Traffic Incident Report
The Regent Neighborhood Association (RNA) Streets and Transportation Committee is providing this form in order to build a database to support improved safety for pedestrians and bicyclists in the neighborhood. This is meant to provide information in addition to concerns reported through more formal means - 911 calls, Alder communication, and use of on-line city of Madison reporting tools.

This form provides an opportunity for Regent neighbors to note concerns involving negative, or potentially negative, interactions between pedestrians and/or bicyclists and automobiles. These concerns may include close calls witnessed, infrastructure issues, speed violations, etc. In short, if there is anything regarding transportation in the neighborhood that you regard as troubling, please report it here. Thanks for helping us make our neighborhood safer.
Date
Please provide the date of the witnessed incident or cause for concern
MM
/
DD
/
YYYY
Time
Please provide the time of the witnessed incident or cause for concern
Time
:
Location
Please provide the location of the witnessed incident or cause for concern. Address or cross streets.
Neighborhood
Select which neighborhood Association this location is within
Transportation mode(s) of incident/concern
Select one or more
Type of incident
Select one or more
Type of Incident or Concern
Please provide a few details regarding the incident or concern
Your name (not required)
May we contact you to follow up, if needed?
Contact method (not required)
Please provide phone number and/or email address
Did you contact the police or City about this incident/concern
Consider contacting Shiva (our alder) at 220-6986 or district 5@cityofmadison and remember that you can report events to the city police on-line here: https://www.cityofmadison.com/reportaproblem/trafficenforcement.cfm
Clear selection
Who did you contact
provide name or position/office contacted
Distinguishing information (please add below under additional information)
Did you get a license plate #, make/model of auto or bicycle or name of any parties involved
Clear selection
Additional Information
Provide any additional information below
Submit
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