Horse Road Incident Report

Horse Road Incident Report

Report to PEI Trail Riders any road-related near-miss, incident, accident or road rage involving a horse on Prince Edward Island.
What type of incident was this?

Motor vehicle incident Cyclist incident Dog attack Other
Date and Time

Month Day Year Hour Minutes AM/PM Option
Location of incident (County)

Prince County Queens County Kings County
Location of incident (Address / road and nearest crossroad / landmark)
Your full name *
Address

Street Address

Street Address Line 2

City Province

Postal Code
Phone Number

Area Code Phone Number
Email *
example@example.com
What is your involvement with the incident?

Rider/driver/handler of horse Motorist Cyclist Witness Police Other
Your age on the date of the incident
Was the incident reported to police?

Yes No I don't know
Police report # (if applicable)
What type or road was this?

Main Highway Secondary Highway/Road Minor (paved) Road Clay Road City/Town/Village Street Other
Speed limit were incident happened

50 km/hr 80 km/hr 90 km/hr Construction/School Zone Other I don't know
What were the road/weather conditions at the time of the incident? (Check more than one if applicable)

Fine/Clear/Cloudy Raining Snowing Foggy Dry Road Wet Road Snowy Road Icy Road
What was being done with the horse(s) at the time of the incident? (If more than one horse and activity, check all that apply)

Ridden Driven Led from ground Led from horseback Loose
What was the location of the horse(s) at time the incident occurred?

Road shoulder, traveling with traffic Road shoulder, traveling against traffic In right hand lane More than one horse, on both sides of the road Other
Did any of the following occur? (Check all that apply)

Motorist appeared to be exceeding the speed limit Motorist was driving a non-street legal vehicle (eg ATV) Motor vehicle passed too close to horse Cyclist passed too close to horse Driver or cyclist purposely startled horse (horn, engine rev, etc) Motor vehicle collided with horse Motor vehicle collided with horse-drawn vehicle Cyclist collided with horse Cyclist collided with horse-drawn vehicle Road rage Object was thrown Rider fell Horse fell Loss of control of horse Horse escaped handler/rider Dog attack from unfenced yard Dog attack from dog escaping handler
What was the injury to the horse(s)? (Check more than one if applicable)

None Minor Moderate Severe Fatal Veterinary attention required
What was the injury to the handler(s)? (Check more than one if applicable)

None Minor Moderate Severe Fatal Medical attention required
Was the handler using any of the following safety equipment? (Check all that are applicable)

Helmet High-visibility vest High-visibility quarter sheet Back/body protector Reflective slow vehicle sign Light(s)
Describe the age and experience (i.e. approximate frequency of road travel) of the horse(s) involved.
Please describe any other pertinent details or events related to this incident.
Names and details of anyone else involved in this incident
If you are happy to let us pass your identifying details on to other organizations for the purposes of improving equestrian safety, please indicate by ticking this box.
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