DATE OF CALL: __________________________           EXACT TIME OF INITIAL CALL:__________________________

CALL TAKEN BY: ________________________             INITIAL CALL FROM:___________________________________

                                                                                        (NOTE WHETHER RADIO, PHONE OR OTHER)

                                                  LOCATION:_________________________________________________________________

                                                  BUS #:____________________ BUS DRIVER:____________________________________

STUDENTS ON BOARD?:_____________________________   INJURIES?:______________________________________

SCHOOL(S):___________________________________________________________________________________________

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FIRE OR FIRE DANGER?:_______________________________________________________________________________

NATURE OF ACCIDENT / INCIDENT:____________________________________________________________________

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FOR IMMEDIATE ACTION (NOTE TIME EACH ITEM COMPLETED)

________ TIME NOTIFY DIRECTORS / SAFETY DEPT                                                          TIME:_______________

________ CALL LAW ENFORCEMENT                            (PHONE:__________________)       TIME:_______________

________ CALL FIRE CONTROL                                        (PHONE:__________________)      TIME:_______________

________ CALL PRINCIPAL(S) (NOTE WHICH SCHOOLS)                                                    TIME:______________                           SCHOOL(S):___________________________________________________________________________________

________ CALL CENTRAL OFFICE                                    (PHONE:__________________)      TIME:_______________

________ CALL SPECIAL ED. DEPT. IF APPROPRIATE. (PHONE:__________________)      TIME:______________
________ CALL DOT                                                            (PHONE:__________________)      TIME:______________
________ DISPATCH ALTERNATE BUS TO SCENE          BUS#:__________________            TIME: _____________
________ RE-ROUTE OTHER BUSES AWAY FROM SCENE                                                    TIME:______________
 

COMMENTS / NOTES:_________________________________________________________________________________

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DISPATCH SIGNATURE:_______________________________________________________________________________