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Blank Florida Traffic Crash Report PDF Form

The Florida Traffic Crash Report form is a crucial document that drivers must complete following a traffic accident that results in property damage. This report serves to provide essential information to the Florida Department of Highway Safety and Motor Vehicles, ensuring compliance with state regulations. It is imperative to fill out this form accurately and submit it within the designated timeframe to avoid potential penalties.

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Blank Florida Traffic Crash Report PDF Form

Article Guide

The Florida Traffic Crash Report form is an essential document designed for drivers involved in accidents that do not require a law enforcement report. This form facilitates the exchange of crucial information among involved parties and serves as a record for insurance purposes. Key sections of the form include details about the crash, such as the date, time, and location, including the county and city codes. It also captures vital information about the vehicles involved, including the make, model, license numbers, and insurance details. Personal information about the drivers, non-motorists, and passengers is required, ensuring that all parties are accurately documented. Witness information can also be included, providing additional context to the incident. The form emphasizes the importance of compliance with state regulations, requiring drivers to submit their report within ten days of the crash. Clear instructions are provided for submission, whether via email or traditional mail, ensuring that the process is straightforward and accessible for all involved.

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Driver Report of Traffic Crash (Self Report) Driver Exchange of Information

	HSMV Report Number

REPORTING AGENCY CASE NUMBER	DATE OF CRASH	TIME OF CRASH AM PM

COUNTY OF CRASH (County Code)

PLACE OR CITY OF CRASH (City Code)

Check if

CRASH OCCURRED ON STREET, ROAD, HIGHWAY

Within City

Limits

AT STREET ADDRESS #

FEET MILES

AT/ FROM INTERSECTION WITH STREET, ROAD, HIGHWAY

OR FROM MILEPOST#

SECTION ONE

VEHICLE

NON-MOTORIST

(optional) EMAIL OWNER/DRIVER

YEAR

MAKE (Chevy, Ford, Etc.)

VEHICLE BODY TYPE (Car, Truck. Etc.)

VEHICLE LICENSE NUMBER

STATE

VIN

INSURANCE COMPANY

INSURANCE POLICY NUMBER

NAME OF VEHICLE OWNER

(Check if same as Driver)

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

NAME OF DRIVER (Take From Driver License)/NON-MOTORIST

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

DRIVER LICENSE NUMBER

STATE

DL TYPE

DRIVER/NON-MOTORIST HOME PHONE

DRIVER/NON-MOTORIST BUSINESS PHONE

SEX

DATE OF BIRTH

Area Code

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

SECTION TWO

VEHICLE

NON-MOTORIST

(optional) EMAIL OWNER/DRIVER

YEAR

MAKE (Chevy, Ford, Etc.)

VEHICLE BODY TYPE (Car, Truck. Etc.)

VEHICLE LICENSE NUMBER

STATE

VIN

INSURANCE COMPANY

INSURANCE POLICY NUMBER

NAME OF VEHICLE OWNER

(Check if same as Driver)

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

NAME OF DRIVER (Take From Driver License)/NON-MOTORIST

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

DRIVER LICENSE NUMBER

STATE

DL TYPE

DRIVER/NON-MOTORIST HOME PHONE

DRIVER/NON-MOTORIST BUSINESS PHONE

SEX

DATE OF BIRTH

Area Code

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

SECTION THREE

VEHICLE

NON-MOTORIST

(optional) EMAIL OWNER/DRIVER

YEAR

MAKE (Chevy, Ford, Etc.)

VEHICLE BODY TYPE (Car, Truck. Etc.)

VEHICLE LICENSE NUMBER

STATE

VIN

INSURANCE COMPANY

INSURANCE POLICY NUMBER

NAME OF VEHICLE OWNER

(Check if same as Driver)

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

NAME OF DRIVER (Take From Driver License)/NON-MOTORIST

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

DRIVER LICENSE NUMBER

STATE

DL TYPE

DRIVER/NON-MOTORIST HOME PHONE

DRIVER/NON-MOTORIST BUSINESS PHONE

SEX

DATE OF BIRTH

Area Code

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

WITNESSES

(1) NAME

CURRENT ADDRESS

CITY AND STATE

ZIP CODE

(2) NAME

CURRENT ADDRESS

CITY AND STATE

ZIP CODE

IGNATURE OF DRIVER MAKING REPORT

DATE

YOU MUST READ AND COMPLY WITH THE INSTRUCTIONS ON THE BACK OF THIS FORM

HSMV 90011S (rev 11/2019)

IF YOU WERE TOLD TO COMPLETE AND FORWARD THIS REPORT TO THE DEPARTMENT, PLEASE REFER TO THE FOLLOWING INSTRUCTIONS AND EXAMPLE:

							HSMV Report Number
Driver Report of Traffic Crash (Self Report)
Driver Report of Traffic Crash (Self Report)					REPORTING AGENCY CASE NUMBER		DATE OF CRASH	TIME OF CRASH AM PM
Driver Exchange of Information							01-01-10	11:30

COUNTY OF CRASH (County Code)	PLACE OR CITY OF CRASH (City Code)				Check if	CRASH OCCURRED ON STREET, ROAD, HIGHWAY
PINELLAS (04)	ST. PETERSBURG (64)				Within City	2ND STREET SOUTH
					Limits

AT STREET ADDRESS # OR	FEET MILES N	S	E W	AT/ FROM INTERSECTION WITH STREET, ROAD, HIGHWAY				OR FROM MILEPOST#

U.S. 19

SECTION ONE

VEHICLE

NON-MOTORIST (optional) EMAIL OWNER/DRIVER

YEAR

MAKE (Chevy, Ford, Etc.)

VEHICLE BODY TYPE (Car, Truck. Etc.)

VEHICLE LICENSE NUMBER

STATE

VIN

FORD

CAR

ABC-123

INSURANCE COMPANY

INSURANCE POLICY NUMBER

INSURANCE COMPANY OF FL

I.C.F. 120000

NAME OF VEHICLE OWNER

(Check if same as Driver)

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

JOHN DOE

1111 FIRST STREET NORTH

PETERSBURG, FL

33731

NAME OF DRIVER (Take From Driver License)/NON-MOTORIST

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

BILL DOE

SAME AS OWNER

DRIVER LICENSE NUMBER

STATE

DL TYPE

DRIVER/NON-MOTORIST HOME PHONE

DRIVER/NON-MOTORIST BUSINESS PHONE

SEX

DATE OF BIRTH

D 561345706000

01-01-70

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

SALLEY DOE

SAME AS OWNER

NAME OF PASSENGER

CURRENT ADDRESS (Number and Street)

CITY AND STATE

ZIP CODE

Effective July 1, 2012, Section 316.066(1)(e),Florida Statute, requires that "The driver of a vehicle that was in any manner involved in a crash resulting in damage to a vehicle or other property which does not require a law enforcement report shall, within 10 days after the crash, submit a written report of the crash to the department. The report shall be submitted on a form approved by the department."

•Keep a copy of this report for your records and for insurance purposes.

•Sign the report at the bottom of the front page.

•Submit this via email to [email protected], OR;

•Mail this report to: Florida Highway Safety & Motor Vehicles Self Report Crash Team

2900 Apalachee Pkwy, MS 28 Tallahassee, Florida 32399

Please use this space for comments and for listing any witnesses and/or additional passengers, stating which vehicle the passenger was in. For additional vehicles or other involved parties, please add additional front pages for this Driver Report of Traffic Crash.

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Form Specifications

Fact Name	Details
Form Purpose	The Florida Traffic Crash Report form allows drivers involved in a crash to report details of the incident, especially when a law enforcement report is not required.
Governing Law	Florida Statute Section 316.066(1)(e) mandates that drivers submit a written report within 10 days if a crash results in property damage but does not require a law enforcement report.
Submission Methods	Drivers can submit the report via email or mail. Email submissions go to [email protected], while mailed reports should be sent to the Florida Highway Safety & Motor Vehicles.
Required Information	Key information includes the date and time of the crash, the location, vehicle details, and personal information of the drivers and passengers involved.
Witness Information	The form provides space to include details about witnesses, which can be crucial for clarifying the circumstances of the crash.
Signature Requirement	Drivers must sign the report, affirming that the information provided is accurate and complete.
Record Keeping	It is advisable for drivers to keep a copy of the report for their records and for insurance purposes, ensuring they have documentation of the incident.

Florida Traffic Crash Report: Usage Guidelines

Filling out the Florida Traffic Crash Report form is an important step after being involved in a traffic accident. This report helps document the details of the crash for insurance and legal purposes. Follow these steps carefully to ensure all necessary information is provided.

Obtain the form: Get a copy of the Florida Traffic Crash Report form. You can find it online or at local law enforcement agencies.
Fill in the top section: Enter the HSMV Report Number, Reporting Agency Case Number, Date and Time of the crash, and the County and City where the crash occurred.
Check the appropriate box: Indicate if the crash occurred on a street, road, or highway and if it was within city limits.
Provide location details: Enter the street address or the distance in feet or miles from the intersection.
Section One - Vehicle and Driver Information: Fill out the vehicle details, including year, make, body type, license number, state, VIN, and insurance information. Include the name and address of the vehicle owner and driver. If the owner and driver are the same, check the box provided.
Driver's License Information: Enter the driver's license number, state, type, home phone, business phone, sex, and date of birth.
Passenger Information: List the names and addresses of any passengers in the vehicle.
Repeat for additional vehicles: If there are more vehicles involved, complete Sections Two and Three with the same information for each vehicle and driver.
Witness Information: Provide the names and addresses of any witnesses to the crash.
Sign the report: The driver making the report must sign and date the bottom of the front page.
Submit the report: Keep a copy for your records. Email it to [email protected] or mail it to the specified address.

After completing the form, ensure all information is accurate and clear. This will help streamline the process for any follow-up actions regarding the crash.

Your Questions, Answered

What is the Florida Traffic Crash Report form?

The Florida Traffic Crash Report form is a document that drivers involved in a traffic accident are required to complete if the crash results in property damage and does not require a law enforcement report. This form helps to document the details of the crash for the Florida Department of Highway Safety and Motor Vehicles.

Who is required to submit the report?

According to Florida law, any driver involved in a crash that results in damage to a vehicle or property must submit this report within 10 days of the incident. This requirement applies when a law enforcement report is not made.

How do I submit the Florida Traffic Crash Report?

You can submit the report by email or by mail. To email, send the completed form to [email protected]. Alternatively, you can mail it to the Florida Highway Safety & Motor Vehicles Self Report Crash Team at 2900 Apalachee Parkway, MS 28, Tallahassee, Florida 32399.

What information do I need to provide on the form?

The form requires detailed information including the date and time of the crash, the location, details about the vehicles involved, and information about the drivers and passengers. You will also need to provide your insurance information and contact details.

Is there a deadline for submitting the report?

Yes, the report must be submitted within 10 days of the crash. It is important to adhere to this timeline to comply with Florida law.

What should I do if I need to add more vehicles or witnesses?

If there are additional vehicles or witnesses involved in the crash, you can use extra front pages of the Driver Report of Traffic Crash form to provide that information. Ensure all relevant details are included for accurate reporting.

Do I need to keep a copy of the report?

Yes, it is advisable to keep a copy of the completed report for your records and for insurance purposes. This can be useful in case of any disputes or claims that arise from the accident.

What if I have questions about filling out the form?

If you have questions or need assistance while completing the form, consider reaching out to the Florida Department of Highway Safety and Motor Vehicles. They can provide guidance on how to fill out the report correctly.

Common mistakes

Incomplete Information: Failing to fill out all required fields can lead to delays or complications. Make sure to provide details such as the HSMV Report Number, date, and time of the crash.
Incorrect Vehicle Details: Entering wrong vehicle information, such as the license number or VIN, can create issues with insurance claims. Double-check these details for accuracy.
Neglecting Witness Information: Not including witnesses can weaken your report. Collect names and addresses of any witnesses present at the scene, as their accounts may be crucial.
Failure to Sign the Report: Omitting your signature at the bottom of the form can render the report invalid. Always ensure that you sign and date the document before submission.

Documents used along the form

When involved in a traffic crash in Florida, it is essential to complete the Florida Traffic Crash Report form. However, several other forms and documents may also be necessary to ensure proper reporting and processing of the incident. Below is a list of commonly used forms that accompany the Florida Traffic Crash Report.

Driver Report of Traffic Crash (Self Report): This form allows drivers to provide their account of the crash, including details about the vehicles involved, the circumstances of the incident, and any injuries sustained.
Driver Exchange of Information: After a crash, drivers should exchange information with each other, including names, contact details, insurance information, and vehicle details. This document serves as a record of that exchange.
Insurance Claim Form: If damages or injuries occur, this form is used to file a claim with the insurance company. It typically requires details about the crash, damages, and involved parties.
Witness Statement Form: Witnesses to the crash can provide valuable information. This form collects their accounts and contact details, which may be important for insurance or legal purposes.
Law Enforcement Report: If a police report is filed, this document provides an official account of the crash, including details about the scene, involved parties, and any citations issued.
Medical Report: If injuries occur, a medical report detailing the nature and extent of injuries can be crucial for insurance claims and legal actions.
Vehicle Repair Estimate: This document provides an estimate of the repair costs for any damages sustained by the vehicles involved in the crash, which is often needed for insurance claims.

Each of these forms plays a vital role in the aftermath of a traffic crash. Completing them accurately can help ensure that all parties receive the necessary support and compensation. It is important to keep copies of all documents for your records and future reference.

Similar forms

The Florida Traffic Crash Report form serves an essential purpose in documenting accidents on the road. Several other documents share similarities with this form, each designed to capture specific information about traffic incidents. Below is a list of eight documents that resemble the Florida Traffic Crash Report form, along with explanations of how they are similar.

Driver Report of Traffic Crash (Self Report): This document is very similar to the Florida Traffic Crash Report as it allows drivers to provide their own account of the crash, detailing the circumstances and parties involved.
Driver Exchange of Information: Like the Florida Traffic Crash Report, this document facilitates the sharing of essential information between drivers involved in an accident, ensuring that all parties have access to necessary contact and insurance details.
Police Report: A police report is generated by law enforcement officers who respond to a crash. It captures details about the accident, including witness statements and officer observations, much like the structured format of the Florida Traffic Crash Report.
Insurance Claim Form: This form is used to file a claim with an insurance company following a traffic accident. It requires similar information about the parties involved and the circumstances of the crash, paralleling the data collected in the Florida Traffic Crash Report.
Accident Report Form: Often used by various agencies, this form collects information about the crash, including location, time, and involved vehicles, similar to the Florida Traffic Crash Report's comprehensive data collection.
Vehicle Damage Report: This document details the extent of damages to vehicles involved in an accident. It shares the common goal of assessing the situation, akin to the Florida Traffic Crash Report's focus on vehicle and driver information.
Witness Statement Form: Witnesses to a traffic crash may fill out this form to provide their observations. This aligns with the Florida Traffic Crash Report's section for witness information, emphasizing the importance of gathering multiple perspectives.
Traffic Incident Report: Similar to the Florida Traffic Crash Report, this document is used by various agencies to record details about traffic incidents, including contributing factors and outcomes, ensuring a thorough understanding of the event.

Each of these documents plays a vital role in the aftermath of a traffic crash, contributing to a clearer picture of the events that occurred. They help ensure that all necessary information is documented for legal, insurance, and safety purposes.

Dos and Don'ts

When filling out the Florida Traffic Crash Report form, keep the following tips in mind:

Provide accurate and complete information in all sections.
Sign the report at the bottom of the front page.
Keep a copy of the report for your records and insurance purposes.
Submit the report within the required timeframe, which is within 10 days of the crash.
Double-check all details before submitting to ensure there are no errors.

Avoid these common mistakes:

Do not leave any sections blank unless they are optional.
Do not submit the report without signing it.
Do not forget to include all relevant details about the crash.
Do not send the report to the wrong address or email.
Do not wait too long to submit the report; timely submission is crucial.

Misconceptions

Understanding the Florida Traffic Crash Report form is crucial for anyone involved in a vehicle accident. However, several misconceptions can lead to confusion. Here are six common misunderstandings:

Only law enforcement can file a report. Many believe that only police can complete this report. In reality, drivers involved in a crash that does not require a law enforcement report are required to submit their own report within ten days.
All crashes require a report. Some people think that every accident necessitates a report. However, a report is only needed if the crash results in damage to a vehicle or property and does not require a law enforcement report.
Personal information is not important. There is a misconception that personal details, such as names and addresses, are not crucial. In fact, accurate information is essential for processing the report and for insurance claims.
Submitting the report is optional. Many individuals assume that submitting the report is a choice. It is actually a legal requirement for drivers involved in certain types of accidents.
Witness information is unnecessary. Some believe that witness details are not relevant. Including witness information can provide additional context and support in case of disputes about the accident.
The report can be submitted anytime after the accident. There is a misconception that there is no strict deadline. In reality, the report must be submitted within ten days of the crash.

Addressing these misconceptions can help ensure that drivers fulfill their legal obligations and protect their rights after an accident. Understanding the importance of accurate reporting can also streamline the claims process with insurance companies.

Key takeaways

Complete all sections: Ensure every part of the Florida Traffic Crash Report form is filled out accurately. Missing information can lead to delays or complications.
Use clear and legible handwriting: If filling out the form by hand, make sure your writing is easy to read. This helps prevent misunderstandings and errors.
Include accurate crash details: Provide the date, time, and location of the crash. This information is crucial for record-keeping and potential investigations.
Document vehicle information: Fill in details about all vehicles involved, including make, model, license number, and VIN. This helps establish ownership and insurance responsibilities.
Report driver and passenger information: Include names and addresses for all drivers and passengers. This ensures that all parties involved are accounted for in the report.
List witnesses: If there were any witnesses to the crash, be sure to include their names and contact information. Their accounts can provide valuable context.
Sign the report: Don’t forget to sign the report at the bottom of the front page. This confirms that the information you provided is accurate to the best of your knowledge.
Submit promptly: Florida law requires that you submit the report within 10 days of the crash. You can do this via email or mail, as specified in the instructions.
Keep a copy for your records: Retain a copy of the completed report for your personal files and for any insurance claims that may arise from the incident.