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 incidentCyclist incidentDog attackOther
Date and Time

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

Prince CountyQueens CountyKings 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 horseMotoristCyclistWitnessPoliceOther
Your age on the date of the incident
Was the incident reported to police?

YesNoI don't know
Police report # (if applicable)
What type or road was this?

Main HighwaySecondary Highway/RoadMinor (paved) RoadClay RoadCity/Town/Village StreetOther
Speed limit were incident happened

50 km/hr80 km/hr90 km/hrConstruction/School ZoneOtherI don't know
What were the road/weather conditions at the time of the incident? (Check more than one if applicable)

Fine/Clear/CloudyRainingSnowingFoggyDry RoadWet RoadSnowy RoadIcy 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)

RiddenDrivenLed from groundLed from horsebackLoose
What was the location of the horse(s) at time the incident occurred?

Road shoulder, traveling with trafficRoad shoulder, traveling against trafficIn right hand laneMore than one horse, on both sides of the roadOther
Did any of the following occur? (Check all that apply)

Motorist appeared to be exceeding the speed limitMotorist was driving a non-street legal vehicle (eg ATV)Motor vehicle passed too close to horseCyclist passed too close to horseDriver or cyclist purposely startled horse (horn, engine rev, etc)Motor vehicle collided with horseMotor vehicle collided with horse-drawn vehicleCyclist collided with horseCyclist collided with horse-drawn vehicleRoad rageObject was thrownRider fellHorse fellLoss of control of horseHorse escaped handler/riderDog attack from unfenced yardDog attack from dog escaping handler
What was the injury to the horse(s)? (Check more than one if applicable)

NoneMinorModerateSevereFatalVeterinary attention required
What was the injury to the handler(s)? (Check more than one if applicable)

NoneMinorModerateSevereFatalMedical attention required
Was the handler using any of the following safety equipment? (Check all that are applicable)

HelmetHigh-visibility vestHigh-visibility quarter sheetBack/body protectorReflective slow vehicle signLight(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.
Should be Empty:

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