Report a Struck By Incident

The Emergency Responder Safety Institute (ERSI), a committee of the Cumberland Valley Volunteer Firemen’s Association (CVVFA), has worked for years to improve the safety of those who respond to incidents on America’s roadways. Continuing to be proactive in this effort, CVVFA/ERSI has again worked to develop a better document and analyze how and where our country’s first responders are being struck, injured, and killed. This will be accomplished through this enhanced platform and capability to solicit and collect struck by incident information from voluntary reporters and significantly upgrading its data collection functionality and depth.

It typically takes 3-4 minutes to complete this reporting form. There are twelve very brief sections. All questions are optional. Please provide as much information as you can. If you do not know the answer to a question, skip it. If you have a problem with or a question about the form, please contact us.

Click here to download a paper copy of this form for internal use by dispatchers to record information for later data entry into the online form.

1. Incident Time & Date (Please estimate if exact time not known)

Please click the box and select a date from the calendar.
Scroll to top