The Florida Traffic Crash Report form serves as an official document for drivers to report vehicular accidents in which they are involved that result in property damage or injury, but do not necessitate immediate police presence on the scene. This form allows for a detailed account of the incident, capturing information on the vehicles, drivers, insurance details, and the specific location and time of the crash, among other crucial data. If you've been involved in a traffic incident in Florida that requires a self-report, ensure to accurately fill out and submit the Florida Traffic Crash Report form by clicking the button below.
Following a road mishap in Florida, the Florida Traffic Crash Report Form steps into the spotlight as a crucial document for drivers involved in accidents not investigated by police. This form, embodying both the Driver Report of Traffic Crash (Self Report) and the Driver Exchange of Information, serves as a detailed communication tool, meticulously recording the specifics of the collision. Key information encapsulated within includes HSMV Report Number, Reporting Agency Case Number, along with the date, time, and precise location of the crash—spotlighting the county, city, and whether the incident occurred within city limits or on specific streets or highways. Vital vehicle details like year, make, vehicle body type, license number, and insurance information are required for each vehicle involved. Additionally, personal details about the vehicle’s owner and driver or non-motorist (if applicable), such as names, addresses, and contact information, must be accurately provided. Crucially, the statute enacted on July 1, 2012, mandates that drivers of vehicles involved in crashes resulting in property damage, without the necessity of a law enforcement report, must submit a written report of the incident to the department within ten days. This form not only becomes an essential record for official and insurance purposes but also instructs on how to submit the report, whether by email or mail, maintaining a copy for personal records. Through capturing exhaustive details about the event, participants, and vehicles involved, it facilitates a systematic approach to handling the aftermath of traffic accidents, ensuring accountability and aiding in the efficient resolution of any claims or disputes that may arise.
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.
After being involved in a traffic crash in Florida that does not require a law enforcement report, you may need to complete the Florida Traffic Crash Report form. This reporting is in line with the Florida Statute, ensuring all parties involved in such incidents submit their accounts within 10 days following the crash. Completing this form accurately provides essential records for the department, aids in the insurance claims process, and fulfills your legal obligation. Here’s a step-by-step guide to filling out the form correctly.
Accurately filling out and promptly submitting the Florida Traffic Crash Report form ensures that you comply with state laws and assists in the efficient handling of any insurance claims related to the incident. It's important to provide as much detailed and accurate information as possible to avoid any complications or delays in processing.
What is the Florida Traffic Crash Report form and who needs to fill it out?
The Florida Traffic Crash Report form is a document that drivers in Florida are required to complete if they are involved in a crash resulting in damage to a vehicle or other property, and the incident does not require a law enforcement report. As of July 1, 2012, according to Section 316.066(1)(e) of the Florida Statutes, drivers must submit this report within 10 days after the crash. It is meant for situations where law enforcement did not respond to the scene, allowing individuals to self-report the details of the incident.
How can I submit the Florida Traffic Crash Report form?
You have two options for submitting the Florida Traffic Crash Report form: by email or by mail. To submit via email, send the completed form to SelfReportCrashes@flhsmv.gov. If you prefer to submit by mail, send it to the Florida Highway Safety & Motor Vehicles, Self Report Crash Team, 2900 Apalachee Pkwy, MS 28, Tallahassee, Florida 32399. Make sure to sign the report at the bottom of the front page before submitting it.
What information is required on the Florida Traffic Crash Report form?
The form requires detailed information about the crash, including the HSMV report number, date, time, and location of the crash, details about the vehicle(s) involved (year, make, vehicle body type, license number, VIN), insurance information (company and policy number), and personal information about the vehicle owner(s) and driver(s) involved (name, address, driver license number, contact details). It also provides space for reporting about any non-motorists (optional), passengers, and witnesses.
Do I need to keep a copy of the completed Florida Traffic Crash Report form?
Yes, it is advised to keep a copy of the completed Florida Traffic Crash Report form for your records and insurance purposes. Having a copy can be useful for future reference or in case of any discrepancies with insurance claims or during any related legal proceedings.
What happens if I do not submit the Florida Traffic Crash Report form within 10 days?
Failing to submit the Florida Traffic Crash Report form within the required 10 days after the crash can lead to penalties. While specific penalties are not detailed in the provided information, generally non-compliance can result in fines, and in some cases, suspension of driving privileges. It's important to adhere to this stipulation to avoid any legal issues.
Filling out the Florida Traffic Crash Report form correctly is essential for ensuring all details about the accident are properly documented. Common mistakes can lead to delays or issues with insurance claims and legal processes. One major mistake is incorrect or incomplete information about the accident's location. Specifying whether the crash occurred within city limits, alongside the correct street address or intersection, is crucial for pinpointing the exact site of the incident.
Another common error involves the misrepresentation of vehicle information. The year, make, model, body type, vehicle license number, and state must match the vehicle's registration documents. Failing to accurately report any of these details can create confusion or suspicion of inaccuracies in the report.
A significant mistake is inaccurately listing insurance information, including the company name and policy number. This data is vital for facilitating communication between insurance providers and ensuring claims are processed efficiently. Any discrepancies in insurance information can lead to delays in claim resolutions or disputes over coverage.
Often, drivers forget to check if the name of the vehicle owner is the same as the driver. This detail is important, especially if the driver at the time of the crash was not the owner. It affects how insurance claims are processed and could have legal implications depending on the circumstances of the accident.
Leaving out or incorrectly filling out personal details like current addresses, driver license numbers, and contact information can also lead to significant issues. These details are necessary for all parties involved—including insurance companies, lawyers, and law enforcement—to make contact as needed after the report is filed.
Not including or incorrectly listing passengers and/or non-motorists involved in the accident is another mistake. It is crucial to document everyone involved, whether they were in the vehicle or not, to ensure that all potential witnesses or injured parties are accounted for during any subsequent legal or insurance proceedings.
Finally, a common oversight is failing to sign the report or submit it within the mandated timeframe. The signature verifies the accuracy of the report, and timely submission is required by law. Delaying or forgetting to submit the report can result in penalties and may complicate insurance claims or legal responsibilities linked to the crash.
When dealing with traffic incidents in Florida, the Florida Traffic Crash Report form is pivotal for documenting the details of the crash. However, this form often needs to be accompanied by other documents to fully cover the scope of the incident and its aftermath. These additional forms and documents play significant roles in insurance claims, legal actions, and record-keeping.
Together, these documents complement the Florida Traffic Crash Report form, creating a comprehensive record of the incident. They assist in the insurance claim process, provide evidence for legal matters, and ensure that all aspects of the crash are accurately documented and dealt with appropriately.
The Property Damage Report bears similarity to the Florida Traffic Crash Report form in its purpose of documenting incidents, focusing instead on damage to property. This form typically includes information on the date, time, location of the incident, details of the property owner, and a description of the damage incurred. Its structured format for collecting factual information mirrors the meticulous detail seen in traffic crash reports, emphasizing the importance of clarity and accuracy in reporting.
Similarly, Police Incident Reports align closely with the Traffic Crash Report form through their organized collection of data following a specific event, in this case, any incident that requires police attention. These forms gather details about the incident location, involved parties, witnesses, and a narrative of events, paralleling the comprehensive data collection critical for traffic crash documentation. The primary aim is to record the incident accurately for legal, insurance, and investigative purposes.
The Worker’s Compensation Claim Form shares similarities with the Traffic Crash Report form, particularly in capturing detailed information following an injury at the workplace. It documents the injured party's personal details, the date, time, and description of the incident, and any witnesses. The emphasis on precise and comprehensive reporting to facilitate the claims process reflects the Traffic Crash Report’s goal of thorough documentation for insurance and legal considerations.
Medical Incident Report Forms are akin to the Traffic Crash Report form in their meticulous approach to documenting health-related incidents within healthcare facilities. These forms detail the patient's information, the incident's circumstances, the response taken, and any witness accounts. The parallel in ensuring detailed and accurate reporting underscores the importance of accountability and the potential for future review or investigation.
The Vehicle Maintenance Log shares an affinity with the Traffic Crash Report form by systematically recording vehicle-related incidents, focusing on maintenance and repairs. Key information includes dates, descriptions of issues, actions taken, and involved parties' details. This congruence lies in the structured approach to record-keeping, essential for tracking a vehicle’s history and ensuring its safety and reliability.
Insurance Claim Forms compare to the Florida Traffic Crash Report form in their critical role in the aftermath of an incident, requesting detailed information on parties involved, the incident description, and any property or bodily injuries. This parallelism is evident in their mutual objective to assess claims and determine liability or coverage, demanding thoroughness and accuracy in the presentation of facts.
Accident Investigation Forms utilized within various organizations to examine workplace accidents share a common goal with the Traffic Crash Report: to compile a detailed account of the incident. These forms typically requires information about the involved individuals, a narrative of the incident, environmental conditions, and potential contributing factors, mirroring the crash report's comprehensive data collection to understand the event fully and prevent future occurrences.
The Emergency Room Admission Form presents similarities with the Traffic Crash Report by documenting the entry of patients into a hospital following accidents, including vehicle crashes. Critical information such as patient demographics, the nature of injuries, and circumstances surrounding the accident is collected, showcasing the shared emphasis on detailed, immediate documentation for subsequent care and record-keeping purposes.
Driving Under Influence (DUI) Report Forms relate closely to the Traffic Crash Report through their focus on documenting specific incidents involving impaired driving offenses. These reports detail the suspect’s information, the incident details, and any tests conducted, reflecting the structured and detailed incident documentation found in traffic crash reports. Both types of documents serve crucial roles in legal and safety processes.
The Vehicle Registration Form, while primarily used for official records creation and not incident reporting, connects with the Traffic Crash Report form through the detailed collection of vehicle information. Required data includes the owner’s details, vehicle make, model, and identification numbers, highlighting the importance of accurate information for identification and legal purposes, akin to the meticulous documentation of a traffic crash.
When completing the Florida Traffic Crash Report form, it's important to be thorough and accurate to ensure all details of the incident are correctly documented. Below are vital do's and don'ts to consider.
Do:
Don't:
When it comes to understanding and completing the Florida Traffic Crash Report form, there are several misconceptions that can lead to confusion. Here, we aim to clarify these points and provide accurate information to ensure that individuals are well-informed about the process.
This is incorrect. The Florida Traffic Crash Report form must be completed for any crash resulting in damage to a vehicle or property, which does not require a law enforcement report, regardless of whether another vehicle is involved.
While it's primarily designed for drivers, the forms also have sections for non-motorists (optional) involved in the incident, ensuring everyone affected has a voice in the report.
Even if the crash occurs on private property, if it results in damage requiring a report, the form should be filled out to ensure all details are legally documented.
While providing as much information as possible is helpful, some sections are labeled as optional, particularly for non-motorists. It's important to provide all the required information but understand not every section may apply to your situation.
It's crucial for your records and insurance purposes that you keep a copy of the report. This documentation can be essential for resolving any disputes or claims related to the crash.
You have the option to submit the form either via email to SelfReportCrashes@flhsmv.gov or by mailing it to the address provided. This flexibility ensures you can choose the submission method that's most convenient for you.
Actually, the form needs to be signed by the driver making the report. There's no requirement for a law enforcement officer's signature, making it simpler for drivers to self-report.
Submitting this form does not negate the requirement to notify your insurance company about the accident. It serves a different purpose, mainly for the state's records and statistical analysis.
The information provided on the form is used for official purposes and statistical analysis. While certain reports may become public record, sensitive personal information is protected by privacy laws.
While not always required, providing witness information can be incredibly helpful for validating the details of the crash and supporting any claims. If possible, including witness details is recommended.
Understanding these key points about the Florida Traffic Crash Report form ensures that individuals are better prepared to accurately and effectively document any incidents on the road. Remembering these facts not only simplifies the reporting process but also helps safeguard your interests and responsibilities following a traffic crash.
Filling out the Florida Traffic Crash Report form correctly and comprehensively is critical for any driver involved in a traffic crash in Florida. Here are six key takeaways that every driver should remember:
The proper handling of the Florida Traffic Crash Report form not only fulfills a legal obligation but also safeguards the interests of all parties involved. It serves as an official record that might be pivotal in resolving disputes and claims related to the crash.
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