Rhode Island Uniform Crash Report 12/2006

Report Number1 Driver2 Passenger3 Pedestrian4 Bicyclist5 Other Cyclist6 WitnessSTATE OF RHODE ISLAND UNIFORM CRASH REPORTAdditional Persons SupplementalPerson Type7 Other Ped. (Wheelchair, Person in Building, Skater, 9 Occupant of a Non-Motor Veh Transportation DevicePed. conveyance, etc.)10 Unknown Type of Non-Motorist8 Occupant of Motor Veh. Not in Transport (Parked, etc.) 11 UnknownUnit ID1 Unit 12 Unit 23 (etc.)or N/ASexM MaleF FemaleU UnkM1 2 34 5 67 8 910 11 12Name: Occupants - Witnesses -Pedestrians - BicyclistsSeat PositionOther Location13 Other Row 17 N/A(Bus) 18 Sleeper14 Unk Row 19 Other Enclosed Area15 Other Seat 20 Other Unenclosed Area16 Unk Seat 21 Towed Unit22 UnkPersonTypeAir BagDeployed1 N/A2 No3 Front4 Side5 Other6 Comb7 UnkEjected1 No2 Partially3 Totally4 N/A5 UnkUnit ID Sex DOB SeatPos.Protection System1 N/A2 None Used3 Shoulder & Lap4 Shoulder Only5 Lap Only6 Type Unk7 Child - Forw Facing8 Child - Rear Facing9 Booster Seat10 Child - Unk11 Helmet Used12 Other13 UnkEjectedAir BagDeployedProt.SystemInjuryInjury1 Complains of Pain2 Non-Incapacitating3 Incapacitating4 Fatal5 No Injury6 UnkTrans byRescueYYYYYYYYYYYYYYYYYYNNNNNNNNNNNNNNNNNNNon-Vehicle Property Damage State Property City/Town Property Private PropertyOwnerAddressHome Phone Cell Phone Work Phone Damage DescriptionNon-Vehicle Property Damage State Property City/Town Property Private PropertyOwnerAddressHome Phone Cell Phone Work Phone Damage DescriptionNon-Vehicle Property Damage State Property City/Town Property Private PropertyOwnerAddressHome Phone Cell Phone Work Phone Damage DescriptionPage 6