Near miss incident report

Please use this form to report near misses on North Lincolnshire's roads.

Date of incident ^*

Time of incident ^*

Location of incident ^*

Type of vehicle(s) involved (e.g. car, bus, cycle, etc.)

Direction of travel ^*

(e.g. towards Ashby)

Condition of road surface ^*

Light conditions ^*

Street furniture damaged?

Lamp post
Property boundary
Service pole
Sign pole
Signal pole
Tree
Other

If Other, please specify

Please describe exactly what happened? ^*

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