BTDS - 0001 - Self Reported Crashes Form (SR1)

Bureau of Transportation Data and Support

Self Reporting Crash Form (SR-1)

ATTENTION 

 

A written report of an accident shall not be required if a law enforcement officer submits a written report of said accident to the division pursuant to R.S. 39:4-131.  

 

Such written reports shall contain sufficiently detailed information with reference to a motor vehicle accident, including the cause, the conditions then existing, the persons and vehicles involved and such information as may be necessary to enable the chief administrator to determine whether the requirements for the deposit of security required by law are inapplicable by reason of the existence of insurance or other circumstances.

 

 

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.