Bicycle Safety Incident Report Form

Note: This form is intended to gather information regarding bicycle safety incidents only.

If you have a general safety question or concern to share with us, please send your comments via email to bridgecomments@goldengate.org or phone our Customer Service Center at (415) 455-2000 (Monday-Friday 7:00am – 6:00pm)

Please note: If Bridge Patrol personnel responded to assist with this incident, we will already have an incident report on file and it is not necessary to report it here.

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* 1. Please enter your contact information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. What type of bike incident were you involved in?

With another person on a bike

With someone walking

No one else was involved

Other (please specify)

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* 3. Were you riding an electric bike?

Yes

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* 4. Date & time of incident

Date / Time

Date

Time

AM/PM

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* 5. Road conditions

Wet

Dry

Anything additional to add about the conditions?

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* 6. Weather conditions

Clear

Rain

Fog

Other

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* 7. Direction of travel

Northbound

Southbound

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* 8. Location of incident

West sidewalk

East sidewalk

Other (please specify)

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* 9. Did you or any another person sustain injuries as a result of this incident?

Yes

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* 10. Was there any property damage incurred as a result of this incident?

Yes

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* 11. Light pole number. If light pole number is unknown, please provide a description of incident location. i.e., midspan, south end, etc..

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* 12. Please provide a narrative description of the incident.

Thank you for taking the time to report this incident. This information in this form will be used to monitor and analyze safety conditions on the Bridge sidewalks and help guide decision making regarding sidewalk safety improvements.