SMC
Pull Over Form
What club are you a member of?
*
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Where you attending an event or run?
Yes
No
Was this your only Pull Over today?
Yes
No
Description of Pull Over
*
Reason Given for the Pull Over
*
How many riders were pulled over?
Number of police vehicles involved
Number of police officers involved
Where any charges laid? If yes, what charges?
Where any warnings issued?
Where photos taken of the following?
Riders
Plates or Licenses
Bike
Colours
Were licenses and insurance coverage checked?
Yes
No
Were drug or alcohol tests administered?
Yes
No
What were the officers like to deal with?
Please Select
Friendly
Aggressive
Abusive
Other
Officers Name(s)
Officers Badge Number(s)
Did you take pictures or video of the stop?
Yes
No
Was it a safe pull over?
Yes
No
Where were you pulled over?
City, Street
Direction of travel
Please Select
North
South
East
West
Road conditions
Please Select
Dry
Wet
Icy
Snowy
Traffic flow
Please Select
No traffic
Light traffic
Moderate traffic
Heavy traffic
Did you take any notes at the time of the pullover?
Yes
No
Please attach any pictures, videos or notes you are willing to share here
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Please tell us in your own words, what happened, how it made you FEEL, and any other information that you think would be helpful.
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