waba@waba.org
Phone: 202.518.0524
Fax: 202.518.0936

Washington Area
Bicyclist Association
2599 Ontario Rd. NW
Washington, DC 20009

Bicycle Crash Reporting Form

This form is designed to gather important information regarding bicycle crashes in the Washington area in order to help WABA work with local law enforcement officials and representatives to make sure that bicyclists are treated fairly when they are involved in an incident.

This information is NOT passed on to any police department directly, but may be shared for advocacy purposes.

If you have been in a bicycle crash, please contact the Police directly by dialing 911.

Where did the crash take place?


Please be as specific as possible with regards to street names, intersections, quadrant and distances.

What type of crash best describes your experience?

Crash Type
Door - Parked/idling motor vehicle door opened into path of cyclist
Right Hook - Motorist made right turn from adjacent lane across path of cyclist traveling straight
Left Hook - Motorist made left turn across path of cyclist traveling straight
Passing - Motor vehicle struck cyclist from behind or sideswiped while passing
Harassment / Assault - Motorist intentionally distracted, intimated, harassed or assaulted you
Other - All other crash types

*If you are unsure, please choose "Other"

When did the crash occur?

Please provide the date & time of the crash.

What was the lighting at the time of the crash?

Lighting

Were there any weather conditions that may have contributed to the crash?

If not, please enter "none".

Examples: bright sun, high winds, fog, rain, snow, slippery roads, etc.

Did the crash involve any of the following vehicles?

Choose one:

If you answered "Other" in the previous question, please describe any vehicle or vehicles involved in the crash here.

Please be as detailed as possible.

To the best of your ability, please provide a brief description of the crash.

Please be as detailed as possible.

Were the police called to the scene of the crash?

If you answered "Yes" to the previous question, which police department responded?

Was a police report taken?

If a police report was taken, did the officer record your statement?

If you answered "No" to the previous question, why not?

Please be as detailed as possible.

Were you issued a citation for an infraction?

If you answered "Yes" to the previous question what was the name and number of the infraction?

Please describe any injuries you sustained during the crash.

If you sustained no injuries, please write "None."

Please be as detailed as possible.

If you were injured, did you receive compensation for your injuries?

Have you retained an attorney?

Are you a WABA member?

How old are you?

What is your gender?

Would you like a WABA staff member to follow up with you about your crash?