Fatal Supplement DT3480

A Fatal Supplement Form (either electronic or paper) is required whenever there is a traffic crash resulting in a fatality. Beginning in 2017 the only way to create a Fatal Supplement is to replicate from the crash form. The death must occur within 30 days of the crash to be considered a traffic fatality. A fetus must be 28 weeks developed to be counted as a traffic fatality. This form replaces the paper MV3480 Fatal Supplement Form when submitted as part of a TraCS electronic crash report and is necessary to comply with the requirements of the federal Fatality Analysis Reporting System (FARS). This form is transmitted when validated.

NOTE: this form is only accessible with a replicate from the Crash form with the Fatality.

This form is owned by Department of State Patrol Crash Records Unit

Each Fatal Supplement form contains one Document group. The fields within the group are shown in the figure below.

Document Number

Document number of the fatal supplement form. Automatically generated via TraCS. For amended reports, this value is taken from the document number override field.

Machine Number

TraCS Machine Number that the Crash report was written on.

Pack

Wisconsin TraCS Pack version that the Crash Report was written on.

Baseline

TraCS Baseline version that the Crash report was written on.

Tags

Used to categorize different types of contacts such as “Click It or Ticket It”. Agencies can add their own tag types. This is an agency table with values being entered using the table manager tool. Instructions for this are in the installation guide in Task 3-5

This section contains general information about the accident. Every Crash report contains one summary group. Most fields in this group are not editable on the Fatal Supplement and if needed needs to be Modified on the Crash form.

Document Number (From DT4000)

This field is not editable in the Fatal Supplement

Document number of the initial form submission for the crash. Automatically generated via TraCS. For amended reports, this value is taken from the document number override field.

Crash Date

This field is not editable in the Fatal Supplement

The date at which the crash occurred.

This crash form, DT4000, has an effective date of 1/1/2017. Any forms prior to that need to be filled out on the MV4000 (paper or electronic). Entering a Crash Date prior to 1/1/2017 will result in TraCS opening the old MV4000 form.

Crash Time

This field is not editable in the Fatal Supplement

The military time at which the crash occurred.

Total Units

This field is not editable in the Fatal Supplement

The total number of units involved in the crash. All modes of transportation, including equipment and non-motorized units.

This field is sometimes grayed out and set to 1. If the Crash Type is a non-domesticated animal without injury, then this field is always set to 1. This field adds and deletes the Unit group. If the unit group is not empty, then it will not delete automatically, and deletion will need to be manually completed.

Total Killed

This field is not editable in the Fatal Supplement

The total number of fatalities (motorists and non-motorists) that resulted from injuries sustained as the result of a specific motor vehicle crash. If a pregnant woman is involved in a fatal crash, she must be in the 3^rd trimester for the fetus to be considered a fatality. In reporting fatality statistics, a 30-day counting rule is generally used for highway safety statistics. This rule provides that only deaths that occur within 30 24-hour periods of a crash will be counted for statistical purposes.

If this field is greater than zero, then fields throughout the form will turn yellow. These yellow fields are required is sending an email to the FARS group at the DOT. See document for more information on Fatal Crashes.

This section contains information about the units involved in the crash. There should be a Unit group for each unit in the crash/fatal supplement. A unit can be the following

• Automobile and all the passengers in it.

• Truck and all the passengers in it.

• Motorcycle and all the passengers on it.

• Bus, Driver and all injured passengers in it.

• Equipment and all passengers in it unless it is a train, then the train engineer and all injured passengers.

• Bicycle and all passengers on it

• Pedestrian, each separate pedestrian is considered a Unit.

A unit contains 1 or more subgroups, below is an example of the unit group.

Unit # on Crash

This field is not editable in the Fatal Supplement

Number assigned to uniquely identify each motor vehicle involved in the crash.

Unit Status

This field is not editable in the Fatal Supplement

The status of the vehicle at the time of the crash. In Transit refers to a general motor vehicle crash

Unit Type

This field is not editable in the Fatal Supplement

The type of vehicle involved in the crash. Can be identified by license plate type

License Plate Number

This field is not editable in the Fatal Supplement

The alphanumeric identifier or other characters, exactly as displayed, on the registration plate or tag affixed to the motor vehicle. For combination trucks, motor vehicle plate number is obtained from the power unit or tractor.

Vehicle Type

This field is not editable in the Fatal Supplement

Describes the vehicle body type. This field is limited by the Unit Type field.

Total Occs

This field is not editable in the Fatal Supplement

The total number of occupants in a unit.

Total Occs Killed

This field is not editable in the Fatal Supplement

The total number of occupants killed in a unit.

Individual Sub-group

This section contains information about the passengers in vehicles involved in the crash. The number of individuals on a fatal supplement report can be different than on the crash report.

• Every unit driver should be added.

• Every individual that suffered a fatality.

• Every individual that was transported to the hospital.

Occupant # on Crash

This field is not editable in the Fatal Supplement

Individual Sequence number on the Crash form.

Person Type

This field is not editable in the Fatal Supplement

The type of person involved in the crash.

Sex

This field is not editable in the Fatal Supplement

The sex of the person involved in the crash.

Last Name

This field is not editable in the Fatal Supplement

The last name of the person involved in the crash.

First Name

This field is not editable in the Fatal Supplement

The first name of the person involved in the crash.

Middle Initial

This field is not editable in the Fatal Supplement

The middle name of the person involved in the crash.

Suffix

This field is not editable in the Fatal Supplement

The suffix of the person involved in the crash.

Date of Birth

This field is not editable in the Fatal Supplement

The year, month, and day of birth, of person involved in the crash.

Hospital

This field is not editable in the Fatal Supplement

The number of the medical facility receiving patient.

This information is most important for Fatal Crash Reporting to the Federal Government.

Date of Death

This field is not editable in the Fatal Supplement

The Date of Death of the Individual in a fatal Crash

Time of Death

This field is not editable in the Fatal Supplement

The Time of Death of the Individual in a fatal Crash