The Florida Traffic Crash Report form is a document that drivers must complete following a traffic accident that does not require a law enforcement report. This form gathers essential information about the crash, including details about the vehicles involved, driver and passenger information, and witness accounts. It is crucial for drivers to accurately fill out this report within 10 days of the incident to comply with state law.
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The Florida Traffic Crash Report form serves as a vital tool for documenting the details of traffic incidents within the state. This form is essential for drivers involved in crashes that do not require a law enforcement report. It includes critical sections where individuals can provide information about the crash, such as the date, time, and location. Drivers must fill out their personal details, including name, address, and driver's license number, as well as information about their vehicle, such as make, model, and insurance details. Additionally, the form allows for the inclusion of passengers and witnesses, ensuring that all parties involved are accounted for. Completing the form accurately is important, as it must be submitted to the Florida Department of Highway Safety and Motor Vehicles within ten days of the incident. The report also emphasizes the need for drivers to keep a copy for their records and insurance purposes. By understanding the components of this form, drivers can navigate the aftermath of a traffic crash more effectively.
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 #
OR
FEET MILES
N
S
E
W
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
DRIVER LICENSE NUMBER
DL TYPE
DRIVER/NON-MOTORIST HOME PHONE
DRIVER/NON-MOTORIST BUSINESS PHONE
SEX
DATE OF BIRTH
Area Code
NAME OF PASSENGER
SECTION TWO
SECTION THREE
WITNESSES
(1) NAME
CURRENT ADDRESS
(2) NAME
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)
J
IF YOU WERE TOLD TO COMPLETE AND FORWARD THIS REPORT TO THE DEPARTMENT, PLEASE REFER TO THE FOLLOWING INSTRUCTIONS AND EXAMPLE:
Driver Report of Traffic Crash (Self Report)
Driver Exchange of Information
01-01-10
11:30
PINELLAS (04)
ST. PETERSBURG (64)
2ND STREET SOUTH
AT STREET ADDRESS # OR
FEET MILES N
E W
0
U.S. 19
NON-MOTORIST (optional) EMAIL OWNER/DRIVER
80
FORD
CAR
ABC-123
FL
INSURANCE COMPANY OF FL
I.C.F. 120000
JOHN DOE
1111 FIRST STREET NORTH
PETERSBURG, FL
33731
BILL DOE
SAME AS OWNER
D 561345706000
M
01-01-70
SALLEY DOE
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 SelfReportCrashes@flhsmv.gov, 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.
Completing the Florida Traffic Crash Report form is essential for documenting the details of a traffic incident. After filling out the form, it is important to keep a copy for your records and submit it to the appropriate department. This ensures that all necessary information is recorded and can be referenced if needed.
What is the Florida Traffic Crash Report form?
The Florida Traffic Crash Report form is a document that drivers involved in a crash must complete when the incident does not require a law enforcement report. This form collects essential information about the crash, including the date, time, location, and details about the vehicles and individuals involved.
Who needs to fill out this form?
If you are a driver involved in a traffic crash that resulted in damage to a vehicle or property, you must fill out this form. According to Florida law, you are required to submit this report within 10 days of the crash if no law enforcement report is filed.
How do I submit the completed report?
You have two options for submitting the completed Florida Traffic Crash Report:
What information is required on the form?
The form requires various details, including:
Do I need to keep a copy of the report?
Yes, it is crucial to keep a copy of the completed report for your records. This can be important for insurance purposes and any potential legal matters that may arise from the crash.
What if there are multiple vehicles involved?
If there are multiple vehicles involved in the crash, you can add additional front pages to the report for each vehicle. Make sure to provide all necessary information for each vehicle and its occupants.
Filling out the Florida Traffic Crash Report form can be a daunting task, especially in the aftermath of an accident. Mistakes can lead to delays in processing or even complications with insurance claims. Here are nine common errors to avoid.
One significant mistake is failing to include the correct reporting agency case number. This number is crucial for tracking the report and ensuring it is properly filed. Omitting or miswriting it can result in confusion and delays in processing your report.
Another common error is not specifying the county and city of the crash. This information is essential for the agency to categorize and manage the report correctly. Without it, the report may not reach the appropriate jurisdiction, complicating the follow-up process.
People often forget to check the box indicating whether the crash occurred within city limits. This detail is important as it can affect local regulations and reporting requirements. Neglecting this step may lead to additional inquiries from authorities.
Providing incomplete or inaccurate vehicle information is another frequent mistake. Ensure that the year, make, and model of your vehicle are correctly listed. Additionally, verify that the vehicle license number and VIN are accurate. Errors in this section can hinder the investigation and affect insurance claims.
Many individuals also overlook the importance of including all passenger details. If there are passengers in the vehicle, their names and addresses should be recorded. This information may be vital for insurance purposes and any potential claims.
Another common oversight is not signing the report. The signature at the bottom of the form is a declaration of the truthfulness of the information provided. Failing to sign can render the report invalid and lead to complications.
Some individuals may neglect to keep a copy of the report for their records. Having a personal copy is important for tracking the status of the report and for insurance purposes. This step is often forgotten in the chaos following an accident.
Lastly, not adhering to the submission guidelines can lead to issues. Whether sending the report via email or mailing it, ensure that it is sent to the correct address. Double-checking this information can save time and prevent unnecessary delays.
By being aware of these common mistakes, individuals can better navigate the process of filling out the Florida Traffic Crash Report form. Taking the time to ensure accuracy will facilitate smoother interactions with law enforcement and insurance companies.
When involved in a traffic crash in Florida, several forms and documents may be necessary in addition to the Florida Traffic Crash Report form. These documents help ensure that all relevant information is recorded and that the proper procedures are followed. Below is a list of commonly used forms that can assist in this process.
Using these forms in conjunction with the Florida Traffic Crash Report can help streamline the process of reporting and managing the aftermath of a traffic accident. Each document plays a crucial role in ensuring that all parties have the necessary information and support.
When filling out the Florida Traffic Crash Report form, it's important to be thorough and accurate. Here’s a list of things you should and shouldn’t do:
Many people believe that this report is necessary only for severe accidents involving injuries or fatalities. However, it is required for any crash that results in property damage, even if it seems minor.
Some individuals think they can only file the report after law enforcement arrives. In reality, if no law enforcement report is made, the driver involved must submit their own report within 10 days of the crash.
Even if another driver takes responsibility for the accident, filing the report is still crucial. It helps document the incident for insurance claims and future reference.
There is a strict timeline. The report must be submitted within 10 days of the crash. Failing to do so may lead to complications with insurance claims or legal issues.
Some people assume that they won’t need a copy after submission. Keeping a copy is essential for your records and may be necessary for insurance purposes later on.
While the driver is primarily responsible, any passengers or witnesses can provide valuable information. Including their details can strengthen the report and clarify the circumstances of the crash.
It’s a common belief that once the report is filed, insurance companies will receive it. In reality, drivers must provide the report to their insurance companies themselves.
Even without injuries, the report is vital for documenting the incident. It can impact insurance claims and protect drivers from potential liability issues in the future.
When filling out and using the Florida Traffic Crash Report form, consider the following key takeaways: