Incident Report

Most truckers on the road today are very safety conscious.  Unfortunately, however, there are a few who can give the industry a bad name.  Please use the form below to report a trucking incident that you have witnessed or you can send us an e-mail at

If you need to use a different comment form, please follow this link to Safety Feedback

Please give us as much information as possible.

(Hint: Use TAB to move from box to box. Using ENTER will immediately submit the form. You can use ENTER in Details or Comments for a new line.)

Red text indicates a required field.

Your Information

Your Name:
Business Phone:
Home Phone:
Your E-mail:
Request a Follow up?

Truck Information

Company Name on Truck:
Decal Number:
Tractor Number:
Tractor License:
Tractor State:
Trailer Number:
Trailer License:
Trailer State:

Incident Information

Location of Incident:
Date and Time:
Please select any of the following violations that apply:
Accident Tailgating Failure to Yield Failure to Signal
Failure to Stop Cut Off Mechanical Violation Littering
Parking Other    
Details or Comments:

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