Do Something About Dangerous Aggressive Driving

	Introduction
	Process
	Citizen Report Form
	Approved Drop-Off Locations

Citizen Report Form

Incident No.

Citizen Report Form

Fax:

905-456-5911

Peel Regional Police

Do not attempt to complete this form while you are operating your vehicle.

Incident Date _______________

Time _________ A.M .P.M.

Incident Location_______________________________________________
___________________________________________________________

Unsafe Driver and Vehicle Information

Driver Description __________________________________________
________________________________________________________
________________________________________________________

Male Auto	Female Truck	Age _____ Bicycle	Hair ______________ Other _____________
Plate #___________

Province ____________ Make ______________ Colour _____________	Vehicle Year ___________________ Model ________________________ Other Features __________________
Details of Incident
________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
Incident Reported By:
You must complete this section in its entirety before the form can be processed. Your name will be kept confidential and not disclosed. Name ___________________________________________________ Address _________________________________________________ City ____________________________ Postal Code ______________ Phone: (____)_________________ Bus #: (____)________________ Signature _____________________________________