Incident Report 2025

SLOBC Incident Report 2025

Required for any Weekly, Monthly or Annual SLOBC Ride during which a participating member is injured in any way or level of severity.
SLOBC Ride Name*
Vacillators, Atascadero Cranks, Chick Ride
Incident Date*

MonthDayYear
Road Location*
Road Name + Nearest Address, Intersection, Mile Marker
GPS Coordinates
Use Google Maps to capture GPS coordinates
Number of Riders Injured: Submit a Report for Each Rider*

1 Rider2 Riders3 + Riders
Road Surface*

PavedGravel/Dirt
Road Type*

HighwayRural RoadCity StreetBike LaneBike PathParking Lot
Riding Activity (Check All That Apply)*

StartingStoppingGoing StraightTurningBeing PassedPassingClimbingDescendingNegotiating IntersectionStationary
Incident Cause Category (Adds Question)*

Road Surface (e.g., Pothole)Road Debris (e.g., Sand/Gravel),Road User (e.g., Bike, Car)Equipment Failure (e.g., Chain)Rider Health (e.g., Pass Out)
Road Surface Options*

PotholeCrackBroken PavementBumpEdgeWet/SlipperyOther
Road Debris Options*

Sand/GravelRock(s)ObjectVegetationGlassTrashOther
Road User Options*

BikeCarTruckMotor CyclePedestrianAnimalOther
Equipment Failure Options*

ChainSpokesDerailleurBrakesPedalsTireOther
Rider Health Options*

Pass OutVertigo/DizzyChest PainDehydratedBonkOther
Incident Description*
Vehicle Involved*

NoYes (Adds Questions)
Driver Name

First NameLast Name
Driver License Number & State
Vehicle License Number & State
Officer Present*

NoYes (Adds Questions)
Officer Affiliation*
Officer Name

First NameLast Name
Officer Report Number
Rider Injured in Incident*

First NameLast Name
Rider Email*
example@example.com
Rider Cell Phone Number*
Rider Affiliation*

SLOBC MemberSLOBC Visitor
Rider Wearing Helmet*

YesNo
Rider's Bike*

Single BikeSingle E-BikeTandem BikeTandem E-BikeTrikeE-Trike
Rider's Proximity To Rider Ahead*

Close (Within 2 Bike lengths)Near (Between 3 and 6 Bike lengths)Distant (Greater than 7 Bike lengths)
Description of Rider's Injuries*
Incident Disposition (Check All that Apply)*

Rider Completed RideRider Rode to Start or HomeRider Accompanied to Start by Another RiderAnother Rider went for HelpRider Transported by Another Rider or Good SamaritanEmergency Contact CalledTransported by Emergency Contact911 CalledTransported by Ambulance
Witness

First NameLast Name
Witness Cell Phone Number
Member Submitting Report*

First NameLast Name
Member Email*
example@example.com
Member Cell Phone Number*
Save a Draft and you will be emailed a link to complete the report.

Submit the Report and a copy will be emailed to you and the SLOBC Board.
SLOBC Ride Coordinator Analysis
Possible Contributing Factors (Check All that Might Apply)

InattentionInappropriate SpeedToo Close to ReactLack of SignalingUnpredictable RidingOther
Observations or Notes
Should be Empty:

SLOBC Incident Report 2025

SLOBC Ride Coordinator Analysis