Crash or Near Miss Form

Bike Walk NE strives identify the locations of unreported crashes and safety issues within Nebraska communities. If you were involved in a crash or near miss while walking or biking and didn't report it please fill out the form below. 

This is purely voluntary please do not share any details you are not comfortable sharing. Your information will not be shared. This is for data collection purposes only.

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Place of Crash (Intersection, Trail, etc.) *
What City/Town was this in? *
Date of Crash (an approximate date works as well)
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DD
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YYYY
Can you tell us what happened?
Was your bike damaged?
Clear selection
If yes, how much damage was done?
Clear selection
Were you hurt?
Clear selection
Were the police involved?
Clear selection
If the police weren't involved, can you tell us why? 
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Is there any additional information we should know about? 
Submit
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