Attachment 19-SF-91 - Motor Vehicle Accident Report Form.pdf
Standard Form PDF 227 KB Posted
- Attached to
- Training Support Services
- Solicitation number
- 70LART25RPFB00006
About this file
This is Standard Form 91 (SF-91), the federal Motor Vehicle Accident Report form used to document accidents involving federal vehicles. The four-page form contains sections for federal vehicle data, other vehicle information, details about killed or injured persons, accident time and location, witness/passenger information, property damage, police information, trip details, federal driver certification, and accident investigation data.
The form is designed to be filled out in three parts: Sections I through IX are completed by the vehicle operator, Section X items 72-82c are filled out by the operator's supervisor, and Sections XI through XIII are completed by an accident investigator for incidents involving bodily injury, fatality, and/or damage exceeding $500. The form includes fields for documenting vehicle and driver information, damage descriptions, insurance details, accident diagrams, and certification statements. This appears to be a blank template form that would be used by federal employees to report vehicle accidents, rather than a completed accident report.
View the file
Other versions and copies of SF 91
Who attaches SF 91
Other files
Show 40 more
Latest 50 of 75 listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
1_DRIVERS_NAME_Last_first:
| 2_DRIVERS_LICENSE_NOSTATE: |
| 3_DATE_OF_ACCIDENT: |
| 4a_DEPARTMENTFEDERAL_AGEN: |
| Comb1: |
| Comb11: |
| 5_TAG_OR_IDENTIFICATION_N: |
| FillText6: |
| 7_YEAR_OF_VEHICLE: |
| 8_MAKE: |
| 9_MODEL: |
| 10_SEAT_BELTS_USED: Off |
| 1_1_DESCRIBE_VEHICLE_DAMA: |
| 12_DRIVERS_NAME_Last_firs: |
| 13_DRIVERS_LICENSE_NUMBER: |
| 14a_DRIVERS_WORK_ADDRESS: |
| Comb2: |
| Comb21: |
| 15a_DRIVERS_HOME_ADDRESS: |
| Comb3: |
| Comb31: |
| 16_DESCRIBE_VEHICLE_DAMAG: |
| FillText7: |
| 18_YEAR_OF_VEHICLE: |
| 19_MAKE_OF_VEHICLE: |
| 20_MODEL_OF_VEHICLE: |
| 21_TAG_NUMBER_AND_STATE: |
| 22a_DRIVERS_INSURANCE_COM: |
| 22b_POLICY_NUMBER: |
| Comb4: |
| Comb41: |
| COOWNED: Off |
| LEASED: Off |
| RENTAL: Off |
| PRIVATELY_OWNED: Off |
| 24a_OWNERS_NAMES_Last_fir: |
| Comb5: |
| Comb51: |
| SECTION_III__KILLED_OR_IN: |
| 26_NAME_Last_first_middle: |
| 27_SEX: |
| 28_DATE_OF_BIRTH: |
| 29_ADDRESS: |
| KILLED1: Off |
| INJURED1: Off |
| DRIVER1: Off |
| HELPER1: Off |
| PASSENGER1: Off |
| PEDESTRIAN1: Off |
| FED1: Off |
| OTHER_2: Off |
| 32_LOCATION_IN_VEHICLE: |
| 33_FIRST_AID_GIVEN_BY: |
| 34_TRANSPORTED_BY: |
| 35_TRANSPORTED_TO: |
| 36_NAME_Last_first_middle: |
| 37_SEX: |
| 38_DATE_OF_BIRTH: |
| 39_ADDRESS: |
| KILLED2: Off |
| INJURED2: Off |
| DRIVER2: Off |
| HELPER2: Off |
| PASSENGER2: Off |
| PEDESTRIAN2: Off |
| FED2: Off |
| OTHER_1: Off |
| 42_LOCATION_IN_VEHICLE: |
| 43_FIRST_AID_GIVEN_BY: |
| 44_TRANSPORTED_BY: |
| 45_TRANSPORTED_TO: |
| a_NAME_OF_STREET_OR_HIGHW: |
| FROM: |
| TO: |
| c_DESCRIBE_WHAT_PEDESTRIA: |
| 47_DATE_OF_ACCIDENT: |
| 48_PLACE_OF_ACCIDENT_Stre: |
| FillText8: |
| FillText9: |
| FED3: |
| FED4: |
| FED5: |
| FED6: |
| FED7: |
| FED8: |
| FED9: |
| FED10: |
| 1: |
| 3: |
| 4: |
| 5: |
| 6: |
| 7: |
| 8: |
| 9: |
| SECTION_V__WITNESSPASSENG: |
| 53_NAME_Last_first_middle: |
| Comb7: |
| Comb71: |
| Comb8: |
| Comb81: |
| 56_BUSINESS_ADDRESS: |
| 57_HOME_ADDRESS: |
| 58_NAME_Last_first_middle: |
| Comb9: |
| Comb91: |
| Comb10: |
| Comb101: |
| 61_BUSINESS_ADDRESS: |
| 62_HOME_ADDRESS: |
| 63a_NAME_OF_OWNER: |
| Comb111: |
| Comb6: |
| Comb12: |
| Comb121: |
| 63d_BUSINESS_ADDRESS: |
| 63e_HOME_ADDRESS: |
| 64a_NAME_OF_INSURANCE_COM: |
| Comb13: |
| Comb131: |
| 64c_POLICY_NUMBER: |
| 65_ITEM_DAMAGED: |
| 66_LOCATION_OF_DAMAGED_IT: |
| 67_ESTIMATED_COST: |
| 68a_NAME_OF_POLICE_OFFICE: |
| 68b_BADGE_NUMBER: |
| Comb14: |
| Comb141: |
| 69_PRECINCT_OR_HEADQUARTE: |
| 70a_PERSON_CHARGED_WITH_A: |
| 70b_VIOLATIONS: |
| SECTION_IX__FEDERAL_DRIVE: |
| 71_a_NAME_AND_TITLE_OF_DR: |
| 72_ORIGIN: |
| 73_DESTINATION: |
| FillText10: |
| DATE1: |
| FillText11: |
| FillText12: |
| DATE2: |
| FillText13: |
| FillText14: |
| ORALLY: Off |
| IN_WRITING_Explain: Off |
| FillText15: |
| 78_WAS_THERE_ANY_DEVIATIO: Off |
| FillText16: |
| 79_WAS_THE_TRIP_MADE_WITH: Off |
| FillText17: |
| 80_DID_THE_OPERATOR_WHILE: Off |
| FillText18: |
| a_DID_THIS_ACCIDENT_OCCU1: Off |
| b_COMMENTS: |
| 82a_NAME_AND_TITLE_OF_SUP: |
| 71b_DRIVER_DATE: |
| Comb15: |
| Comb151: |
| SECTION_XI__ACCIDENT_INVE: Off |
| 84_PERSONS_INTERVIEWED: |
| a_b: |
| DATE3: |
| FillText20: |
| FillText21: |
| d_C: |
| DATE4: |
| FillText19: |
| FillText22: |
| SECTION_XII__ATTACHMENTS: |
| SECTION_XIII__COMMENTSAPP: |
| FillText23: |
| 82b_SUPERVISOR_DATE: |
| b_NAME_First_middle_last: |
| c_TITLE: |
| d_OFFICE: |
| Comb16: |
| Comb161: |
| 87a_date: |
| 88a_date: |
| b_NAME_First_middle_last1: |
| c_TITLE1: |
| d_OFFICE1: |
| Comb17: |
| Comb171: |
File details come from the government source that posted it. Updated .