Were you directly involved in the incident? *
--------- Yes, this happened to me No, I witnessed this happen to someone else
What were you riding?
--------- Bicycle E-scooter I was a pedestrian I was driving
What type of incident was it? *
--------- Collision with a stationary object or vehicle Collision with a moving object or vehicle Near miss with a stationary object or vehicle Near miss with a moving object or vehicle
Lost control and fell
What sort of object did you collide or nearly collide with? *
--------- Head on Side impact Angle impact Rear end Turning right Turning left Passing Open vehicle door Another cyclist Pedestrian Animal E-scooter Curb Train Tracks Pothole Lane divider Sign/Post Roadway Other (please describe)
What type of bicycle were you riding?
--------- Personal (my own bicycle or a friend's) Bike share Bike rental E-scooter
Did the incident involve a pedal-assist electric bike (eBike)?
--------- Yes No I don't know
What class of e-bike were you riding?
--------- Pedal assist up to 20 mph (32 km/h) Throttle assist up to 20 mph (32 km/h) Pedal or throttle assist over 20 mph (32 km/h)
Approximately what speed was your e-bike traveling at the time?
--------- Under 5 mph (8 km/h) Between 5-20mph (8-32 km/h) Over 20mph (32 km/h)
Were you injured? *
--------- Medical treatment not required Saw a family doctor Visited the hospital emergency dept. Overnight stay in hospital No injury
I don't know
How did this incident impact your bicycling? *
--------- No impact I'm now more careful about where/when/how I ride I bike less I'm now more careful about where/when/how I ride AND I bike less I haven't biked since Too soon to say I was not directly involved
What was the purpose of your trip?
--------- To/from work or school Exercise or recreation Social reason (e.g., movies, visit friends) Personal business During work
Please give a brief description of the incident