Connected Vehicle Safety Issue Reporting Form
Report safety concerns regarding connected vehicles. Please provide accurate details to help us address your issue efficiently.
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Vehicle Make
*
Vehicle Model
*
Vehicle Year
*
Vehicle Identification Number (VIN) (optional)
Date and Time of Issue
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Issue (City, State, or GPS coordinates)
*
Type of Safety Issue
*
Please Select
Software malfunction
Connectivity failure
Unexpected vehicle behavior
Sensor or camera issue
Warning or alert malfunction
Other
Describe the Safety Issue
*
Upload Supporting Files (photos, screenshots, logs, etc.)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Report
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