GaDOE BUS ACCIDENT REPORT
The Bus Accident Report shall be submitted by the local school system to the Georgia Department of Education in accordance with State Board Rule 160-5-3-.08. The report shall be submitted within 45 days of the accident. An accident is a sequence of events which produces unintended injury, death or property damage. Any school bus incident that: (1) generates a police accident or incident report; (2) involves any amount of property damage; (3) involves operation of the bus which causes personal injury or fatality to occupants in the bus, in other vehicles or pedestrians should be reported via the method prescribed by the Department. This report is used to monitor statewide trends so a more effective safety program can be presented in order to reduce preventable accidents.
* District Name-Click on box and select district name.
* Date of Accident-Click on box and select date from calendar. * Day of the Week Accident Occurred – Pick day from pull down box. * Time the Accident Occurred – Select from pull down box within 30 minutes. Then you can edit the minutes to the exact time. * Weather Conditions at Time of Accident – Pick from pull down box. * Accident Reported to What Law Enforcement Agency – Enter agency name. Examples: Georgia State Patrol, XYZ Sheriff’s Department, XYZ Police Department, NONE. Case Number Assigned by Agency Reported To – Enter number. * Accident Involved School Bus and – check all that apply. * Accident Occurred on – Pick from pull down box.
* Roadway Surface Composition – Pick from pull down box.
* Road Accident Occurred On – Enter name of highway or street. Examples: Highway 441S, Green Street, Intersection of Highway 23 & Stephens Road, 3421 Ledan Road. City in Which Accident Occurred – Enter City if necessary. State in which accident occurred – Enter State if necessary from pull down box. * Accident Severity – Pick ONE of 4 Categories. Use drop down arrow or click within empty field to display choices.
* Bus Design Capacity – Pick from pull down box.
* Number of Children on Bus – Enter number.
* Bus Number – Enter number.
*Year Model of Bus – Enter 4 digit year model of bus.
* Chassis Manufacturer – Pick from pull down box.
* Body Company – Pick from pull down box.
* Bus Driver’s First Name – Enter First Name.
* Bus Driver’s Last Name - Enter Last Name.
* Bus Driver’s Age – Enter age of driver.
* Bus Driver’s Sex – Pick one.
* Years of Bus Driving Experience – Enter number of years experience driving a school bus. Estimated Bus Pre-Crash Travel Speed – Enter speed of bus prior to accident. Estimated Impact Speed – Enter speed at time of impact. * Bus Towed from Accident Location – Pick one.
Other Vehicle Information
* Vehicle Type – Pick from pull down box.
Estimated Vehicle Pre-Crash Travel Speed – Enter estimated speed of vehicle prior to accident. * Other Vehicle Towed from Accident Location – Pick one.
To Add Additional Vehicles (3, 4, etc.) CLICK ON GREEN “ADD NEW BOX” to provide another line for data. You may add as many vehicles as required. If an unneeded blank row is displayed, please ignore.
* Injured parties – Pick from pull down box – You will need to enter ALL injuries/fatalities that apply to the applicable category (None, Bus Driver, Bus Passengers, Other Vehicle Driver(s), Other Vehicle Passengers, Pedestrians). * Total injuries – Enter Number per category or 0.
* Treated by EMS & Released – Enter Number per category or 0. * Treated by doctor and released – Enter Number per category or 0. * Hospitalized – Enter Number per category or 0.
* Fatalities – Enter Number per category or 0.
After adding the First Category (example Bus Driver) CLICK ON GREEN “ADD NEW BOX” to provide another line if needed (example Bus Passengers, etc.). You could possibly have 5 lines as an answer for this question. If an unneeded blank row is displayed,...
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