NHDOT Work Zone Crash Report

1. Location of Crash *

Click and drag or double click to move the marker to the crash location.

Latitude:

Longitude:

2: Town or City

3. Project Name

4. Project Number

5. Bureau *

6. District/Shed/Contractor *

7. Crash Date *

8. Crash Time *

9. Number of Vehicles Involved

10-1. General Public Injuries

If unknown, leave blank.

In Motor Vehicles:

Motorcyclists:

Bicyclists:

Pedestrians:

10-2. General Public Fatalities

If unknown, leave blank.

In Motor Vehicles:

Motorcyclists:

Bicyclists:

Pedestrians:

10-3. Project Personnel Injuries

If unknown, leave blank.

Operating Equipment:

Pedestrians:

In Motor Vehicles:

10-4. Project Personnel Fatalities

If unknown, leave blank.

Operating Equipment:

Pedestrians:

In Motor Vehicles:

12. Roadway Design *

Other Design:

13. Roadway Alignment *

14. Roadway Surface Type *

Travel Lane:

Shoulders:

15. Roadway Condition *

16. Surface Condition *

17. Light Condition *

19. Traffic Volume *

20. Posted Speed Limit *

21. Traffic Control Package *

Package Designation:

MUTCD:

NHWZTC:

Other:

Condition of Devices

22. Pavement Marking *

Left TW:

Centerline:

Right TW:

23. Lane Width (feet) *

Lanes:

Left Shoulder:

Right Shoulder:

24. Changeable Message Signs *

Message:

Phase 1:

Phase 2:

25. Work Zone Flaggers *

26. Work Zone Uniformed Officers *

27. At the time of the crash was there Work Zone related activity? *

28. Police Report *

Town/City/State Troop Number:

Officer Name:

Report Number:

29-1. Location Within the Work Zone *

29-2. Did the crash occur at the end of a queue of traffic?

29-3. Did the crash occur within a queue of traffic?

30. Sketch Required *

31. Additional Documents (Photos, Daily Report, TCP, Etc)

32. Crash Description and Additional Comments

33. Report Generated by: *

Name:

Email Address:

34. Supervisor: *

Name:

Email Address:

NHDOT Work Zone Crash Report

1. Location of Crash *

Latitude:

Longitude:

2: Town or City

3. Project Name

4. Project Number

5. Bureau *

6. District/Shed/Contractor *

7. Crash Date *

8. Crash Time *

9. Number of Vehicles Involved

10-1. General Public Injuries

In Motor Vehicles:

Motorcyclists:

Bicyclists:

Pedestrians:

10-2. General Public Fatalities

In Motor Vehicles:

Motorcyclists:

Bicyclists:

Pedestrians:

10-3. Project Personnel Injuries

Operating Equipment:

Pedestrians:

In Motor Vehicles:

10-4. Project Personnel Fatalities

Operating Equipment:

Pedestrians:

In Motor Vehicles:

11. Type of Crash/Collision *

Frontal-Side

Sideswipe

Rear End

Other

Head On

Rollover

Bicyclist

Worker

Pedestrian

Flagger-Officer

Construction Equipment

Went Over a Drop Off

Fixed Object

Other Crash Type:

11-1. Fixed Object

Sign Post

Guardrail

Water

Tree

Boulder

Light Post

Channelizing Devices

Changeable Meassage Sign

Temporary Concrete Barrier

Construction Equipment

Telephone Pole

Material Stockpile

Retaining Wall

Abutment-Pier

Arrowboard

Ledge Outcrop

Impact Attenuator

Other

12. Roadway Design *

Other Design:

13. Roadway Alignment *

14. Roadway Surface Type *

Travel Lane:

Shoulders:

15. Roadway Condition *

16. Surface Condition *

17. Light Condition *

18. Weather Conditions *

Clear

Cloudy

Fog

Rain

Snow

Hail