Fill Out Your Florida Traffic Crash Report Form
The Florida Traffic Crash Report form serves as a vital tool for documenting the details surrounding vehicle accidents. Recognizing the importance of accurate information, this form streamlines the process for drivers involved in accidents to report essential particulars about the incident. Key components include personal information about the drivers, passengers, and vehicles involved, such as the make, model, year, and insurance details. It also captures the location and time of the crash, divided into clear sections to ensure all pertinent information is easily accessible. Witnesses can be noted on the form, adding further clarity on the circumstances surrounding the incident. Additionally, the form requires the driver’s signature, asserting that the information provided is truthful and complete. Following recent legislative changes, the legal requirement for submitting this report has been emphasized, making it imperative for drivers to be familiar with its structure and content. Overall, the Florida Traffic Crash Report form not only facilitates adherence to legal obligations but also plays a crucial role in resolving insurance claims and understanding the dynamics of traffic incidents.
Florida Traffic Crash Report Example
Driver Report of Traffic Crash (Self Report) 
Driver Exchange of Information
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HSMV Report Number |
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REPORTING AGENCY CASE NUMBER |
DATE OF CRASH |
TIME OF CRASH AM PM |
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COUNTY OF CRASH (County Code) |
PLACE OR CITY OF CRASH (City Code) |
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Check if |
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CRASH OCCURRED ON STREET, ROAD, HIGHWAY |
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Limits |
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AT STREET ADDRESS # |
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FEET MILES |
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AT/ FROM INTERSECTION WITH STREET, ROAD, HIGHWAY |
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OR FROM MILEPOST# |
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SECTION ONE |
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VEHICLE |
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(optional) EMAIL OWNER/DRIVER |
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YEAR |
MAKE (Chevy, Ford, Etc.) |
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VEHICLE BODY TYPE (Car, Truck. Etc.) |
VEHICLE LICENSE NUMBER |
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VIN |
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INSURANCE COMPANY |
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INSURANCE POLICY NUMBER |
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NAME OF VEHICLE OWNER |
(Check if same as Driver) |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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NAME OF DRIVER (Take From Driver |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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DRIVER LICENSE NUMBER |
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DL TYPE |
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DATE OF BIRTH |
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Area Code |
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NAME OF PASSENGER |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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NAME OF PASSENGER |
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CURRENT ADDRESS (Number and Street) |
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SECTION TWO |
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VEHICLE |
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(optional) EMAIL OWNER/DRIVER |
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YEAR |
MAKE (Chevy, Ford, Etc.) |
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VEHICLE BODY TYPE (Car, Truck. Etc.) |
VEHICLE LICENSE NUMBER |
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STATE |
VIN |
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INSURANCE COMPANY |
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INSURANCE POLICY NUMBER |
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NAME OF VEHICLE OWNER |
(Check if same as Driver) |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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NAME OF DRIVER (Take From Driver |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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DRIVER LICENSE NUMBER |
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DL TYPE |
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SEX |
DATE OF BIRTH |
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Area Code |
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Area Code |
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NAME OF PASSENGER |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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NAME OF PASSENGER |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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SECTION THREE |
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VEHICLE |
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(optional) EMAIL OWNER/DRIVER |
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YEAR |
MAKE (Chevy, Ford, Etc.) |
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VEHICLE BODY TYPE (Car, Truck. Etc.) |
VEHICLE LICENSE NUMBER |
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STATE |
VIN |
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INSURANCE COMPANY |
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INSURANCE POLICY NUMBER |
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NAME OF VEHICLE OWNER |
(Check if same as Driver) |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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NAME OF DRIVER (Take From Driver |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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DRIVER LICENSE NUMBER |
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DL TYPE |
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SEX |
DATE OF BIRTH |
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Area Code |
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Area Code |
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NAME OF PASSENGER |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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NAME OF PASSENGER |
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CURRENT ADDRESS (Number and Street) |
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CITY AND STATE |
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ZIP CODE |
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WITNESSES |
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(1) NAME |
CURRENT ADDRESS |
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CITY AND STATE |
ZIP CODE |
(2) NAME |
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CURRENT ADDRESS |
CITY AND STATE |
ZIP CODE |
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IGNATURE OF DRIVER MAKING REPORT |
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DATE |
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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:
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HSMV Report Number |
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Driver Report of Traffic Crash (Self Report) |
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REPORTING AGENCY CASE NUMBER |
DATE OF CRASH |
TIME OF CRASH AM PM |
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Driver Exchange of Information |
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11:30 |
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COUNTY OF CRASH (County Code) |
PLACE OR CITY OF CRASH (City Code) |
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Check if |
CRASH OCCURRED ON STREET, ROAD, HIGHWAY |
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PINELLAS (04) |
ST. PETERSBURG (64) |
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Within City |
2ND STREET SOUTH |
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Limits |
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AT STREET ADDRESS # OR |
FEET MILES N |
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AT/ FROM INTERSECTION WITH STREET, ROAD, HIGHWAY |
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OR FROM MILEPOST# |
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U.S. 19
SECTION ONE
VEHICLE
YEAR |
MAKE (Chevy, Ford, Etc.) |
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VEHICLE BODY TYPE (Car, Truck. Etc.) |
VEHICLE LICENSE NUMBER |
STATE |
VIN |
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FORD |
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CAR |
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FL |
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INSURANCE COMPANY |
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INSURANCE POLICY NUMBER |
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INSURANCE COMPANY OF FL |
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I.C.F. 120000 |
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NAME OF VEHICLE OWNER |
(Check if same as Driver) |
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CURRENT ADDRESS (Number and Street) |
CITY AND STATE |
ZIP CODE |
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JOHN DOE |
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1111 FIRST STREET NORTH |
PETERSBURG, FL |
33731 |
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NAME OF DRIVER (Take From Driver |
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CURRENT ADDRESS (Number and Street) |
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BILL DOE |
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SAME AS OWNER |
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DRIVER LICENSE NUMBER |
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DATE OF BIRTH |
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D 561345706000 |
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NAME OF PASSENGER |
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SALLEY DOE |
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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.
Form Characteristics
| Fact Name | Description |
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| Form Purpose | This form is used by drivers involved in a crash to report details of the incident to the Florida Department of Highway Safety and Motor Vehicles. |
| Governing Law | Florida Statute 316.066(1)(e) requires drivers to submit this report if a crash results in property damage and does not require a law enforcement report. |
| Submission Timeline | Drivers must submit the report within 10 days after the crash to comply with state law. |
| Contact Information | The report can be submitted via email or by mail to a specific address provided on the form. |
| Driver Details | Information collected includes the driver's name, contact details, license number, date of birth, and gender. |
| Vehicle Information | Details about the vehicles involved, including make, model, vehicle identification number (VIN), and insurance information, are required. |
| Witness Statements | The form allows for the collection of witness information, enhancing the details surrounding the crash. |
| Signatures | Drivers must sign the report to verify the accuracy of the information provided. |
| Record Keeping | It is important for drivers to keep a copy of the report for their records and insurance purposes. |
Guidelines on Utilizing Florida Traffic Crash Report
Completing the Florida Traffic Crash Report form is necessary for documenting accidents in which damage occurs. Ensure you gather all required information before you start filling out the form to make the process smoother. Follow these steps carefully to complete the report accurately.
- Begin by noting the HSMV Report Number and Driver Report of Traffic Crash sections at the top of the form.
- Enter the Reporting Agency Case Number, Date of Crash, and Time of Crash (indicate AM or PM).
- Fill in the County of Crash and the Place or City of Crash, using the appropriate county and city codes.
- Indicate whether the crash occurred on a street, road, or highway and if it was within city limits.
- Provide the exact street address or distance (feet or miles) from the nearest intersection or milepost.
- In Section One, input information about the vehicle involved, including Year, Make, Body Type, License Number and VIN.
- Note the Insurance Company and Insurance Policy Number for the vehicle.
- Include the name and current address of the Vehicle Owner, marking if it's the same as the driver.
- Provide details for the driver, including their name, address, driver license number, type, home and business phone numbers, sex, and date of birth.
- List any passengers, ensuring to provide their names and addresses.
- If applicable, repeat the process for additional vehicles or non-motorists in Section Two and Section Three.
- Record any witnesses' information, providing names and addresses in the designated area.
- Sign the report at the bottom of the front page and indicate the date.
- Keep a copy of the report for personal records and insurance purposes.
- Email the completed report to SelfReportCrashes@flhsmv.gov or mail it to the specified address in Tallahassee.
Once the report is submitted, retain it for your documentation. Be mindful of any follow-up instructions, especially if involved in legal or insurance matters related to the incident.
What You Should Know About This Form
What is the Florida Traffic Crash Report form used for?
The Florida Traffic Crash Report form is used to document accidents that do not require a law enforcement report. If you're involved in a crash that resulted in damage to vehicles or property, you must submit this report within 10 days of the incident.
Who is required to fill out the report?
The responsibility to complete the report typically falls on the driver of the vehicle involved in the crash. If multiple vehicles are involved, each driver must file their own report to ensure all information is documented accurately.
What information do I need to provide on the form?
The form requires essential information including the date and time of the crash, location details, descriptions of all vehicles involved, driver information, and the insurance details. You'll also need to provide names and addresses of any passengers and witnesses.
Where should I submit the completed form?
You can submit the completed form via email to SelfReportCrashes@flhsmv.gov. Alternatively, you can mail it to the address provided on the form, which is the Florida Highway Safety & Motor Vehicles Self Report Crash Team in Tallahassee.
Do I need to sign the report?
Yes, it is essential to sign the report at the bottom of the front page. Your signature indicates that the information provided is true and accurate to the best of your knowledge.
What if there are multiple vehicles involved?
If your crash involved multiple vehicles, each driver should complete a separate report. You can use additional pages to list other involved parties, ensuring each vehicle and driver is documented correctly.
How can I obtain a copy of the report once submitted?
Once you submit your report, make sure to keep a copy for your records and for insurance purposes. The Florida Highway Safety & Motor Vehicles may provide you with confirmation, but it’s a good practice to hold on to your copy as evidence of the filing.
What should I do if I need to make changes to the report after submission?
If you need to amend any information on the report after it has been submitted, it's best to reach out directly to the Florida Highway Safety & Motor Vehicles for guidance on how to properly update your submission.
Are there any additional instructions I need to be aware of?
Yes, it’s crucial to read and comply with the instructions that appear on the back of the report form. Following these instructions will help ensure that your report meets all necessary requirements and is handled properly by the department.
Common mistakes
Filling out the Florida Traffic Crash Report form can be a daunting task, and many people make common mistakes that can lead to complications. One significant error is skipping crucial sections. Each part of the form is designed to gather specific information about the crash. If you ignore a section, critical details may be omitted, leading to misunderstandings and delays in processing.
Another frequent mistake involves incorrect or incomplete information about the vehicles involved. It's vital to ensure that the year, make, and model of the vehicle are accurately reported. For instance, using a general description like “truck” instead of specifying “Ford F-150” can cause confusion later on. Remember, precise information helps create a clear picture of what occurred.
Many individuals also neglect to double-check the driver's and passenger's details. The name, address, and driver license number must match the corresponding individuals. Errors here can lead to problems with claims or investigations. Failing to ensure all names are correctly spelled can create unnecessary headaches down the line.
Inadequate witness information is another common pitfall. If there were witnesses to the accident, their names and contact details should be included fully. Omitting a witness, even inadvertently, may hurt the validity of your report and could impact legal outcomes or insurance claims.
Additionally, some people forget to sign the report. The signature serves as a confirmation that you are submitting the information honestly and that you understand the contents of the document. Submitting a report without this important step can result in it being disregarded or delayed.
Lastly, failing to keep a copy of the completed form can be a major oversight. It's essential to have a record for your own protection and reference. Whether for insurance purposes or potential legal actions, having your own copy ensures you can always access the details you reported and confirm what was submitted.
Documents used along the form
When involved in a traffic crash in Florida, the Florida Traffic Crash Report form is a crucial document. However, other forms and documents are often needed to ensure a complete understanding of the incident and to meet legal requirements. Below is a list of five additional documents frequently associated with the Traffic Crash Report.
- Driver Report of Traffic Crash (Self Report): This document allows the driver to provide their own account of the crash. It is particularly useful when a law enforcement report is not available. The driver must submit this report within ten days of the crash.
- Driver Exchange of Information: In cases of car accidents, drivers are typically required to exchange pertinent information, such as names, addresses, and insurance details. This exchange helps facilitate claims processing and legal follow-ups.
- Witness Statements: Documenting statements from witnesses can provide additional perspectives on the accident. These statements may help to establish the facts of the case and clarify who was at fault.
- Insurance Claim Form: After a crash, drivers usually need to file an insurance claim. This form allows the insurance company to assess the damage and process any potential compensation.
- Police Report (if applicable): If law enforcement arrives at the scene, they often file an official police report. This document contains details about the crash, including comments from officers and insights regarding potential violations of law.
Understanding these documents can aid in navigating the aftermath of a traffic crash. Each piece of information plays a vital role in resolving insurance claims and legal responsibilities. For effective resolution, it is advisable to gather and maintain copies of all relevant documents.
Similar forms
The Florida Traffic Crash Report form is an important document for anyone involved in a traffic accident. This report shares similarities with several other documents that also serve to record or provide information in the event of a traffic incident. Here are four such documents, presented with an explanation of their similarities:
- Driver Report of Traffic Crash (Self Report) - This document is designed for drivers to provide details about a crash they were involved in. Much like the Florida Traffic Crash Report, it requires information such as the date, type of vehicles involved, and the contact information of all drivers and passengers.
- Accident Report from Law Enforcement - Law enforcement officers create this report at the scene of an accident. Similar to the Florida Traffic Crash Report, it includes crucial details about the crash, witness statements, and any citations issued. Both documents aim to provide an official account of the incident.
- Insurance Claim Form - When filing a claim with an insurance company, policyholders often need to complete a form detailing the accident. This form typically requires information about the vehicles, the incident, and the parties involved. Like the Florida Traffic Crash Report, it gathers essential data to assess the situation and help with claims processing.
- Medical Report related to an Accident - If injuries occur due to the crash, medical providers might issue a report outlining the injuries sustained. This document parallels the Florida Traffic Crash Report in that it gathers vital information related to the crash, including details about those injured and treatment received, which can influence insurance claims and legal proceedings.
Understanding these documents and their purpose is essential for anyone involved in a traffic accident. Each one plays a role in providing clarity and supporting any necessary actions following an incident.
Dos and Don'ts
Filling out the Florida Traffic Crash Report form can feel overwhelming, but it’s important to get it right. Here’s a list of things to do and avoid when completing the form:
- Do include accurate details about the crash, such as the date, time, and location.
- Do ensure that all vehicle and driver information is correct, including license numbers and VINs.
- Do sign the report at the bottom to validate your submission.
- Do keep a copy of the report for your records and insurance needs.
- Do submit the report within the required timeframe, typically within 10 days of the crash.
- Don’t leave out any information; incomplete forms may delay processing.
- Don’t forget to list all involved parties, including witnesses, to provide a full account of the incident.
- Don’t provide false information; accuracy is crucial for legal and insurance purposes.
- Don’t neglect to read the instructions thoroughly before filling out the form.
- Don’t submit the form without keeping a personal copy for your own records.
Misconceptions
Misconceptions about the Florida Traffic Crash Report form can lead to confusion during an already stressful time. Here are nine common myths clarified:
- Only law enforcement can complete the report. Many believe only law enforcement officers can fill out this form. In reality, any driver involved in a crash can and should complete it if there is property damage.
- The report is only necessary for serious accidents.A common misunderstanding is that a report is needed only for serious accidents. However, any accident resulting in property damage requires a report, regardless of severity.
- Filing a report means admitting fault. Some drivers fear that filling out the report equates to admitting liability. This is not true; the report is simply a factual account of the incident.
- You can file the report at any time. There is a belief that time isn't an issue. Unfortunately, the law requires submission within ten days of the crash if it does not require a law enforcement report.
- Insurance information is optional. Many think they can skip providing insurance details on the form. However, including accurate insurance information is crucial for processing claims.
- The form does not need to be signed. Some drivers overlook the importance of signing the report. A signature is necessary to validate the form and ensure it is processed.
- Witness information is not important. While some may consider witness information unimportant, it can strengthen a claim or provide clarity regarding the incident.
- There’s no need to keep a copy of the report. Many overlook the importance of retaining a copy. Keeping a personal copy is essential for tracking claims and necessary for future reference.
- This report only benefits insurance companies. Some believe the report solely aids insurers. In truth, it serves both the driver’s and insurer’s interests by documenting the facts of the accident.
Understanding these misconceptions is vital for all drivers in Florida. Accurate reporting can ease the claims process and help clarify the details surrounding a traffic incident.
Key takeaways
Understand the Purpose: The Florida Traffic Crash Report form is designed to document vehicle collisions involving damage. It serves as a crucial record for insurance claims and potential legal issues that may arise from the incident.
Timely Submission: Florida law mandates that this report must be completed and submitted within 10 days of the crash. Delaying this can lead to complications or fines.
Accurate Details: Fill out the form with precise and truthful information. This includes details about all vehicles, drivers, passengers, and witnesses. Accurate data is essential for resolving any disputes regarding the crash.
Multiple Vehicle Involvements: If your report involves multiple vehicles or parties, it's advisable to attach additional forms. Each vehicle and driver should have their own detailed entry.
Keep a Copy: After completing the form, retain a copy for your records. This is important for both personal reference and insurance claims. Signing the report validates your acknowledgment of the information provided.
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