The film is set 10 years after the Flight 180 explosion, 9 years after the highway pile-up in Route 23, and 4 years after the Devil’s Flight roller coaster derailment. While watching a race at McKinley Speedway for a break from studying, college student Nick O’Bannon (Bobby Campo) has a premonition of a car crash which sends debris into the audience, crushing some spectators and resulting in the stadium collapsing, which would have killed everyone present in the 180 section. In a panic Nick manages to convince his girlfriend Lori Milligan (Shantel VanSanten), and friends Hunt Wynorski (Nick Zano) and Janet Cunningham (Haley Webb) to leave. The quartet is followed out by a security guard named George Lanter (Mykelti Williamson), a car mechanic Andy Kewzer (Andrew Fiscella), his girlfriend Nadia Monroy (Stephanie Honore), and racist Carter Daniels (Justin Welborn), who have become angry with Nick (except for Janet, who was scared to leave the race track in the first place, and George) after he pushes past them to escape. Cynthia Daniels (Lara Grice), wants to follow her husband, but was ordered by Carter not to. Also, mother Samantha Lane (Krista Allen) follows her family outside. George intervenes when everyone begins to argue outside, just as the catastrophe Nick had foreseen occurs. A tire flies over the arena and splatters Nadia’s head (shortly after Nadia dies, Cynthia probably was sliced in half like in the premonition). After a memorial service at McKinley Speedway, Carter and Samantha died violently in freak accidents: Carter is burned alive with his tow truck after trying to burn a cross on George’s lawn as revenge for “killing his wife” and Samantha is killed by a flying rock propelled by a lawnmower – the rock being thrown on the lawn by her obnoxious kids, which goes right through her eye (the clue to her death is that she said the her kids “I got my eye on you”). Right before their deaths, Nick had seen omens of how they would die.

After hearing about Carter and Samantha’s deaths on the news, Nick and Lori begin doing research, and learn about the disasters that occurred in the previous three films and discover that the survivors (who were saved by premonitions) began dying in a series of improbable accidents shortly afterward. While Hunt and Janet refuse to believe them, Nick and Lori manage to convince George that Death is after them. The trio begins trying to warn Andy, only to see him killed when a CO² canister flings him backwards through a chain-link fence which dices his torso. As they learn Hunt and Janet are next, they split up to save both of them in time. Lori and George go to save Janet, which is successful, as they find Janet in a carwash, having her head stuck through her sunroof after escaping being drowned from the amount of water pouring into her car. They save her right before her head gets crushed by a huge pipe in the carwash. Meanwhile, Nick goes to a pool to look for Hunt, who dies after he unintentionally switches the lever for draining the pool on and after he dives to look for his lucky coin his intestines are sucked down the pool drain violently.

Later on, Nick, Lori & George celebrate as they think it’s all over, since George was trying to kill himself all day and didn’t succeed – he threw up the sleeping pills, then he tried to gas himself in his garage, but his car stalled and finally he tried to hang himself, but the rope couldn’t support his weight. As Lori and Janet are going to the movies, Nick realizes George wasn’t meant to die then, it wasn’t his turn, for there was another survivor confined to a hospital named Jonathan Grove (Jackson Walker). As he and George arrive at Jonathan’s room, Jonathan is crushed by a bathtub overflowed with water from the room above him. As the two go outside the hospital, George is abruptly killed by a speeding ambulance, just after Nick has a second premonition showing him that Lori and Janet will die while in the movie theater when an explosion occurs in a room under construction behind the screen. Nick rushes to reach them, while Lori begins spotting omens warning her that the danger is not over. Once Nick arrives, he and Lori attempt to convince Janet to leave, but are unsuccessful in their efforts. Janet is killed in the theater when the screen explodes (though the explosion had released a lots of pieces of metal and gone through everyone, and for Janet, nails impale her face and a big shard had impaled her stomach) though the viewers can see that Janet coughing up blood when Lori and Nick return to the theater. Lori is also killed while escaping by being crushed by the escalator conveyor belt. Nick then realizes that the event hasn’t happened yet, and is able to save his friends by extinguishing the fire that would have caused the initial explosion.

Two weeks later, Janet, Lori and Nick, thinking they have conquered Death’s plan, celebrate surviving in a cafe. Nick notices a loose leg on a scaffold outside the cafe, and he tells a construction worker to fix it. Once inside he drifts off into thought after seeing omens around him, and realizes that his premonitions and signs, along with all the disasters and deaths that had occurred since the speedway incident, are red herrings from Death used to manipulate them into where and when it would really come for them. While Nick realizes this, the scaffold falls, and in order to avoid it, a truck swerves, crashes through the cafe window as the scene changes to X-ray view, and kills the group (Janet is crushed by the truck’s tires, Lori is forced against the wall where her neck breaks, and Nick is smashed to the café wall where his jaw shatters), thus leaving all connected to the McKinley Speedway disaster dead. The end credits show some previous deaths from the last three films.