Roadside Safety Incident Reporting Tool

Roadside Safety Incident Reporting Tool

A form to report any incidents of road safety such as near misses, individuals not slowing down, or flying debris that posed a danger.

Which agency are you reporting from? (can select only one)
Time
Location
Address of Incident
Address of Incident
Address 1
Address 2
City/Town
Province
Postal
Location Description (can select more than one)
If this was an emergency response scenario, what type of emergency response were you providing at the time of the incident? (can select more than one) You can skip this question if Not Applicable (was not an emergency response scenario)
Number of emergency vehicles on scene:
If this was NOT an emergency response was it:
Road Conditions: What were the road conditions like at the time of the incident? (can select more than one)
Visibility Conditions: What were the visibility conditions like at the time of the incident? (multiple choice, can select more than one with exception of Clear / day)
Distance of Visibility: Was the incident: (multiple choice, can select more than one)
Safety Measures in Place: Were there any traffic management or safety measures in place at the scene? (multiple choice, can select more than one)
Type of incident: Was the incident related to passing motorists: (can select more than one)
Response of the Motorist(s): How did the motorist(s) involved in the incident react? (multiple choice, can select more than one.
Outcome of the incident; Was anyone injured as a result of the incident?
Was a WCB Claim Filed
Was an Occupational Health and Safety Report filed?
Were there any damages to:
Was an insurance claim filed for:
Request for Contact Information: To maintain the highest level of accuracy and consistency in our reporting, we may occasionally require further clarification on the information provided. In such rare instances, we kindly request your contact details to facilitate this process. Please rest assured, your contact information will be used solely for the purpose of clarifying data and will be handled with the utmost confidentiality in compliance with our privacy policies.
Name
Name
First
Last

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