRIVE OR ROAD/PRIVATE PROPERTY/PARKING LOT
Texas Peace Officer's Crash Report (Form CR-3 ALTERNATE 1/1/2015)
Mail to: Texas Department of Transportation, Crash Data & Analysis, P.O. Box 149349, Austin, TX 78714. Questions? Call 844/274-7457
*These fields are required on all additional sheets submitted for this crash (ex.: additional vehicles, occupants, injured, etc.).
Page
of
i
*Crash Date
*Crash Time
Case
Local
(MM/DD/YYYY)
(24HRMM)
ID
Use
*County
*City
Name
Name
Speed
Roadway
Limit
Part
Construction
Latitude
Longtitude
.
.
Zone
(Decimal)
(Decimal)
*Address
If No, Distance from Intersection/
Direction from Intersection/
Crash at
Intersection
Reference Marker
Reference Marker
Railroad
Crossing Num.
Unit Number
Parked Vehicle
Did this unit "Hit and Run"?
Unit Description
LP State
LP Number
VIN
Vehicle
Vehicle
Vehicle
Vehicle
Year
Make
Model
Color
Body
Style
DL/ID
Type
DL/ID
DL/ID
DL
DOB
CDL
DL
State
Number
Class
(MM/DD/YYYY)
Endorse.
Restrict.
Address
(Street, City, State, Zip)
Owner/Lessee
Proof of
Name & Address
Insurance
Insurance
Policy
Ins. Company
Company
Number
Phone Number
Vehicle
Towed By
Towed To
Inventoried
1. Person Type
2. Seat Position
3. Injury Severity
4. Ethnicity
5. Ejected
6. Restraint Used
7. Airbag
8. Helmet Use
1 = Driver
1 = Front Left
10 = Cargo Area
A = Incapacitating Injury
W = White
1 = No
1 = Shoulder & Lap Belt
1 = Not Deployed
1 = Not Worn
2 = Passenger/Occupant
2 = Front Center
11 = Outside Vehicle
B = Non-Incapacitating
B = Black
2 = Yes
2 = Shoulder Belt Only
2 = Deployed, Front
2 = Worn, Damaged
3 = Pedalcyclist
3 = Front Right
13 = Other in Vehicle
Injury
H = Hispanic
3 = Yes, Partial
3 = Lap Belt Only
3 = Deployed, Side
3 = Worn, Not Damaged
4 = Pedestrian
4 = 2nd Seat Left
14 = Passenger in Bus
C = Possible Injury
A = Asian
97 = Not Applicable
4 = Child Seat, Facing Forward
4 = Deployed, Rear
4 = Worn, Unknown
5 =
5 = 2nd Seat Center
16 = Pedestrian,
K = Killed
I =
99 = Unknown
5 = Child Seat, Facing Rear
5 = Deployed, Multiple
Damage
6 = Motorcycle Passenger
6 = 2nd Seat Right
Pedalcyclist, or Motorized
N = Not Injured
6 = Child Seat, Unknown
97 = Not Applicable
97 = Not Applicable
98 = Other (Narrative)
7 = 3rd Seat Left
Conveyance
99 = Unknown
98 = Other
7 = Child Booster Seat
99 = Unknown
99 = Unknown if Worn
99 = Unknown
8 = 3rd Seat Center
98 = Other (Narrative)
99 = Unknown
96 = None
9 = 3rd Seat Right
99 = Unknown
97 = Not Applicable
98 = Other (Narrative)
99 = Unknown
1.
2.
3.
4.
5.
6.
7.
8.
Person
Person
Seat
Injury
Age
Ethnicity
Sex
Ejected
Restraint
Airbag
Helmet
Sol.
Num.
Type
Position
Severity
(Y or N)
Driver / Primary Person:
.
Alcohol Test Result
Alcohol Specimen
Drug
Drug Test
Specimen
Result
Drug
Category
Law Enforcement and TxDOT Use ONLY Form CR-3A (Rev. 1/1/2015)
Case ID
Page
of
ii
Unit Number
Parked Vehicle
Did this unit "Hit and Run"?
Unit Description
VIN
LP State
LP Number
Vehicle
Vehicle
Vehicle
Vehicle
Year
Make
Model
Color
Body
Style
DL/ID
Type
DL/ID
DL/ID
DL
DOB
CDL
DL
State
Number
Class
(MM/DD/YYYY)
Endorse.
Restrict.
Address
(Street, City, State, Zip)
Owner/Lessee
Proof of
Insurance
Name & Address
Insurance
Policy
Ins. Company
Company
Number
Phone Number
Vehicle
Towed By
Towed To
Inventoried
1. Person Type
2. Seat Position
3. Injury Severity
4. Ethnicity
5. Ejected
6. Restraint Used
7. Airbag
8. Helmet Use
1 = Driver
1 = Front Left
10 = Cargo Area
A = Incapacitating Injury
W = White
1 = No
1 = Shoulder & Lap Belt
1 = Not Deployed
1 = Not Worn
2 = Passenger/Occupant
2 = Front Center
11 = Outside Vehicle
B = Non-Incapacitating
B = Black
2 = Yes
2 = Shoulder Belt Only
2 = Deployed, Front
2 = Worn, Damaged
3 = Pedalcyclist
3 = Front Right
13 = Other in Vehicle
Injury
H = Hispanic
3 = Yes, Partial
3 = Lap Belt Only
3 = Deployed, Side
3 = Worn, Not Damaged
4 = Pedestrian
4 = 2nd Seat Left
14 = Passenger in Bus
C = Possible Injury
A = Asian
97 = Not
4 = Child Seat, Facing Forward
4 = Deployed, Rear
4 = Worn, Unk. Damage
5 =
5 = 2nd Seat Center
16 = Pedestrian,
K = Killed
I =
Applicable
5 = Child Seat, Facing Rear
5 = Deployed, Multiple
97 = Not Applicable
6 = Motorcycle Passenger
6 = 2nd Seat Right
Pedalcyclist, or Motorized
N = Not Injured
99 = Unknown
6 = Child Seat, Unknown
97 = Not Applicable
99 = Unknown if Worn
98 = Other (Narrative)
7 = 3rd Seat Left
Conveyance
99 = Unknown
98 = Other
7 = Child Booster Seat
99 = Unknown
99 = Unknown
8 = 3rd Seat Center
98 = Other (Narrative)
99 = Unknown
96 = None
9 = 3rd Seat Right
99 = Unknown
97 = Not Applicable
98 = Other (Narrative)
99 = Unknown
1.
2.
3.
4.
5.
6.
7.
8.
Person
Person
Seat
Injury
Age
Ethnicity
Sex
Ejected
Restraint
Airbag
Helmet
Sol.
Num.
Type
Position
Severity
(Y or N)
Driver / Primary Person:
.
Alcohol Test Result
Alcohol Specimen
Drug
Drug Test
Specimen
Result
Drug
Category
Unit
Person
Date of Death
Time of Death
Taken To
Taken By
Num.
Num.
(MM/DD/YYYY)
(24HRMM)
Damaged Property Other Than Vehicles
Owner's Name
Owner's Address
iii
Law Enforcement and TxDOT Use ONLY Form CR-3A (Rev. 1/1/2015)
Case ID
Page
of
Damage Rating (See diagram)
Damage Rating 1 (Most Severe)
Damage Rating 2
Special Cases:
Damage
Damage
VB-1 (Vehicle burned, NOT due to collision)
Unit
Direction of
Area of
Direction of
Area of
Severity
Severity
VB-7 (Vehicle caught fire due to collision)
Num.
Force (1-12)
Damage
Force (1-12)
Damage
(0-7)
(0-7)
TP-0 (Top damage only)
VX-0 (Undercarriage damage only)
MC-1 (Motorcycle, moped, scooter, etc.)
NA (Not applicable (farm tractor, etc.))
Investigator's Narrative Opinion of What Happened
Field Diagram - Not to Scale
(Explain all "98-Other" answers in narrative. Attach additional sheets if necessary.)
Indicate
North
Law Enforcement and TxDOT Use ONLY Form CR-3A (Rev. 1/1/2015)
Case ID
iv
Page
of
Unit
CMV Disabling
Vehicle
Num.
Damage?
Operation
Carrier
Carrier
Carrier
ID Type
ID Num.
Corp. Name
Carrier
Primary Address
Vehicle
Type
Bus
Haz Mat. Released
Type
Hazardous Material ID Number
Haz Mat
Class No.
Hazardous Material ID Number
Haz Mat
Class No.
Cargo
Body
Style
Unit
Unit
CMV Disabling
CMV Disabling
Trailer
Trailer
Num.
Num.
Damage?
Damage?
1
2
Type
Type
9. Sequence of Events
9. Sequence of Events
1-Non-Collision: Ran Off Road
8-Non-Collision: Cross Median/Centerline
15-Collision: Train
Event
Event
Event
Event
2-Non-Collision: Jackknife
9-Non-Collision: Equipment Failure
16-Collision: Pedalcycle
1
2
3
4
3-Non-Collision: Overturn Rollover
10-Non-Collision: Other
17-Collision: Animal
4-Non-Collision: Downhill Runaway
11-Non-Collision: Unknown
18-Collision: Fixed Object
5-Non-Collision: Cargo Loss/Shift
12-Collision: Pedestrian
19-Collision: Work Zone Maintenance Equip.
6-Non-Collision: Explosion/Fire
13-Collision: Motor Vehicle in Transport
20-Collision: Other Movable Object
7-Non-Collision: Separation of Units
14-Collision: Parked Motor Vehicle
21-Collision: Unknown Movable Object
98-Other (Narrative)
10. Factors and Conditions
1-Animal on Road, Domestic
23-Failed to Drive in Single Lane
37-FTYROW, Turning Left
51-Opened Door into Traffic Lane
65-Turned Improperly, Wrong Lane
2-Animal on Road, Wild
24-Failed to Give Half of Roadway
38-FTYROW, Turn on Red
52-Oversized Vehicle or Load
66-Turned when Unsafe
3-Backed Without Safety
25-Failed to Heed Warning Sign
39-FTYROW, Yield Sign
53-Overtake and Pass Insufficient
67-Under Influence, Alcohol
4-Changed Lane when Unsafe
26-Failed to Pass to Left Safely
40-Fatigued or Asleep
Clearance
68-Under Influence, Drug
14-Disabled in Traffic Lane
27-Failed to Pass to Right Safely
41-Faulty Evasive Action
54-Parked and Failed to Set Brake
69-Wrong Side, Approach or Intersection
15-Disregard Stop and Go Signal
28-Failed to Signal or Gave Wrong
42-Fire in Vehicle
55-Parked in Traffic Lane
70-Wrong Side, Not Passing
16-Disregard Stop Sign or Light
Signal
43-Fleeing or Evading Police
56-Parked without Lights
71-Wrong Way, One Way Road
17-Disregard Turn Marks at
29-Failed to Stop at Proper Place
44-Followed Too Closely
57-Passed in No Passing Lane
73-Road Rage
Intersection
30-Failed to Stop for School Bus
45-Hand Been Drinking
58-Passed on Right Shoulder
74-Cell/Mobile Device Use-Talking
18-Disregard Warning Sign
31-Failed to Stop for Train
46-Handicapped Driver (Narrative)
59-Pedestrian FTYROW to Vehicle
75-Cell/Mobile Device Use-Texting
at Construction
32-FTYROW, Emergency Vehicle
47-Ill (Narrative)
60-Unsafe Speed
76-Cell/Mobile Device Use-Other
19-Distraction in Vehicle
33-FTYROW, Open Intersection
48-Impaired Visibility (Narrative)
61-Speeding, (Over Limit)
77-Cell/Mobile Device Use-Unknown
20-Driver Inattention
34-FTYROW, Private Drive
49-Improper Start from Parked
62-Taking Medication (Narrative)
98-Other (Narrative)
21-Drove Without Headlights
35-FTYROW, Stop Sign
Position
63-Turned Improperly, Cut Corner on Left
22-Failed to Control Speed
36-FTYROW, To Pedestrian
50-Load Not Secure
64-Turned Improperly, Wide Right
10. Contributing Factors (Investigator's Opinion)
11. Vehicle Defects
11. Vehicle Defects (Investigator's Opinion)
5-Defective or No Headlamps
10-Defective or No Vehicle Brakes
Unit
May Have
Unit
May Have
Contributing
Contributing
6-Defective or No Stop Lamps
11-Defective Steering Mechanism
Num.
Contributed
Num.
Contributed
7-Defective or No Tail Lamps
12-Defective or Slick Tires
8-Defective or No Turn Signal Lamps
13-Defective Trailer Hitch
9-Defective or No Trailer Brakes
98-Other (Narrative)
Unit
Person
Charge
Citation/Reference Num.
Num.
Num.
Time Notified
How
Time Arrived
Report Date
(24HRMM)
Notified
(24HRMM)
(MM/DD/YYYY)
Investigation
Investigators Name (Print)
Badge/ID
Service/
Complete
First Initial, Last Name
Num.
Region/DA
ORI
*Agency
Num.
Law Enforcement and TxDOT Use ONLY
Texas Peace Officer's Crash Report, Additional Persons (Form CR-3 ALTERNATE 1/1/2015)
Mail to: Texas Department of Transportation, Crash Data & Analysis, P.O. Box 149349, Austin, TX 78714. Questions? Call 844/274-7457
*These fields are required on all additional sheets submitted for this crash (ex.: additional vehicles, occupants, injured, etc.).
v
Page
of
TxDOT
*Crash Date
*Crash Time
Case
Crash ID
(MM/DD/YYYY)
(24HRMM)
ID
*County
*City
Name
Name
*Address
ORI
Service/
*Agency
Num.
Region/DA
1. Person Type
2. Seat Position
3. Injury Severity
4. Ethnicity
5. Ejected
6. Restraint Used
7. Airbag
8. Helmet Use
1 = Driver
1 = Front Left
10 = Cargo Area
A = Incapacitating Injury
W = White
1 = No
1 = Shoulder & Lap Belt
1 = Not Deployed
1 = Not Worn
2 = Passenger/Occupant
2 = Front Center
11 = Outside Vehicle
B = Non-Incapacitating
B = Black
2 = Yes
2 = Shoulder Belt Only
2 = Deployed, Front
2 = Worn, Damaged
3 = Pedalcyclist
3 = Front Right
13 = Other in Vehicle
Injury
H = Hispanic
3 = Yes, Partial
3 = Lap Belt Only
3 = Deployed, Side
3 = Worn, Not Damaged
4 = Pedestrian
4 = Second Seat Left
14 = Passenger in Bus
C = Possible Injury
A = Asian
97 = Not
4 = Child Seat, Facing Forward
4 = Deployed, Rear
4 = Worn, Unk. Damage
5 =
5 = Second Seat Center
16 = Pedestrian,
K = Killed
I =
Applicable
5 = Child Seat, Facing Rear
5 = Deployed, Multiple
97 = Not Applicable
6 = Motorcycle Passenger
6 = Second Seat Right
Pedalcyclist, or
N = Not Injured
99 = Unknown
6 = Child Seat, Unknown
97 = Not Applicable
99 = Unknown if Worn
98 = Other (Narrative)
7 = Third Seat Left
Motorized Conveyance
99 = Unknown
98 = Other
7 = Child Booster Seat
99 = Unknown
99 = Unknown
8 = Third Seat Center
98 = Other (Narrative)
99 = Unknown
96 = None
9 = Third Seat Right
99 = Unknown
97 = Not Applicable
98 = Other (Narrative)
99 = Unknown
1.
2.
3.
4.
5.
6.
7.
8.
Unit
Person
Person
Seat
Injury
Age
Ethnicity
Sex
Ejected
Restraint
Airbag
Helmet
Sol.
Num.
Num.
Type
Position
Severity
(Y or N)