Rochester Bicycling Club

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ROCHESTER BICYCLING CLUB INCIDENT REPORTING

Introduction and Guidelines


Incident Report Introduction:

The Rochester Bicycling Club would like your help in collecting information regarding Incidents which occur during Club Rides and Events.   The data we collect will help us to identify issues for our Safety Committee to address.   If you have experienced or witnessed a Cycling Incident on a Club ride or Club sponsored cycling event, your completion of an Incident Report is important to our continued effort to promote rider safety.  The more complete information you provide about your incident, the better we will be able to identify and target areas for safety education.   Incidents are not limited to events that result in injury.   For the purpose of this reporting form Incidents would include, but are not limited to falls, crashes, close calls, traffic conflict, and unsafe actions.     

[Note:  When completing form online avoid using Firefox due to

known issues with Printing/Saving the form.  Suggest use of Edge, Chrome or Safari]

Form Completion Guidelines:
      • Individual Involved” refers to the individual  who was injured or affected by or who's actions contributed to the incident.
      • One "Individual Involved" per form.   Use multiple forms if more than one cyclist is involved.
      • Please remember to check all boxes that apply when requested to do so.
      • Describe the incident as fully as possible.
      • You have the ability to modify your responses before hitting the Submit button.  Please review your answers to ensure all information  is accurate and complete.  
      • You have the opportunity to print or save your report before submitting.  

The RBC Safety Committee may wish to follow up with you to obtain further information or clarification so we encourage you to provide your contact information.  All personal information gathered will be treated confidentially.

If you have any questions about the survey, please contact the Safety Committee at rbcsafety2@gmail.com.  
 
Thank you for taking the time to complete our Incident Report Form.

Incident Reporting Form (Google Doc for completing online) (preferred)

Incident Reporting Form (PDF for printing, filling in, and mailing) (only if you must)


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