Table 1 : Accident Analysis Format According to Total Number of Accidents by Month of the Year

Name of State Name of District

Name of PIU Package No.
statement containing particaulars of road accidents in the State of _______________ For the year ending December
Number of Accident
S.No. Name of Road Month Injury needing Injury not needing
Fatal Total
Hospitalization Hospitalization Damage to Property
Table 2 : Accident Analysis Format by Type of Area and Time
Number of Accident
Habitation Rural-
S.No. Name of Road Time
Injury nedding Injury not Injury needing Injury not Damage
Fatal needing Total Fare needing to Total
Hospitalization Hospitalization Hospitalization Hospitalization Property

600 - 700
700 - 800
800 - 900
900 - 1000
1000 - 1100
1100 - 1200
1200 - 1300
1300 - 1400
1400 - 1500
1500 - 1600
1600 - 1700
1700 - 1800
1800 - 1900
1900 - 2000
2000 - 2100
2100 - 2200
2200 - 2300
2300 - 2400
Table 3 :Accident Analysis Format by Type of Collision
Name of State- Name of District-
Name of PIU- Package No.-
Number of Accident
S.No. Name of Road NUMBER OF FATALITIES Injury needing Injury not needing Damage to
Fatal Total
Hospitalization Hospitalization Property
Head on collision
Hit from Back
Hit from Side
Overturn
Hit fix object
Hit Pedestrian
Run off the road
Unknown / Hit & Run
Total
Table 4 :Accident Analysis Format by Weather
Name of State- Name of District-
Name of PIU- Package No.-
Number of Accident
NUMBER OF Injury not
S.No. Name of Road Injury needing Damage to
FATALITIES Fatal needing Total
Hospitalization Property
Hospitalization
1. Fine / Clear
2. Rainy
3. Foggy
4. Other
5. Total
Table 5 : Accident Analysis Format According to Location of Accident Spot

Name of State- Name of District-

Name of PIU- Package No.-
Number of Accident
S.No. Name of Road NUMBER OF FATALITIES Injury needing Injury not needing Damage to
Fatal Total
Hospitalization Hospitalization Property
1. Road Section
2. At / Near Junction
3. Others
4. Total
Table 6 : Accident Analysis Format According to Age Profile of Victim (Including Drivers)

Name of State- Name of District-

Name of PIU- Package No.-
Number of Accident

S.No. Name of Road Driver Details Injury not

Injury needing Damage to
Fatal needing Total
Hospitalization Property
Hospitalization

(A) Sex
Male
Female

(B) Age
1. Under 18 Years
2. 18-25
Years 3.
26-40 Years
4. 41-60 Years
5. Age above 60

(C) License
1. Proper
License
2. No / Expired License
Table 7 : Accident Analysis Format by Presence of Alcohol and Safety Device Profile of Victim

Name of State- Name of District-

Name of PIU- Package No.-
Number of Accident
S.No. Name of Road Injury Profile of Victim Injury needing Injury not needing Damage to
Fatal Total
Hospitalization Hospitalization Property

(A) Presence of Alcohol &

Drugs
1. Yes
2. No
3. Unknown
4. Total

(B) Use of Requisite Safety

Devices
1. Yes
2. No
3. Unknown
4. Total
Table 8 : Accident Analysis Format According to Nature of Traffic Violations

Name of State- Name of District-

Name of PIU- Package No.-
Number of Accident
Traffic Violations by involved
S.No. Name of Road Injury needing Injury not needing Damage to
vehicle (S) Fatal Total
Hospitalization Hospitalization Property

1. Over-Speeding
2. Jumping
Red Lights
3. Driving on Wrong Side
4. Unknown
5. Not
Applicable
6. Total
Table 9 : Accident Analysis Format by Type of Vehicle

Name of State- Madhya Pradesh Name of District-

Name of PIU- Package No.-
Number of Accident

S.No. Name of Road TYPE OF VEHICLE Injury not

Injury needing Damage to
Fatal needing Total
Hospitalization Property
Hospitalization
1 Motorized two Wheeler
2 Auto Rickshaw
3 Car / Jeep/ Van/ Taxi
4 Bus
5 Light Truck
6 Heavy Articulated Truck
7 Tempo / Tractor
8 Bicycle
9 Cycle Rickshaw
10 Hand Drawn Cart
11 Animal Drawn Cart
12 Total