Report a Crash - CNHBC
Crashes happen in an instant.  If you or someone you know has been involved in a bike crash in the area please fill out the form below.  By reporting a crash you help us compile data and determine where more bike awareness needs to be on the roads.

If your bike crash involved serious injury, another biker, or a car.  Please inform the proper authorities. 

This form will take less than 10 minutes to fill out. Thank you for taking the time to fill out this form and make biking safer in communities across New Hampshire.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email *
Phone Number
What type of crash are you reporting? *
What Town/City did this occur in? *
What street did it happen on? (Please add a brief description of where on the road) *
What day did the crash happen? *
MM
/
DD
/
YYYY
What time did the crash happen? (approx.) *
Time
:
Describe the crash in as much detail as possible: Witnesses? Were you biking alone? Was a car involved in the crash? Did the car drive off? Were there any injuries?, etc. *
Were you wearing a helmet when the crash happened? *
Did you have headphones in when the crash happened
Clear selection
Did you contact the police?
Clear selection
If you answered yes to the question above: was a police report taken?
Clear selection
Can we follow up with you about the incident for more details if needed? *
Thank you for your time! Your detailed response helps us target unsafe cycling areas and make them better for the future!
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report