E-Bike Incident Reporting Form
Date
/
Month
/
Day
Year
Date
Approximate Time
Day of Week
State
1. Forest, Park or BLM District Name
2. Trail name and approximate location of incident
3. E-Bike type: Class 1, Class 2, Class 3, Out-of-Class, Don't Know
4. Is E-Bike use authorized by the land management agency on this trail?
Yes
No
5. If E-Bike use is authorized, what class of e-bike use is authorized?
Class 1
Class 2
Class 3
6. E-Bike brand, model and color
7. How did you know it was an electric bicycle (and not a regular bicycle)?
8. Type of Incident: Positive Encounter, Biker Failed to Yield, Excessive Speed, Lack of Trail Etiquette
Positive
Biker Failed to Yield
Excessive Speed
Lack of Trail Etiquetter
9. Was any person or your stock injured as a result of this incident?
Yes
No
If yes, please provide details here.
10. Was a report on the incident filed with law enforcement?
Yes
No
If yes, will you provide the report #
11. How did the incident with e bike(s) affect your trail experience?
Name
Email
example@example.com
Phone
Format: (000) 000-0000.
Zip Code
Attach pictures or documents
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: