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STD-430 INCIDENTACCIDENT REPORT - PennDOT Home

STD-430 INCIDENTACCIDENT REPORT - PennDOT Home 2026

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4.7 out of 5

60 votes

The document is a standardized incident/accident report form (STD-430) used by the Commonwealth of Pennsylvania. It outlines the necessary information to be collected and submitted regarding incidents or accidents, including details about the time and location, persons injured, property damage, descriptions of the incident, and claim information. The report must be sent to the Bureau of Risk & Insurance Management (BRIM) and emphasizes not sending multiple copies unless verification of receipt is confirmed.

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Click ‘Get Form’ to open the STD-430 INCIDENT/ACCIDENT REPORT in our editor.
Begin by entering the 'Date Prepared' at the top of the form. This is crucial for record-keeping.
In section 1, fill in the 'Incident/Accident Date', 'Time', and 'Location'. Ensure accuracy as this information is vital for investigations.
Proceed to section 2 to document any persons injured. Include their names, addresses, ages, and extent of injuries.
In section 3, provide details about property damage. List the owner's information, estimated damage, and a description of the property involved.
Section 4 requires a detailed description of the incident or accident. Be thorough to ensure clarity.
Complete sections 5 through 9 with relevant statements from departments, witness information, claim details, and your contact information.

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Versions	Form popularity	Fillable & printable
2017	4.9 Satisfied (51 Votes)
2013	4.7 Satisfied (60 Votes)

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