School Bus Accident Report

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Chloe Edwards
10 years ago
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1 School Bus Accident Report Regardless of severity, the following School Bus Accident Report must be submitted by a school division whenever a school bus is involved in an accident. This report can be submitted online through the Pupil Transportation Unit s website ( mailed to the Pupil Transportation Unit, Portage Avenue, Winnipeg, R3G 0T3; or faxed to Report submitted by: Name and Position School Division Date Pupil Transportation Unit Manitoba Education, Citizenship and Youth

This report can be submitted online through the Pupil Transportation Unit s website (www.edu.gov.mb.

2 General Accident Information... School Bus Unit Number: Accident Date: Day of Week: M T W Th F Sa Su Accident Location (eg. street, highway number, driver s residence): Town/City: OR On rural route Time of Accident: a.m. Number of Students on Bus (excluding driver): p.m. Type of Bus: 1 Conventional 2 Handi-Transit 3 Van 4 Van 4 Flat Nose (Type C) (Type B ) (Type A1) (Type A2) (Type D) School Bus Use at Time of Accident: 1 Regular route 4 Maintenance/Fueling 2 Special education 5 Off duty 3 Field trip 6 Other (specify) School Bus Driver Information... Driver s Name: School bus driver experience: 1 Less than 1 year years 5 More than 10 years years years Number of school bus accidents in past three years: Did driver receive 24 hours of school bus operator instruction prior to being certified? Has driver received eight hours of inservicing in the past 12 months? At Time of Accident... Posted speed limit: km/h OR Not applicable Approximate speed of bus: km/h OR Stopped Was driver wearing seat belt? 3 Driver off bus at time of accident Is bus strobe light equipped? 1 Yes Was it activated at time of accident? 1 Yes 2 No 2 No Were the police notified? 1 Yes Was a police report completed? 1 Yes 2 No 2 No

er, driver s residence): Town/City: OR On rural route Time

3 1. Accident involved school bus and: 1 Another motor vehicle 4 Animal 2 School bus only 5 Pedestrian 3 Fixed object 6 Cyclist 7 Train What? 8 Other What? 2. Amount of damage to all property involved (i.e. vehicles and/or other objects): 1 No damage 2 $1,000 or less 3 More than $1, Did accident occur at an intersection? 4. Type of collision between vehicles or objects: 1 Angle 4 One vehicle backing 2 Head on 5 Rollover 3 Rear end 6 Other What? 5. Direction of vehicles at time of accident: 1 Angle, both moving 4 One vehicle stopped 2 Same direction, both moving 5 Single vehicle accident 3 Opposite direction, both moving 6 Other What? 6. Contributing Circumstance(s): Bus Driver Action Other Circumstances 1 Improper speed 10 Actions of other driver 2 Failed to yield right of way 11 Obstructed view 3 Failed to obey stop sign 12 Weather conditions/visibility 4 Failed to obey traffic signal 13 Vehicle defect What? 5 Crossed centre line 6 Improper passing 14 Road conditions What? 7 Improper turning 8 Improper backing 15 Other 9 Followed too closely circumstance What? 7. Weather Conditions/Visibility: 1 Clear 5 Snow/sleet 2 Cloud/overcast 6 Haze/smoke 3 Rain 7 Exhaust fog 4 Fog 8 Other What? 8. Road Surface: 1 Pavement 2 Gravel 3 Dirt

Type of collision between vehicles or objects: 1 Angle 4 One vehicle backing 2 Head on 5

4 13 Crossing Arm 9. Road Condition: 10. Lighting: 1 Dry 5 Snow packed 2 Wet 6 Potholes/ruts 3 Muddy 7 Under repair 4 Icy 8 Other What? 1 Dawn 4 Dark, artificially illuminated 2 Daylight 5 Dark, no artificial illumination 3 Dusk 11. Circle point of first impact (roof) (undercarriage) 14 No impact/other circumstance What? 12. Please provide a brief description of the accident, and if it assists with the explanation, complete the accident sketch below.

1 Dawn 4 Dark, artificially illuminated 2 Daylight 5 Dark, no artificial illumination 3 Dusk 11.

5 COMPLETE ONLY IF ACCIDENT INVOLVED A PEDESTRIAN/CYCLIST 13. Direction of bus at time of accident: 1 Straight 4 Backing 2 Turning right 5 Bus stopped 3 Turning left 6 Other What? 14. At time of accident, the pedestrian/cyclist was: 1 On the side of the road 3 In a crosswalk 2 In the roadway 4 Other What? COMPLETE ONLY IF ACCIDENT OCCURRED WHILE LOADING/UNLOADING 15. At time of accident, was the bus: 1 Entering the loading area 2 Stopped in the loading area 3 Leaving the loading area 16. Did a don t pass law violation occur? 17. Was anyone injured in this accident? Was the pupil/other person injured in the loading area: 1 Struck by 2 Struck by 3 Other the bus another vehicle incident What? COMPLETE ONLY IF ACCIDENT RESULTED IN INJURY Severity of Injury Students Driver Minor Moderate Serious Fatal Number of Injured ON Bus Other Passengers Students Driver Number of Injured OFF Bus Other Persons

At time of accident, was the bus: 1 Entering the loading area 2 Stopped in the loading area 3 Leaving the loading area 16. Did a don t pass law violation occur? 17.

School Bus Accident Report Form

School Bus Accident Report Form Regardless of severity, a School Bus Accident Report Form must be submitted by a school division whenever a school bus is involved in an accident. Please complete the following