Form Center

2. Have you had a close call with a bicycle, pedestrian or motorist? For example:

   • Were you in a crosswalk (on foot, bike, skateboard) and a car almost hit you?
   • Were you riding your bike on the right side of the road and a car almost hit you?
   • Were you walking on the sidewalk and a bike almost hit you?

   If you actually had an accident where physical contact was made in one form or another, please report that to the Police Department, it's the law to report all crashes and also helps the City identify countermeasures to reduce future collisions and improve transportation safety. For emergencies, Dial 911. For non-emergencies, call 434-970-3280.

   Please complete the form below and provide your contact information. The city's bicycle and pedestrian coordinator may contact you for more information.

4. Location of Close Call*
   Provide the approximate address and/or closest intersection.
5. Description of the Incident*
   Describe the incident including street name and direction of travel.
7. Date/Time
   Date/Time

   Date/Time
   Please include approximate date/time of the incident.
8. Image
   Upload relevant image
10. First Name
11. Last Name
13. Reply Email*
    Please include an email address to be contacted for more information
15. Phone Number
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field