Florida Traffic Crash Report PDF Details

In the bustling state of Florida, navigating the aftermath of a traffic crash involves more than just assessing damages and exchanging worried glances. The Florida Traffic Crash Report form steps in as a crucial document designed to meticulously record the details of vehicular mishaps. This form encompasses several key segments, including the Driver Report of Traffic Crash (Self Report) and the Driver Exchange of Information, ensuring that all parties involved have a clear and structured record of the incident. Detailed fields prompt for information such as the HSMV Report Number, the exact date and time of the crash, location specifics, and comprehensive details about the vehicles and individuals involved, including drivers, passengers, and any non-motorists. Additionally, it meticulously collects data on vehicle make, body type, license information, insurance details, and personal contact information. What makes this form stand out is its dual purpose not only as a report to the Department of Highway Safety and Motor Vehicles but also as a vital document for insurance claims and legal inquiries. The directives at the end of the form stress the importance of submitting this report within 10 days post-accident if law enforcement does not file a report, highlighting the form’s significance in the broader spectrum of Florida's traffic incident management protocols.

QuestionAnswer
Form NameFlorida Traffic Crash Report
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesaccident report florida, crash report florida, buy crash report florida, delayed accident report

Form Preview Example

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

 

 

 

 

 

 

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

 

 

 

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

 

 

 

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

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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:

 

 

 

 

 

 

 

HSMV Report Number

 

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#

0

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

 

80

 

FORD

 

 

 

CAR

ABC-123

 

FL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

FL

 

 

 

 

 

 

 

M

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 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.

How to Edit Florida Traffic Crash Report Online for Free

We found the best computer programmers to develop the PDF editor. This app will assist you to fill out the crash report florida form conveniently and won't take up a great deal of your time and effort. This easy guideline will enable you to begin.

Step 1: Select the orange "Get Form Now" button on the web page.

Step 2: So, you're on the form editing page. You may add information, edit existing details, highlight certain words or phrases, place crosses or checks, insert images, sign the form, erase unwanted fields, etc.

You'll have to enter the next information if you would like prepare the template:

step 1 to filling in florida highway patrol accident reports

Add the expected particulars in the NAME OF PASSENGER, CURRENT ADDRESS Number and Street, CITY AND STATE, ZIP CODE, SECTION TWO, VEHICLE, NONMOTORIST, optional EMAIL OWNERDRIVER, YEAR, MAKE Chevy Ford Etc, VEHICLE BODY TYPE Car Truck Etc, VIN, INSURANCE COMPANY, INSURANCE POLICY NUMBER, and NAME OF VEHICLE OWNER box.

florida highway patrol accident reports NAME OF PASSENGER, CURRENT ADDRESS Number and Street, CITY AND STATE, ZIP CODE, SECTION TWO, VEHICLE, NONMOTORIST, optional EMAIL OWNERDRIVER, YEAR, MAKE Chevy Ford Etc, VEHICLE BODY TYPE Car Truck Etc, VIN, INSURANCE COMPANY, INSURANCE POLICY NUMBER, and NAME OF VEHICLE OWNER fields to fill out

Focus on the crucial information on the WITNESSES NAME, CURRENT ADDRESS, CITY AND STATE, ZIP CODE, NAME, CURRENT ADDRESS, CITY AND STATE, ZIP CODE, SIGNATURE OF DRIVER MAKING REPORT, DATE, YOU MUST READ AND COMPLY WITH THE, and HSMV S rev area.

WITNESSES NAME, CURRENT ADDRESS, CITY AND STATE, ZIP CODE, NAME, CURRENT ADDRESS, CITY AND STATE, ZIP CODE, SIGNATURE OF DRIVER MAKING REPORT, DATE, YOU MUST READ AND COMPLY WITH THE, and HSMV S rev in florida highway patrol accident reports

You have to include the rights and obligations of the parties in the IF YOU WERE TOLD TO COMPLETE AND, HSMV Report Number, Driver Report of Traffic Crash, REPORTING AGENCY CASE NUMBER, DATE OF CRASH, TIME OF CRASH AM, COUNTY OF CRASH County Code, PLACE OR CITY OF CRASH City Code, Check if, CRASH OCCURRED ON STREET ROAD, PINELLAS, ST PETERSBURG, Within City, Limits, and ND STREET SOUTH space.

part 4 to entering details in florida highway patrol accident reports

Fill in the document by checking all of these fields: Please use this space for comments.

part 5 to completing florida highway patrol accident reports

Step 3: When you have clicked the Done button, your document will be ready for export to every electronic device or email you identify.

Step 4: In order to prevent probable forthcoming risks, be certain to possess at least a few duplicates of every form.

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