Incident Reporting

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Closes 21 Aug 2020

Introduction

This form is designed to capture the details of any incidents that occur (e.g. collisions, trips etc.) as a result of the implementation of the Cycle Enfield programme.

All fields must be completed for the form to be accepted. It is essential we are able to follow up the incident with the person reporting the incident, including the ability to be able to speak with those directly involved.

All incidents raised will be logged, however, where follow-up is not able to take place with those directly involved, the log will reflect this.

1. What is your name?

2. What is your email address?

If you enter your email address then you will automatically receive an acknowledgement email when you submit your response.

3. What is your contact telephone number?

4. Were you directly involved in the incident, or did you witness the incident?

(Required)

5. If you were not directly involved but you know the name of the person who was involved, please add their name and describe your relationship. If you do not know the person involved please say 'person not known'. If you have indicated that the incident involved you, please add 'n/a' (not applicable).

6. What was the date of the incident?

7. What was the time of the incident?

8. What was the specific location of the incident?

9. Please describe the nature of the incident in as much detail as possible.