Florida Traffic Crash Report PDF Details

This form includes several parts, such as the Driver Report of Traffic Crash (Self Report) and the Driver Exchange of Information, to ensure all parties have a detailed incident record. Specific information is required, such as the HSMV Report Number, the precise date and time of the accident, location details, and information about the vehicles and individuals involved, like drivers, passengers, and pedestrians.

The Florida Traffic Crash Report also collects data on vehicle make, body type, license information, insurance details, and personal contact information. This form is unique because it serves as a report to the Department of Highway Safety and Motor Vehicles and as documentation for insurance claims and legal investigations. The directives at the end of the form stress the importance of submitting this report within ten days post-accident if law enforcement does not file a report.

QuestionAnswer
Form Name Florida Traffic Crash Report
Form Length 2 pages
Fillable? Yes
Fillable fields 123
Avg. time to fill out 15 min
Other names accident 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

Completing the Florida Traffic Crash Report form guarantees that all essential traffic incident information is correctly recorded. This documentation is essential for insurance claims and legal matters, as well as for adhering to state laws that might mandate a report for accidents with property damage, injuries, or fatalities. Here is a detailed guide to help you fill out this form using our PDF editor.

1. Basic Crash Information

Please fill in the details of the crash, including the HSMV report number, date and time of the crash, and the county and city where the crash occurred. If the crash happened within city limits, ensure you check the box.

step 1 to filling in florida highway patrol accident reports

2. Document the Crash Location

Provide the specific location of the crash. This includes the street, road, or highway name and any pertinent details like the address number, miles or feet from an intersection, and direction (north, south, east, or west).

3. Vehicle and Driver Information

For each vehicle involved, input the year, make, model, body type, license number, state, and VIN. Also, provide insurance details, including the company name and policy number. Repeat this step for all vehicles involved in the crash.

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

4. Personal Information for All Parties

Record the names, current addresses, states, ZIP codes, driver’s license numbers, and contact information for all drivers, passengers, and non-motorists involved. Specify their roles and if any injuries were sustained.

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

5. Describe the Accident

Provide a narrative description of how the crash occurred. This section should include all relevant details explaining the sequence of events leading to the accident. If the platform allows, you can also upload or draw a diagram of the accident scene.

part 4 to entering details in florida highway patrol accident reports

6. Witness Information

If there were witnesses to the crash, enter their names, addresses, and contact information. This data can be crucial for insurance and legal purposes.

part 5 to completing florida highway patrol accident reports

7. Review and Submit

Before submitting, review all the information entered for accuracy. Once confirmed, follow the instructions for submission, which may include options to email or mail the report to the FLHSMV.

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