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Run: Passenger Incident and Injury Report

Capture passenger injuries, near-misses, and onboard incidents in one structured report. This template helps transit, shuttle, and vehicle operators document...

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Submission Notice

Reporter name (required)

Reporter role (required)

Reporter contact email or phone

Optional. Use only if follow-up is needed.

Date of incident (required)

Time of incident (required)

Incident Details

Type of incident (required)

Location of incident (required)

Route, trip, or service name

Optional. Enter only if it helps identify the trip.

Incident description (required)

Describe the sequence of events, including what the passenger was doing immediately before the incident.

Contributing factors

Passenger Information

Passenger name

Optional unless required for follow-up or reporting.

Passenger contact information

Optional. Do not collect more PII than needed.

Passenger age group

Mobility aid or assistive device used

Was an interpreter or reasonable accommodation needed?

Injury and Medical Response

Did an injury occur? (required)

Injury description

Describe the apparent injury using minimum necessary detail.

Medical response provided

Was an emergency contact notified?

Medical facility or destination

Witnesses and Immediate Response

Were there witnesses? (required)

Witness details

Immediate actions taken (required)

Scene notes

Include any hazards, equipment issues, or operational conditions that may have contributed.

Follow-up and Review

Supervisor notified (required)

Risk management notified (required)

Corrective actions or preventive measures

Describe any actions taken to reduce the chance of recurrence.

Supporting attachments

Optional. Upload photos, statements, or related documents.

Get your results

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Email (required)

Your name (optional)

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