Canada Road Safety
Canada Road Safety Week Data Collection Form
Name Of Police Service / RCMP Division
Province / Territory
Participation in Canada Road Safety Week
Yes
No
From
to
Impaired Driving Statistics
Number of Alcohol Impared driving charges
Number of Drug Impaired Driving Charges
Number of Suspensions using an approved screening device
Number of administratibe driving prohibitions (over .08)
Number of administratibe driving prohibitions (under .08)
Total number of impaired driving charges
Aggressive Driving Statistics
Number of speeding charges
Number of stunt driving charges
Number of moving voilations
Total Number of aggressive driving charges
Distracted Driving Statistics
Number of electronic device charges
Number of careless driving charges
Total number of distracted driving charges
Seatbelt Statistics
Number of drivers without a seatbelt charges
Total number of "Without a seatbelt" charges
Total
Total Number of all Road Safety charges
Number of driver/operator contacts
Contact Information
Contact Name
Contact Phone Number
Contact Email