STEO AccidentIncidentRequest

Operator

Route

Run

Driver

Communicated by

A report MUST be submitted to STEO when any school vehicle, while loaded with students, is involved in an accident or an incident. The report MUST also be copied to each school involved.

VERBAL REPORT: COMPLETED IMMEDIATELY

WRITTEN REPORT: WITHIN 24HRS

Type of Report *

Accident

Incident

Was anyone injured *

Yes

Contractor to determine if *

Preventable

Non-Preventable

Type of Incident

Age Range

Date of Occurrence

Day of the Week

Vehicle Year

Vehicle Make

Vehicle Type

Insurance Company

Expiry Date

Driver Type

Driver's Last Name

Driver's First Name

Driver's License #

Vehicle Plate #

V.I.N

Vehicle Damage YesNoN/A *

Location Type

Driver Collision
_{(in the last 24 mths)}

Contactor Collision
_{(in the last 24 mths)}

Company Follow Up

Class Work

Retraining

Re-evaluation

N/A

Other

Driving wearing sear belt

Yes

Hire Date

Experience Driving

Driver's Name

Best Contact #

Ext.

Other Vehicle

Other Vehicle Damage

Collision Type

Contributing Circumstances

Weather Conditions

Road Conditions

Road Contour

Road Surface

Speed you were travelling _(km/h)

Other vehicle travelling _(km/h)

Posted Speed Limit _(km/h)

Were Charges Laid

Yes

Against Whom

Location of Accident/Incident. Include city/town/township, roads, cross streets.

Description of Accident/Incident

Description of Damage to School Vehicle

Supported Graphic file types: png, jpg, bmp, gif, tiff, exif

Description of Damage to Other Vehicle

Description of Injuries

Police Notified

Yes

Police Department

Time

Police Report # Please forward copy of report A.S.A.P

Ambulance Notified

Yes

Time

Fire Department Notified

Yes

Time

All schools attended by students on the bus at the time of the accident/incident must be notified. A student list for each school must be submitted to the schools Please list School Name, Person Notified and Time

Format: School - Person Notified - Time

Students on board and school student is attending

# of riders on vehicle

Age Range

Format: Student's Name - School Attending

Last Name

First Name

STEO AccidentIncidentRequest

Diagram of Accident

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