BTDS - 0001S - Self Reported Crashes Form (SUPPLIMENTAL)

Bureau of Transportation Data and Support

Self Reporting Crash Form (SR-1) -- SUPPLIMENTAL

ATTENTION: You DO NOT have to fill out this form unless you are adding to or changing information submitted in a prior report.

I have a:

User Instructions

  • NOTE: To navigate this form you can use the tabs across the top as well as blue navigation button at the bottom of the page.
  • Please provide as much information as you can accurately remember. 
  • For YOUR FULL NAME, please enter your first and last name. 
  • For YOUR EMAIL ADDRESS, please enter email address where you can best be contacted with notificatons from this process.
    • IMPORTANT: When checking for responses from this process, be sure to check both your regular INBOX and any JUNK or SPAM folders you have set up.
  • For all calendar entries: clicking the Month/Year (between the left/right arrows) will allow you to select a month in the current year; clicking again will allow you to use the left/right arrows to scroll through a decade range in which to select a year.
  • For all dollar amounts: rounding to the nearest dollar is acceptable.
  • For each additional vehicle (after the second) click the GREEN BAR on the ADDITIONAL VEHICLES tab to fill in the information for that vehicle.
  • For each injured individual click the GREEN BAR on the INURY INFO tab to fill in their information.
  • Conditions-at-the-scene statistics for each additional vehicle (after the second) can be entered on the CONDITIONS INFO tab, by clicking the GREEN BAR at the bottom.
  • Please make certain your insurance policy from date is BEFORE your insurance policy to date.
  • Please click the SUBMIT button to finish the form.