Accident Report

Notifications

Did you contact HR?*

Call Center Notified?*

Police Notified?*

Responding Police/Sheriff/State Trooper City

Emergency Services Notified?*

Accident Details

Date of Incident

Program*

Choose Your Program Manager*

Type of Accident*

Vehicle vs Vehicle
Vehicle vs Stationary Object (building, sign, tree, etc...)
Vehicle Maneuver (abrupt stop, sharp turn, road condition)
Client or Driver Illness or Injury
Incident Only
Observation
Other (please provided details in general description)

County Accident Occurred In*

Number of Clients Onboard*

Please enter a number from 0 to 20.

Address, Intersection, Street:*

Time of Accident

Lighting Conditions*

Weather Conditions*

At Fault?*

Driver Name*

Please list all clients on the vehicle, indicated "none" if no clients were present.*

Bus Number*

Vehicle VIN*

License Plate Number*

Bus Type*

5307
5311
Company Owned

Drug Test Performed*

This decision must be made by Human Resources or the contract Drug and Alcohol Program Manager.

If Drug Test was performed, was it:

FTA Threshold
Reasonable Suspicion

If yes, who was the requesting party

Were riders injured or removed by an ambulance?*

What medical center were they transported to?

If yes, please provide last names of clients and brief description of why

Accident Detail: Select all that apply:*

A fatality
Someone transported by Ambulance
Any vehicle towed
Vehicle had to be evacuated
None of the Above

Was the vehicle removed from service because of the accident / incident?*

If yes, please provide the type of damage

General Description of Accident / Incident*

Video Available?*

Yes
No

Post Image

Drop files here or

Max. file size: 10 MB.

Stop! Have you contact Human Resources to determine the need for a drug test?

Notifications

Accident Details

ADDRESS

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