OST Project Area Crash Data Form

EXHIBIT F SS4A PROJECT CRASH DATA FORM

Safe Streets and Roads for All (SS4A) FY 2024 Implementation Grant Application - Project Area Crash Data Reporting Form

Applicant Agency Name

Applicant Agency UEI

Instructions:

Fill in your Agency Name and UEI. Then, input crash data for the appropriate project locations and types for your Implementation Grant application.

See Implementation Grant Project Area Crash Data Fact Sheet for additional instructions. Once you have completed this form please upload to your application as an Excel file (.xlsx).

Corridor Projects

Systemwide Projects

Spot / Intersection Projects

Road Name

Limit 1 (Intersecting Road or Project Road mile marker)

Limit 2 (Intersecting Road or Project Road mile marker)

# of Fatal Crashes along Corridor from 2017-2021

# of Serious Injury Crashes along Corridor From 2017-2021

# of Suspected Injury Crashes along Corridor From 2017-2021

Cost Estimate

Safety Problem Addressed

# of Locations/ Miles Needing Improvements (based on High Injury Network/safety analysis)

# of Locations/ Miles Requesting Grant Funding

# of Fatal Crashes Linked to Identified Safety Concern at Selected Locations from 2017-2021

# of Serious Injury Crashes Linked to Identified Safety Concern at Selected Locations from 2017-2021

# of Suspected Injury Crashes Linked to Identified Safety Concern at Selected Locations from 2017-2021

Cost Estimate

Road Name

Latitude

Longitude

# of Fatal Crashes at Spot from 2017-2021

# of Serious Injury Crashes at Spot From 2017-2021

# of Suspected Injury Crashes at Spot From 2017-2021

Cost Estimate