Abuse Report



ABUSE REPORT FORM

BCLU form for reporting incidents of abuse experienced by nonmotorized travelers. The age of the incident is not important--please report all! One incident per form, please.
SORRY, FORM IS CURRENTLY BROKEN, PLEASE CALL OR EMAIL JASON MEGGS, (510) 725-9991

Please type in your real name:

Please input your email address:

Street Address:

City, State and Zip:

PLEASE FILL OUT BOTH BOXES BELOW WITH A DESCRIPTION OF WHAT HAPPENED

Please describe the incident in full, including the time, date, place, any license numbers or badge numbers, make and color of vehicle, what all parties did immediately prior, during, and after the incident, etc. If someone was cited or arrested, please tell what the charge(s) were and what became of them. Were there injuries? If so, what happened with the injuries? Please be as clear and complete as possible and describe the incident in as chronological a manner as possible. The lines provided are just a guideline to remind you to be as complete as possible.
What happened next? Did you file a complaint? File a lawsuit?

We respect your privacy.  Please check one of the following boxes.
Note that there may be some situations in which we may be ordered
to hand over this information by the legal system.

Keep this private!
You can use the text, but change my personal information
Consider this public information

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