CTRAC Child Passenger Safety Seat Report Survey

In order to maintain CTRAC records for the Child Passenger Safety Seat program, each participating agency/facility must submit an activity report monthly. This information will help maintain an accurate inventory as well as document distribution. Each agency is responsible to have the parent/guardian complete and sign a Child Restraint Agreement and Release of Liability form at the time of distribution. These forms must be kept by the agency and are not to be sent to CTRAC.

*
1. Please complete the below information.

Please complete the below information. Name:
Company:
Address:
City/Town:
State:
ZIP/Postal Code:
Email Address:

2. Reporting for:

Reporting for: Month
Year

3. CONVERTIBLE SEATS

CONVERTIBLE SEATS Beginning inventory
Number of seats recieved
Number of seats distributed
Number of seats transferred to another entity
Ending inventory

4. HIGH-BACK BOOSTER SEATS

HIGH-BACK BOOSTER SEATS Beginning inventory
Number of seats recieved
Number of seats distributed
Number of seats transferred to another entity
Ending inventory

5. LOW or NO-BACK BOOSTER SEATS

LOW or NO-BACK BOOSTER SEATS Beginning inventory
Number of seats received
Number of seats distributed
Number of seats transferred to another entity
Ending inventory

6. INFANT/REAR FACING SEATS

INFANT/REAR FACING SEATS Beginning inventory
Number of seats recieved
Number of seats distributed
Number of seats transferred to another entity
Ending inventory

7. OTHER SEATS

OTHER SEATS Description
Beginning inventory
Number of seats recieved
Number of seats distributed
Number of seats transferred to another entity
Ending inventory

Thank you for completing the report! Please click 'Done' to send in your report.

CTRAC Child Passenger Safety Seat Report

1. Default Section