LOCAL PUBLIC AUTHORITY CRASH DATA REQUEST FORM


Contact Information:
Local Public Authority:  
Contact Person:  
Contact Title:  
Address 1:  
Address 2:
City:  
State (abv):  
Zip: (ex. xxxxx or xxxxx-xxxx)  
Phone #: (ex. 785*******)  
Phone Ext:
Other Phone #: (ex. 785*******)  
Email:    

Crash Data Request:
Target Location: City and/or County  
Data Years Needed: (ex. 20XX-20XX)   *Data Requested MUST Be Between 2000-Current Year
Date Needed: (ex. dd/mm/yyyy)    
Special Instructions? (250 char. max)  


NOTE: The data output contains specific fields related to traffic engineering within a city or county as recorded by the reporting officer on the crash forms. The distribution file will be in .xls format (MS EXCEL) and emailed upon completion unless otherwise instructed.