ABRIDGED OFFENCE REPORT FOR STATEMENT OF OFFENCE No.
ABRIDGED OFFENCE REPORT FOR STATEMENT OF OFFENCE No. (Indicate the origin of the report in this space) Event code Record No.
A Identification of defendant
B Vehicle V.R.N. Number of occupants Colour of vehicle
C Lighting Day 1 c Daylight 2 c Semi-darkness Night 3 c Lighted highway 4 c Unlighted highway
Weather 5 c Clear 6 c Cloudy 7 c Fog 8 c Rain 9 c Sleet 10 c Snow
Zone 11 c School 12 c Residential 13 c Commercial 14 c industrial 15 c Rural 16 c Park
Roadway Type 17 c Concrete 18 c Asphalt 19 c Gravel 20 c Dirt
Condition 21 c Dry 22 c Wet 23 c Snow 24 c Ice 25 c Mud 26 c Construction
Configuration 70 c Flat/straight 71 c Flat/curve 72 c Downhill/straight 73 c Downhill/curve 74 c Uphill/straight 75 c Uphill/curve
Presence of road 27 c None 28 c Veh. same direction 29 c Veh. app. direction 30 c Veh. inters. road 31 c Pedestrian(s) 32 c Worker(s) 33 c Cyclist(s)
Type of vehicle 41 c Automobile 42 c Light truck 43 c Truck 44 c Truck tractor 45 c Vehicle transporting hazardous materials 46 c Specialized mobile equipment 47 c Specialized vehicle 48 c Bus 49 c School bus 50 c Minibus 51 c Taxi 52 c Emergency veh. 53 c Motocycle 54 c Moped 55 c Recreational veh. 56 c Snowmobile 57 c Bicycle 99 c Other
D Radar Speed recorded km/h Speed zone km/h Radar device c moving c stationary Make Model Series
1st radar check c Electronic c Tuning fork time time km/h km/h 2nd radar check c Electronic c Tuning fork time time km/h km/h
c In proper working order c Other vehicles present in radar beam Distance at which the radar device clocked vehicle speed c Certified operator c No source of interference with operation c Visual estimate metres
E Relevant facts, details or particulars c Continued on another page
F Relevant facts, details or particulars c Continued on another page
Attestation of the facts I have personally observed the facts mentioned in
Name 1- Peace officer c 2- Other Quality Officer’s No. Unit Date (Y-M-D) Validation code I have personally observed the facts mentioned in Name 1- Peace officer c 2- Other Quality Officer’s No. Unit Date (Y-M-D) Validation code
Attestation of hard-copy conversion I attest that this document is true to its duplicate in electronic form. Authorized person Surname Given name Quality Date (Y-M-D) Time (H-M-S) Validation code