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Date of accident *

Time period of the incident *

Jurisdiction

Area where it happened

Severity level observed *

Pedestrian injured?

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Who was impacted? *

Number of people injured (if known)

Lighting condition

Roadway surface condition

Roadway alignment

Intersection type

Were weather conditions likely a factor?

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Weather condition (optional)

Email (optional, if we may contact you for clarification)

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Report an Accident