Type of Event

* Required

Event preventable Event non-preventable

Lost child

Name

Grade

Child not met at the stop

Name

Grade

In the Event of an Accident

Accident Location *

School yard	Loading zone	Intersection	Railway crossing
Other

Specify Location

Accident Type *

Backing	Left or right turn	Rear-ender	Collision with parked vehicle or fixed object
Other (please specify below)

Specify

Damage Estimated at Less Than $1000: *

Yes No

Bus Driver Charged Yes No *

Weather Conditions

Clear	Rain	Fog	Snow	Sleet
Other:

*

Road Conditions

Dry	Muddy	Snow covered/slushy	Wet	Icy
Other:

*

Student Manifest

Please provide a route copy clearly indicating which student was on board.

Student Injuries

Yes No *

If Yes, Details Below Are Manditory

	School Name	Student Name	Grade	Injury Detail	Hospital Released or Admitted

Persons Advised

		Name	Yes	No	Time	Contacted by:
	Francobus Operations Supervisor or Director		False	False
	Francobus Transportation Technician *		False	False
	Parents		False	False
	Others		False	False

Attachments

Police Report

Number

Company Accident / Incident Report

Upload

Submitted by

Last Name

First Name

Email

Confidentiality Statement

In accordance with the Personal Information Protection and Electronic Documents Act, Article 29, Paragraph (2), personal information requested in this form will assist in providing transportation services. The information is gathered in accordance with the Education Act S.R.O. 1980, c. 129, s.166 (1).