Traffic Accident Report (TARAS) Form

1. REPORT NO. 10-2008-08 3. POLICE STATION: NFSTI POL STN 5. NUMBER OF VEHICLES INVOLVED 6. NUMBER OF DRIVER CASUALTIES 7. NUMBER OF PASSENGER CASUALTIES 8. NUMBER OF PEDESTRIAN CASUALTIES 15. JUNCTION (TYPE)

Y

1. Not at Junction

5.

2.

6.

3.

7. Railway

4.

8. Other

20. WEATHER

21. LIGHT

1. Fair 2. Rain 3. Wind 4. Smoke 5. Fog 6. Dazzle 7. Storm

1. Daylight 2. Dawn/Dust 3. Night (lit) 4. Night (unlit)

REPUBLIC OF THE PHILIPPINES PHILIPPINE NATIONAL POLICE TRAFFIC ACCIDENT REPORT FORM

4. REGIONAL OFFICE NCRPO 10. Month 11. Day 12. Year DATE: October 20, 2008 13. Day of the Week 14. TIME (Military Time) 0900H

2 1 0 0

9. ACCIDENT SEVERITY F. Fatal Accident S. Serious Injury Accident M Minor Injury Accident D. Property Damage Only 16. TRAFFIC CONTROL 17. COLLISION TYPE 1. None 2. Centerline 3. Pedestrian Crossing 4. School Crossing 5. Police Controlled 6. Traffic Lights 7. Stop Sign 8. Give Way 9. Other ....................

22. ROAD CHARACTER 1. Straight+Flat 2. Curve Only 3. Incline Only 4. Curve+Incline 5. Bridge ......... 6. Crest

27. ROAD REPAIRS 1. Yes .................... 2. No .....................

2. PROVINCIAL OFFICE

1. Head On 6. Hit Object in Road 2. Rear End 7. Hit Object Off Road 3. Right Angle 8. Hit Parked Vehicle 4. Side Swipe 9. Hit Pedestrian 5. Overturned Vehicle 10. Hit Animal 11. Other .........................

23. SURFACE CONDITION

24. SURFACE TYPE

1. Dry 2. Wet 3. Muddy 4. Flooded 5. Other

1. Concrete 2. Asphalt 3. Gravel 4. Earth

28. HIT & RUN 1. Yes .................... 2. No .....................

18. MOVENMENT 1. 1-Way 2. 2-Way 19. SEPARATION 1. Median 2. Not Median

25. MAIN CLAUSE 1. Vehicle Defect 2. Road Defect 3. Human Error 4. Other

26. ROAD CLASS 1. National 2. Provincial 3. City 4. Municipal 5. Barangay

29. LOCATION TYPE 1. Urban Area .................... 2. Rural Area .....................

LOCATION Name of City/Town/Barangay: PPSC, Fort Bonifacion, Global, Taguig City Landmark 1 ............................ Name of Road NPC Ave., PPSC, Fort Bonifacio BETWEEN Global, Taguig City Landmark 2 ...........................

Distance ............... (km/m) Distance ............... (km/m) Distance ............... (km/m)

JUNCTION ACCIDENT ONLY: Name of Second Road: ESCARCHA DRIVE, PPSC, FB, Global, Taguig City Distance ............... (km/m) LOCATION SKETCH MAP: Show site in relation to prominent landmarks COLLISION DIAGRAM SKETCH: Mark the position and direction of each such as KM post or Major intersection. Mark distances to the landmarks

vehicle and details of the road layout at the site of the accident

N

Signatures: Driver 1...................... ..

POLICE DESCRIPTION OF ACCIDENT

DRIVER STATEMENT Driver 1

Driver 2................................

WITNESSES 1.Name: Address: 2. Name: Address: INVESTIGATING OFFICER SPO1 RICHARD JOHN DM MACACHOR SUPERVISING OFFICER PROF FELINO AGUIT BRAGADO ACTION TAKEN RECOMMENDATION

Driver 2

STATUS OF CASE: Case Filed at Taguig City Prosecutors Office

Additional Form(s) will be needed if there are more than 2 vehicles ; more than 4 passenger casualties or more than 2 pedestrian casualties. Fill in the report no, provincial office, police station and dates and fix forms together securely 1. REP NO 2. PROV OFFICE 3. POL STN 4. REG OFFICE 5. DATE 30. VEHICLE PLATE NUMBER

VEHICLE 1

DRIVER 1

31. OWNER’S NAME & ADDRESS

Name:

ADDRESS

CHASSIS/NUMBER

32. ENGINE NUMBER

LICENSE NUMBER:

33. INSURANCE

OC/CR DETAILS

LICENCES TYPE

EXPIRY DATE

MANUFACTURER (MAKE)

MODEL/YEAR

40 DRIVER SEX

42. DRIVER INJURY

34. VEHICLE TYPE

35 VEHICLE MANUEVER 1. Left Turn 7. Overtaking

41. DRIVER AGE

1. Fatal 3. Minor 2. Serious 4. Not Injured Hospital: ............................

1. Bicycle 2. Pedicab 3. Motorcycle 4. Tricycle 5. Car 6. Jeepney

7. Bus 8. Truck (Rigid) 9. Truck (Artic) 10. Van 11. Animal 12 Other

2. Right Turn 3. “U” Turn 4. Cross Traffic 5. Merging 6. Diverging

13. Parked 8. Going Ahead on Rd 9. Reversing 14. Other 10. Sudden Start 11. Sudden Stop 12. Parked off Road

43. DRIVER ERROR 1. None 2. Fatigue/Asleep 3. Inattentive 4. Too Fast 5. Too Close

6. No Signal 7. Bad Overtaking 8. Bad Turning 9. Using Cell Phone 10. Other ..........................................

36. LOADING

37. DIRECTION

38. VEHICLE DEFECT

39. VEHICLE DAMAGE

44. ALCOHOL/DRUGS

1. Legal 2. Over Loaded 3. Unsafe Load

1. North 2. South 3. East 4. West

1. None 5. Tire 2. Lights 6. Multiple 3. Brakes 7. Other 4. Steering ..............

1. None 5. Left 2. Front 6. Multiple 3. Rear 7. Other 4. Right ..............

1. Alcohol Suspected Drug Suspected 2. Not Suspected

VEHICLE 2

30. VEHICLE PLATE NUMBER

DRIVER 2

31. OWNER’S NAME & ADDRESS

45. SEAT BELT/HELMET 1. Seat Belt/Helmet Worn 2. Not worn 3. Not Worn Correctly

Name:

ADDRESS

CHASSIS/NUMBER

32. ENGINE NUMBER

LICENSE NUMBER:

33. INSURANCE

OC/CR DETAILS

LICENCES TYPE

EXPIRY DATE

MANUFACTURER (MAKE)

MODEL/YEAR

40 DRIVER SEX

42. DRIVER INJURY

34. VEHICLE TYPE

35 VEHICLE MANUEVER 1. Left Turn 7. Overtaking

41. DRIVER AGE

1. Fatal 3. Minor 2. Serious 4. Not Injured Hospital: ............................

1. Bicycle 2. Pedicab 3. Motorcycle 4. Tricycle 5. Car 6. Jeepney

7. Bus 8. Truck (Rigid) 9. Truck (Artic) 10. Van 11. Animal 12 Other

2. Right Turn 3. “U” Turn 4. Cross Traffic 5. Merging 6. Diverging

13. Parked 8. Going Ahead on Rd 9. Reversing 14. Other 10. Sudden Start 11. Sudden Stop 12. Parked off Road

43. DRIVER ERROR 1. None 2. Fatigue/Asleep 3. Inattentive 4. Too Fast 5. Too Close

36. LOADING

37. DIRECTION

38. VEHICLE DEFECT

39. VEHICLE DAMAGE

44. ALCOHOL/DRUGS

1. Legal 2. Over Loaded 3. Unsafe Load

1. North 2. South 3. East 4. West

1. None 5. Tire 2. Lights 6. Multiple 3. Brakes 7. Other 4. Steering ..............

1. None 5. Left 2. Front 6. Multiple 3. Rear 7. Other 4. Right ..............

1. Alcohol Suspected Drug Suspected 2. Not Suspected

6. No Signal 7. Bad Overtaking 8. Bad Turning 9. Using Cell Phone 10. Other ..........................................

45. SEAT BELT/HELMET 1. Seat Belt/Helmet Worn 2. Not worn 3. Not Worn Correctly

PASSENGER CASUALTIES : Complete 1 Full Line for each passenger casualty = see reference boxes below NAME AND ADDRESS 46. VEH. NO 47. SEX 48. AGE 49. INJURY/ HOSP

50. POSITION

51 Action

PEDESTRIAN CASUALTIES : Complete 1 Full Line for each pedestrian casualty = see reference boxes below NAME AND ADDRESS 52. SEX 53. AGE 54. INJURY/ HOSP

55. POSITION

56 Action

FOR REFERENCE ONLY DO NOT CIRCLE

49. PASSENGER INJURY 54. PEDESTRIAN INJURY F. Fatal S. Serious M Minor

50. PASSENGER POSITION 1. Front Seat 2. Rear Seat 3. M/C Passenger 4. Bus Passenger 5. Outside Sitting 6. Outside Standing

51. PASSENGER ACTION

55.PEDESTRIAN LOCATION

56. PEDESTRIAN ACTION

1. None 2. Boarding 3. Alighting 4. Falling 5. Other

1. On Pedestrian Crossing 2. Within 50m ped Crossing 3. On Central Refuge 4. In Road Centre 5. On Footpath/Verge

1. None 2. Crossing Road 3. Walking along Road 4. Walking along Edge 5. Playing on Road 6. On Footpath