# Statement Template!



## Vikeonabike (19 Apr 2010)

Guys as promised: 
Top one is a blank to be cut and pasted, use the next version as a reference: I have broken the second version down into paragraphs, there is no need to do this in an actual statement. 

IPPEC method of statement-taking:
Introduction
People
Places
Event
Closure (to include victim personal statement)

I am making this statement about an incident that occurred on the (insert Date in full) 2010 on (road), (town), involving a (vehicle/person/object etc). In this account I will mention (number of people) people and a (vehicle, make, model, colour / object) with the index number (xxXXxxx). I have been cycling for X amount of years as (commuter/competitive) and consider myself to be a (experienced/inexperienced/ competent cyclist) I also hold a full car/motorcycle/HGVdriving licence and have done so for X amount of years. I consider myself to be an experienced/competent driver. The first person I will mention is (colour, sex, age, hair colour (length and style) facial features (eyes, facial hair, spots, etc), clothes, scars tattoos). This person I will refer to as “the driver” was driving a (make & model, colour, index) with (further distinguishing marks such as spoilers, body kit, loud exhaust, graphics, blacked out windows lowered suspension, dents, etc). The second person I will mention is (colour, sex, age, hair colour (length and style) facial features (eyes, facial hair, spots, etc), clothes, scars tattoos). This person I will refer to as: “The Passenger / Witness 1 etc”. This incident took place on (Road name / number) at the junction with (road name / number). I would describe this as road as (Description). A copy (of the video of the incident taken with my (name of camera)) / Photos of damage / injuries I exhibit as XXX y (your initials and number of exhibit). At the time of the incident the weather was (sunny (direction of sun may be important) / dark, overcast windy frosty icy snowy etc) I was wearing (clothing) and displaying (lights / reflectives etc).
At (time) on the (insert Date in full) 2010 I was cycling to/from (place) along the (road) in the direction of (place or compass direction) ….............................................
……………………………………………………………………………………………………………….Your text here. This should be a full description of actions, words and behaviours of the offender and yourself……………………………….
…………………………………………………………………………………………
At the time of the incident visibility was XXXXX, I was no more than XX metres/feet from the offender and there were XXX obstructions to my view. In total the incident lasted XX minutes/seconds. I know / do not know the person, I would / would not recognise them again. I am willing to attend court to give evidence if required.
This is the worst case of Driving / behaviour /abuse I have suffered/seen in X years of cycling. The incident has left me with x injuries that required x treatment (include Dr’s details /hospital details), damage to my bike to the value of £ and it will be some (length of time) before I can / feel ready to venture out on my bike again.

I have had the Victim Personal Statement Scheme explained to me and this is what I have to say on the matter.
Full explanation of how the incident has left you feeling…include any physiological / psychological injury and how you feel the matter should be dealt with in court / by police


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## Vikeonabike (19 Apr 2010)

*Reference*

Introduction:
I am making this statement about an incident that occurred on the First of April 2010 on Clarkson Road, Hamsterville, involving 2 males driving a Mean machine. In this account I will mention 2 people and a Mean machine in purple and black with the index number DD1. I have been cycling for 10 years as commuter and competitive rider and consider myself to be an experienced cyclist. I also hold a full car, motorcycle, and tracked driving licence and have done so for 20 years. I consider myself to be a competent driver. 
People:
The first person I will mention is a white male, about 30 – 40 years of age and is about 6 foot tall, slim build. He has a long hooked nose, pointy chin and a very long black handlebar moustache. I could not see the colour of his hair as he was wearing a large Blue and red striped baseball cap with silver sunglasses on the peak. He was also wearing a long blue overcoat, black trousers and black shoes and red gauntlets. He spoke with an upper class English accent. This person I will refer to as “the driver” was driving a Mean Machine in purple with black trim, the index was DD1, with large yellow, roof spoiler, and yellow pointed nose fin. The vehicle had the number “00” on the door and a green circle at the front with a black “w” on it. The second person I will mention is a yellow male, I do not know how old, he was about 3 foot tall and of a rotund build. He was covered in yellow hair although his nose and ears were black, this male wore a red collar and spoke a foreign language that I did not understand. This person I will refer to as: “The Passenger”. The third person I wish to mention is a white female, around 5’7” tall, slim build with blonde hair in a pony tail and blue eyes, she was wearing a pink helmet, pink jacket and trousers and white boots. She was driving a Pink Compact Pussy Cat index PP1. This lady introduced herself to me as Penelope and spoke with a very high pitched American accent, possibly from the southern states of America. This person I will refer to as “PENELOPE”. 
Places:
This incident took place on Clarkson Avenue at the junction with Hammond Crescent. I would describe this as road as wide road, straight road in a residential area with a 30mph speed restriction. The houses are set well back from the road and all have off street parking. The road has two lanes allowing vehicles to travel in opposite directions with plenty of room between them. There are several junctions along this road that lead off to more residential areas, one of which is Hammond Crescent. The road was quiet with very little traffic, the road was dry and clear or any obstructions. A copy of the video of the incident taken with my MOVIO 3000 I exhibit as SAG1. At the time of the incident the weather was Bright and clear, the sun was high in the sky, I was wearing a purple helmet, fluorescent pink cycling top and bright yellow shorts, my shoes where luminous green.
Event:
At 1300 hours on the Sunday the first of April 2010 I was cycling to Mayville along the Clarkson Road in westerly direction. I had been cycling for about 20 minutes, I had a light tail wind so I was riding at about 20 mph when I heard a car approaching from behind me, it appeared to be travelling at around the speed limit. I looked over my right shoulder and saw a Pink Compact Pussy Cat Car. As we were approaching Hammond Crescent the car had pulled in behind me and was indicating to turn left. Suddenly there was a loud roar and we were both overtaken by a Mean Machine at high speed. The Mean Machine turned left without warning, causing me too brake heavily, I hit the side of the Mean Machine and was catapulted over the bonnet, landing heavily on my right shoulder in the road. I heard a loud bang from behind me. As I sat up the Driver and Passenger got out of the Mean Machine and walked up to me and said “You TWAT why don’t you look where you are going, you ****ING cyclists shouldn’t be on the road, you don’t even pay road tax….look what you have doe to my car your ARSE HOLE. Next time I see you I am going to make sure you never get on a bike again..”, I was still very shaken and did not reply, the passenger then just giggled. The driver walked over to the other side of his car and then launched a tirade of abuse at Penelope calling her a “lipstick wearing hussy”. He has picked up my bike and thrown it down in front of his car and shouted “DRAT AND DOUBLE DRAT” the passenger giggled again. The both got into the Mean Machine and drove off over my bike. I could here the passenger giggling as they left the scene. Penelope then called the police and an ambulance. I was taken to Mayville hospital A&E where I was treated for a fractured collar bone and severe abrasions to my back.
Closure:
At the time of the incident visibility was excellent, I was no more than 1 metre from the offender and there were no obstructions to my view. In total the incident lasted 5minutes. I do not know the person, I would recognise them again. I am willing to attend court to give evidence if required.
This is the worst case of Driving and abuse I have suffered in 10 years of cycling. The incident has left me with a Fractured Collar bone that required treatment at Mayville hospital; where I was seen by Dr Foster. My bike is a total write off and will cost £3000 to replace. I will also be off work for 6 weeks and as a self employed basket weaver will loose in excess of £5000 income. It will be some at least 8 weeks before I feel ready to venture out on my bike again.

I have had the Victim Personal Statement Scheme explained to me and this is what I have to say on the matter.
The abuse I suffered from the driver of the vehicle has left me feeling extremely nervous and I feel even when fully recovered I may not be able to venture out on my bike again. I took his threats seriously and fully believe the next time he sees me on my bike he will run me off the road. The incident was caused by the reckless nature of the driver and he was not at all concerned for my health or my property, he appeared to blame the incident on the fact that I was a cyclist and should not be allowed on the road. His mentality shows that he should not be allowed to drive a motor vehicle on a road and that he has no thought for other road users. I would describe his behaviour as totally DASDARDLY


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## Armegatron (19 Apr 2010)

Thanks - much appreciated. I think I will be using this sooner than I would like


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## Theseus (19 Apr 2010)

Very useful, thank you.

Mods: can we make this a sticky?


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## Origamist (26 May 2010)

Vik, thanks for this template - it's v helpful.


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## fimm (26 May 2010)

I know this is a serious thread and a serious subject, but can I just say that the example statement is brilliant...


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## benborp (23 Jul 2010)

Even though I had to give a verbal statement, preparing a written one first from this template made a difficult situation much easier[sup]*[/sup]. Thanks Vikeonabike.


*Although it was quite amusing at times:

Me: Then he said "Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."
PC: He said "******* do that again you ******* ****. Go on, you ******* *******. ******* ******."
Me: No. "Do that again you *******"- No, I mean, "Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."
PC:"Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."?
Me: Yes. Then he said ... etc


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## decca234uk (15 Oct 2010)

This is great, very useful. thanks for taking the time to do it and share it.


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## Angelfishsolo (6 Jul 2011)

fimm said:


> I know this is a serious thread and a serious subject, but can I just say that the example statement is brilliant...


Seconded


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## Angelfishsolo (6 Jul 2011)

benborp said:


> Even though I had to give a verbal statement, preparing a written one first from this template made a difficult situation much easier[sup]*[/sup]. Thanks Vikeonabike.
> 
> 
> *Although it was quite amusing at times:
> ...


Now sadly that is all too familiar  

I remember my first car crash (non fault as I was T-boned whilst driving through green lights). I screamed and shouted at the driver all manner of things. Then came the insurance form - "Please relate any conversation you had with the driver" - My reply "I lost my tempter and shouted at him but when I cooled down I apologised for my outburst" Had I written what was actually said (could U remember I would have been locked away )


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## Matthew_T (1 Sep 2011)

that is just incredible! So easy to put you own words into it. When I inevitably do have a collision with a vehicle, I will certainly use this. 

What an absolute scorcher.


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## cabern10 (7 Sep 2011)

Thanks for this....the template is so useful


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## Rural halfwit (30 Dec 2011)

I'd like to add to Vike's splendid effort..before the 'Victim personal statement' put in 'I support police action in this matter and I am willing to attend court if required. i also consent to details of any medical treatment in relation to this matter being used and disclosed in any court proceedings'

Vike will point out this is covered on the back of the MG11(The witness statement form) but always good I think to have it in the spiel too!


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## Vikeonabike (11 Jan 2012)

butlerana said:


> He's the one on the right, twylight.


Huh?


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## Vikeonabike (21 Mar 2012)

Can't believe I'm having to use my own statement template to write a statement!


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## Theseus (22 Mar 2012)

Vikeonabike said:


> Can't believe I'm having to use my own statement template to write a statement!


 
Was it that Mean machine with the index number DD1 again?


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## Vikeonabike (22 Mar 2012)

Everytime.. really should stop stalking Penelope Pitstop. Dick Dastardly is about where ever she is.


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## Vikeonabike (17 May 2012)

Dianne Perry said:


> Very useful, thank you.


A Pleasure Mi' Lady!


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## clarion (2 Jul 2012)

Thank you, Vike. Sadly, I've experienced an incident this morning which I've decided to report. I checked out the car details on the DVLA website, and discovered that the car concerned is not recently relicensed. At least the thug might get done for that. And driving without insurance, I'm prepared to bet.

I shall be very surprised indeed if the Traffic Criminal 'Justice' Unit give a shoot about me.


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## Wester (30 Mar 2013)

Angelfishsolo said:


> Seconded


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## sue perb (8 Jun 2013)

Many thanks had to use this for a mg11 for sunday because of a white van man doing abh on me will put video up after case.
Should it take 4 days for police to take a mg11 ?..


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## Vikeonabike (16 Jun 2013)

sue perb said:


> .
> Should it take 4 days for police to take a mg11 ?..


Sue t 'shouldn't, make sure you also have photos, documantation of injuries etc. MG19 needs to be signed by you and request for Drs Statement if applicable!


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## CopperCyclist (16 Jun 2013)

sue perb said:


> Many thanks had to use this for a mg11 for sunday because of a white van man doing abh on me will put video up after case.
> Should it take 4 days for police to take a mg11 ?..



Depends on the force and their systems. 

In your case in my force, if the statement isn't taken immediately on your first contact with the police, then the job gets sent to investigation officers. How soon you get dealt with then depends on their case load and how they prioritise it, and a delay of more than a week isn't unknown. 

On the whole though, your statement should be taken at your first point of contact with the police, which should be AT MOST under 72 hours in my force. 

Different forces have different practices and policies though...


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## sue perb (16 Jun 2013)

I'm in Essex. I called 101 for advice the day of the incident (Thursday) and they told me an officer couldn't come and get my statement till 2pm Sunday. I then got a call 1.30pm Sunday telling me they wouldn't be able to make it. I offered to go to the station but they said civilian staff couldn't take my statement and that a officer would be out to me at some point.


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## Vikeonabike (20 Jun 2013)

sue perb said:


> I'm in Essex. I called 101 for advice the day of the incident (Thursday) and they told me an officer couldn't come and get my statement till 2pm Sunday. I then got a call 1.30pm Sunday telling me they wouldn't be able to make it. I offered to go to the station but they said civilian staff couldn't take my statement and that a officer would be out to me at some point.


 
Keep us updated Sue, any news on police attendance yet?


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## sue perb (20 Jun 2013)

Will do they have arrest pack ready they popped round his last night but was not in ;(


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## sue perb (7 Jul 2013)

Now put on PNC .


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## classic33 (7 Jul 2013)

sue perb said:


> Now put on PNC .


How do you know that?


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## sue perb (7 Jul 2013)

classic33 said:


> How do you know that?


The sgt in charge let me know.


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## classic33 (7 Jul 2013)

sue perb said:


> The sgt in charge let me know.


At least they're keeping you informed. Thats one thing I suppose.


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## sue perb (7 Jul 2013)

classic33 said:


> At least they're keeping you informed. Thats one thing I suppose.


Police have been great the plonker is never in when they pop round


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## classic33 (7 Jul 2013)

sue perb said:


> Police have been great the plonker is never in when they pop round


Been there. Appointments made and never kept, often cancelled at the last minute.


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## sue perb (7 Jul 2013)

classic33 said:


> Been there. Appointments made and never kept, often cancelled at the last minute.


Police have tried to arrest him three times a day for the last four weeks


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## classic33 (7 Jul 2013)

sue perb said:


> Police have tried to arrest him three times a day for the last four weeks


Tell them to try a little harder. They must really want to get their hands on him.


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## sue perb (7 Jul 2013)

classic33 said:


> Tell them to try a little harder. They must really want to get their hands on him.


O yes wait for the video to go up you will see have channel five over Tuesday about it.


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## classic33 (7 Jul 2013)

Could be worth watching out for, from the sounds of things.


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## sue perb (7 Jul 2013)

classic33 said:


> Could be worth watching out for, from the sounds of things.


I have been off work for five weeks and had a MRI scan


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## classic33 (7 Jul 2013)

sue perb said:


> I have been off work for five weeks and had a MRI scan


Given this bit of information, what I said in the previous post is out of order. I was commenting on the effort the police were putting into trying to catch him. Not on your predicament.
MRI's are nowt to worry about. Had enough of them over the years. Take a CD with you, they may play it for you to help put your mind at ease.


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## sue perb (9 Jul 2013)

Tv filming done.




[/URL][/IMG]
http://i1292.photobucket.com/albums/b568/sue_perb1/GOPR0205_zpsa2113147.jpg
Very hot today


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## Vikeonabike (10 Jul 2013)

Using my own template again to get somebody in front of the Beak... 
Unfortunately my head cam didn't pass the drop test last week so it's my word against his....


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## HLaB (10 Jul 2013)

Vikeonabike said:


> Using my own template again to get somebody in front of the Beak...
> Unfortunately my head cam didn't pass the drop test last week so it's my word against his....


A lot of muppets out tonight too; fortunately in the dry the Bianchi can stop on the proverbial sixpence.


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## sue perb (10 Jul 2013)

Vikeonabike said:


> Using my own template again to get somebody in front of the Beak...
> Unfortunately my head cam didn't pass the drop test last week so it's my word against his....


50/50 good luck sounds to me it may be n/f/a


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## Vikeonabike (10 Jul 2013)

sue perb said:


> 50/50 good luck sounds to me it may be n/f/a


 Sue this is me we are talking abour.. 75 /25 in my favour.. recon I'll get a due care and attention out of it.


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## sue perb (10 Jul 2013)

Vikeonabike said:


> Sue this is me we are talking abour.. 75 /25 in my favour.. recon I'll get a due care and attention out of it.


Cps may say driver awareness course lol


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## sue perb (11 Jul 2013)

Vikeonabike said:


> Sue this is me we are talking abour.. 75 /25 in my favour.. recon I'll get a due care and attention out of it.


Any updates mate??
Is driver going to get a nip within 14 days for it??


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## Vikeonabike (12 Jul 2013)

Sent the NIP out Yesterday, I already know who the driver is though... Hopefully I'll get the ball rolling on Monday and get him interviewed by one of my Traffic Buddies who is also a cyclist.


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## sue perb (12 Jul 2013)

Great news


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## sue perb (14 Jul 2013)

Vikeonabike said:


> Sent the NIP out Yesterday, I already know who the driver is though... Hopefully I'll get the ball rolling on Monday and get him interviewed by one of my Traffic Buddies who is also a cyclist.



Vikeonabike Would you say a
*SECTION 59 ???*


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## Vikeonabike (16 Jul 2013)

sue perb said:


> Vikeonabike Would you say a
> *SECTION 59 ???*



Plus a few other offences too


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## sue perb (16 Jul 2013)

Vikeonabike said:


> Plus a few other offences too


 
Now have a look at this.

 = 
*police caution *


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## Vikeonabike (17 Jul 2013)

sue perb said:


> Now have a look at this.
> 
> =
> *police caution *




Unfortunately If he has no previous then A caution is all that will happen. They obviously didn't chase any driving offences. Which is a shame....
Every cyclist should have a point of contact with a pro cycling cop in their area. Unfortunately that is rarely the case.


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## sue perb (17 Jul 2013)

Vikeonabike said:


> Unfortunately If he has no previous then A caution is all that will happen. They obviously didn't chase any driving offences. Which is a shame....
> Every cyclist should have a point of contact with a pro cycling cop in their area. Unfortunately that is rarely the case.


 
I'm thinking private prosecution (may work)


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## sue perb (18 Jul 2013)

The nip was not sent out by sgt???


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## Vikeonabike (24 Jul 2013)

sue perb said:


> The nip was not sent out by sgt???


 Nope Constables are quite capable of sending those out. Obviously I can't interview and report him, but a cyclist colleague of mine will!


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## sue perb (6 Aug 2013)

Can this be careless driving??


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## Twelve Spokes (2 Sep 2013)

sue perb said:


> Can this be careless driving??



It's definitely plain stupidity.


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## sue perb (17 Sep 2013)

View: http://www.youtube.com/watch?v=Jm4uhcaKfWI

Have a look
http://www.bbc.co.uk/news/uk-england-essex-24124187#?utm_medium=twitter&utm_source=twitterfeed


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## Archie_tect (18 Sep 2013)

[QUOTE 2606568, member: 1314"]Reply - fair enough.
Dear Mr Crockers,
....Thank you for your time and understanding whilst I reviewed the matter and trust you are satisfied with the outcome.
Kind regards

xxx[/quote]
*Three* kisses... wow!


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## sue perb (18 Sep 2013)

Archie_tect said:


> *Three* kisses... wow!


LOL


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## Leedsbusdriver (18 Sep 2013)

sue perb said:


> Have a look
> http://www.bbc.co.uk/news/uk-england-essex-24124187#?utm_medium=twitter&utm_source=twitterfeed


Module my arse.Ticket machine modules go in the ticket machine so shouldn't be in the drivers hand at all, that's assuming that the model of ticket machine on the bus requires a module.
Most bus companies now use ticket machines which don't require a module just a credit card style swipe card individual to the driver.


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## sue perb (19 Sep 2013)

Leedsbusdriver said:


> Module my arse.Ticket machine modules go in the ticket machine so shouldn't be in the drivers hand at all, that's assuming that the model of ticket machine on the bus requires a module.
> Most bus companies now use ticket machines which don't require a module just a credit card style swipe card individual to the driver.


O yes have a look at this notice the size of it.


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## arallsopp (28 Oct 2014)

Thanks again to the OP (@Vikeonabike) for putting this together. 

4 times I've had to use it, twice (fortunately) for collisions in which I was only a witness. Each time, all parties (with the general exception of the Dastardly character) have complemented the cycling community on their general level of awareness as to things around them. At last night's incident, the attending officer said "We love it when the call says the witness is on a bicycle. Chances are a cyclist is going to know where everyone is, the direction they were coming from, how they were driving, the condition of the road, the direction of the wind, you name it."

I think he may have come across a user of your template before


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## Vikeonabike (8 Nov 2014)

Good to know my little piece was of use!


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## matthew (22 Jan 2015)

Vik, Thanks for this, I knew it was here and hoped not to need it but after an incident on the way home this evening I have just completed it in readiness for a visit from my local constabulary tomorrow morning. No injuries or damage fortunately just intimidation and a forced stop from a Range Rover as escalation of poor driving.


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## Sbudge (25 Sep 2015)

I know this may sound grim (given the context of the thread) but can I suggest another useful tool? In this case how to better call for an ambulance...you'd be amazed how garbled things can get, I know it should be obvious and the operators are very good but you'll find this helps. Very easy and useful acronym: *L I O N E L*

*L*ocation : "I'm at the junction of Smith St and Jones Road etc" Don't assume your mobile phone gives enough information
*I*ncident : e.g. "There's been a road traffic accident etc"
*O*ther Services needed : e.g. "We need the Police as well etc"
*N*umber of casualties : "2 people are hurt etc"
*E*xtent of injuries : "One is unconscious, the other has hurt their leg etc"
*L*ocation : Just in case you weren't clear

This way you can deliver the maximum amount of information, in a useful order, in the minimum time. I've had to use it a few times and it really settles the mind when you're otherwise not necessarily thinking straight. 

Budge
p.s. It's also really useful to teach to kids.


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## Arjimlad (19 Dec 2017)

Thanks for this again. I just followed it to produce a four-page statement about a road-raging driver and the interview with me was only 15 mins instead of an hour or more. The police have taken the statement word for word and will be interviewing the driver next.


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