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Crash Criteria Items
Crash Date:
Year:
Month:
SCI Case Type: State:
Mortality/Injury Severity: Number of Vehicles:
Min:  
Max:    
Vehicle
Make:
Model: Start Model Year:
Body Category: End Model Year:
Vehicle Damage
Plane of Impact: PDOF: to degrees
Plane Sub-section: Delta V: to
Electronic Data Recorder: Barrier Equivalent Speed: to
Rollover:
Occupant
Age:  to   Sex:
Seat Position: Height: to cm
Weight: to kg  
Injury
Body Region: AIS/NASS Code:
Maximum AIS: to  
ISS: to  
Restraint Use
Manual Belt Available to Use: Air Bag Available:
     Air Bag Location:
Automatic Belt Available to Use: Air Bag Deployed:
     Child Seat Used:

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