Kauai Police Department

kpdonline@kauai.gov

3990 Kaana Street Lihue, HI 96766

Non Emergency Line: (808) 241-1711 Emergency Line: 911

Minor Traffic Collision (one vehicle involved)

Was anyone involved in the collision injured or is reporting any injury?

Yes, there are injuries I want to report.

No, there are no injuries to report.

Important Notice:

If anyone was injured or is reporting an injury, this incident may not be reported online.

Please call our non-emergency line at (808) 241-1711 to file a report in person with an officer.

Date and Approximate time of the collision

Circumstances of the collision

Driver Information (reporting party information)

Driver's License Information

Driver's License Number *

Issuing State / Country *

Expiration Date *

Phone Number

Do you have a US address?

Yes

No, I have an International address

International Address (if living outside of the US)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code / Zip

Country

Vehicle Information

Vehicle Type

Vehicle Description

Make *

Model *

License Plate *

Additional information

Vehicle Year

Color

Number of Passengers

Vehicle Insurance Information

Policy Name *

Policy Number *

Expiration Date *

Are there any damages to report for this vehicle?

Yes

Please Mark the Areas of Damage

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Upload file(s): photographs / insurance cards / etc.

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Online Report Number

Declaration

By submitting this report, I affirm that the information provided is true and accurate to the best of my knowledge. I understand that knowingly filing a false police report is a criminal offense.

Pursuant to Hawai‘i Revised Statutes §710-1015, filing a false report with law enforcement is a misdemeanor crime.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.