325 WEST GAINES STREET
    ROOM 1114
    TALLAHASSEE, FLORIDA 32399-0400
    (850) 488-4405
    FAX (850) 487-8608
    www.myfloridaeducation.com
     
     
    An affirmative action/equal opportunity employer
     
     
     
    Charlie Crist
     
       
      
     
      
      
     
      
      
    Commissioner
      
     
     
    October
    31
    , 2002
     
     
    M E M O R A N D U M
     
    TO: School District
    Transportation Directors
     
    FROM: Herman Carter, Senior Transportation Specialist
     
    School Transportation Management Section
     
    SUBJECT: School Bus Accident Reporting Form (ESE 256)
     
    Rule 6-3.017(9)(b)1, FAC. requires that an accident report be filed with the Department of
    Education after each accident involving a school bus that includes injuries, fatalities, or vehicle
    damages of $500 or more for all vehicles. We are working to establish an automated reporting
    system for school bus accidents. Until that process is implemented the usual accident reporting
    procedures will be followed.
     
    An electronic copy of the School Bus Accident Report Form ESE 256 is attached.
    You are
    permitted to duplicate this form as needed for reporting school bus accidents
    . You will
    receive by mail the usual two camera-ready hard copies of this form, and we will maintain a
    small supply for emergency district requests. If you have questions please call (850) 488-4405,
    SunCom 278-4405 or email Herman.Carter@fldoe.org.
     
     
    HC
     
    Attachments
     
    FLORIDA DEPARTMENT OF EDUCATION
    DAVID A. MORRIS, CHIEF
    BUREAU OF SCHOOL BUSINESS SERVICES
     
    CHARLIE HOOD,
    ADMINISTRATOR
     
    SCHOOL TRANSPORTATION MANAGEMENT

     
    Completed form must be submitted to the
    Superintendent or his designee and returned to:
    School Transportation Management Section
    Florida Department of Education
    325 West Gaines Street, Room 1114
    Tallahassee, Florida 32399-0400
    (850) 488-4405, SunCom 278-4405
    FLORIDA DEPARTMENT OF EDUCATION
    SCHOOL TRANSPORTATION MANAGEMENT
     
     
    SCHOOL BUS ACCIDENT REPORT FORM
     
    School District: _____________________________________________ District Number: ___________________
    Bus Information: Year:
    ________ Chassis: ____________ Body: ___________________________
    Type: ________ Capacity: ____________ Bus Number:______________________
    Bus Driver Name: __________________________ Driver License Number: __________________ Age of Driver: ____
     
    …
    Male
    …
    Female School Bus Driver Charged:
    …
    Yes
    …
    No
    Day of Week: ______________________ Date: _________________ Time of Accident: ___________________
    Location of Accident: _____________________________________________________________________________
    PART I - SCHOOL BUS PHYSICALLY INVOLVED:
     
    1. Type of Accident:
    01
    …
    noncollision 06
    …
    other collision (animal,
    02
    …
    railroad train animal drawn cart, etc.)
    03
    …
    pedestrian 07
    …
    pedalcycle
    04
    …
    fixed object: (specify) __________________
    05
    …
    between motor vehicles: (specify) _________
    2A. Perceived Bodily Injury:
    Fatality
    …
    Yes
    …
    No Number ________
    Injury
    …
    Yes
    …
    No Number ________
    2B. Property Damage over $500:
     
      
    …
    Yes
    …
    No
    3. Type of Roadway (mark "X" one or more):
    01
    …
    2 lane road 05
    …
    4 or more lane road
    02
    …
    intersection 06
    …
    railroad crossing
    03
    …
    unpaved road 07
    …
    school ground
    04
    …
    private property
    4. Bus Directional Analysis (mark "X" one or more):
    01
    …
    loading or unloading 06
    …
    stopped at railroad
    02
    …
    stopped at intersection or in traffic
    03
    …
    changing lanes 07
    …
    backing
    04
    …
    turning left 08
    …
    turning right
    05
    …
    moving straight ahead 09
    …
    parked
    5A. Manner of Collision between Vehicles or Objects:
    01
    …
    angle 03
    …
    rear-end
    02
    …
    head-on 04
    …
    other
    5B. Enter First Point of Impact in the Box Below:
     
     
     
     
     
     
     
    Enter (one response only):
     
    6. Contributing Circumstances as Noted on
    Investigating Officer’s Report as Pertaining to the
    Bus:
    01
    …
    over posted speed limit
    02
    …
    passed stop sign
    03
    …
    failed to yield
    04
    …
    improper lane change
    05
    …
    improper parking
    06
    …
    improper passing
    07
    …
    defective road surface
    08
    …
    defective equipment (specify) ____________
    09
    …
    view obstructed by object (tree, fence, shrubbery,
      
    etc.)
    10
    …
    other (specify) ________________________
    11
    …
    over safe speed
    12
    …
    disregarded traffic signal
    13
    …
    drove to left of center
    14
    …
    followed too closely
    15
    …
    improper turn
    16
    …
    improper stop in roadway
    17
    …
    careless driving
     
    7. Condition of Road (mark "X" one or more):
    01
    …
    dry 04
    …
    under repair
    02
    …
    icy 05
    …
    holes or ruts
    03
    …
    slippery 06
    …
    other (specify) _____________
     
    8. Light Condition:
    01
    …
    dawn 04
    …
    dark, artificially illuminated
    02
    …
    daylight 05
    …
    dark, not artificially illuminated
    03
    …
    dusk
     
    9. Weather Conditions (mark "X" one or more):
    01
    …
    clear 04
    …
    sleeting 06
    …
    raining
    02
    …
    fog 05
    …
    dust 07
    …
    smog/smoke
    03
    …
    other (specify) ________________________
     
    10. School Bus Use At Time of Accident:
    01
    …
    regular route (specify a.m./p.m.) ___________
    02
    …
    field/activity trip
    03
    …
    exceptional student education
    04
    …
    joint-use program
    05
    …
    other use (specify) _____________________
     
    11. Was Driver's Lap Belt in Use at Time of Accident:
    01
    …
    yes 02
    …
    no
     
     
    ESE 256
    Exp. 07/31/03 DOE Page 1 of 3
    Florida Departrment of Education
     
    A
    B
    C
    D
    E
    F
    G
    H
    I
    J
    K
    L

     
    SCHOOL BUS ACCIDENT REPORT FORM
    PART II - LOADING/UNLOADING ZONE ACCIDENTS:
     
    (See Definitions)
    1.
    At the Time of the Accident the Bus was (mark "X"
    only one response):
    01
    …
    approaching the zone
    02
    …
    stopped in the zone
    03
    …
    leaving the zone
    04
    …
    not in sight
    2. Was/Were the Pupil(s):
    01
    …
    hit by bus 02
    …
    hit by other vehicle
    3. Number injured:
    Fatality
    …
    Yes
    …
    No Number ________
    Injury
    …
    Yes
    …
    No Number ________
    4. Location of injured pupil(s) when struck:
    01
    …
    on side of road
    02
    …
    on sidewalk
    03
    …
    crossing
    04
    …
    other (specify) _________________________
    _________________________________________
    _________________________________________
     
    PART III - ON-BOARD ACCIDENTS:
    (On-board accidents include pupils injured by falls,
    striking, stanchions, etc., when bus is in motion and not
    involved in other accident types specifically identified.
    Accident must be traced to a sudden movement of the
    bus.)
    Fatality
    …
    Yes
    …
    No Number ________
    Injury
    …
    Yes
    …
    No Number ________
    PART IV - DRIVER EXPERIENCE:
    1. Driver's experience driving school bus:
     
      
    …
    Less than 6 months
    …
    2 - 5 years
     
      
    …
    1 year or less
    …
    5 - 10 years
     
      
    …
    1 - 2 years
    …
    Over 10 years
    2. Did driver receive a preservice training course?
     
      
    …
    Yes
    …
    No
    3. Did driver receive an inservice training course in the
    last 12 months?
     
      
    …
    Yes
    …
    No
    4. Attach latest available DHSMV Driver History Record
    and submit with ESE 256.
     
    Please use this space to diagram the accident.
    Complete the following diagram showing direction and
    positions of vehicles involved, designating clearly the point
    of contact. (If this diagram will not serve for the accident in
    question, attach a separate sheet with illustration.) Indicate
    by arrow direction of North.
     
    INDICATE BY ARROW
    DIRECTION OF NORTH
     
     
     
     
     
     
    Written description of accident:
     
    REPORT SUBMITTED BY:
     
    ____________________________________________________________________ __________________________
    Signature of Transportation Director or Designee Date
     
    ____________________________________________________________________ __________________________
    Printed Name Position of Designee
     
    This form must be submitted to the Superintendent or his designee and returned to:
    School Transportation Management Section
    Florida Department of Education
    325 West Gaines Street, Room 1114
    Tallahassee, Florida 32399-0400
    (850) 488-4405, SunCom 278-4405
     
     
    ESE 256 DOE Page 2 of 3

     
    SCHOOL BUS ACCIDENT REPORT FORM
     
    INSTRUCTIONS
    Purpose:
    To compile accurate, uniform, and reliable information about school bus accidents so that problems and trends can
    be identified and needed safety programs can be developed.
    Who should fill out this form:
    The Transportation Director or designee.
    This form should be filled out WHETHER STUDENTS ARE PRESENT OR NOT if the accident you are reporting involves
    property damage of $500.00 or more or personal injury or fatality to:
    a. occupants in the bus (pupils, driver, or other persons);
    b. occupants of any other vehicle(s) involved in the accident;
    c. nonoccupants of the school bus or other vehicle (e.g., students in the loading or unloading zone, pedestrian
    bystanders, etc.).
    DEFINITIONS
    Accident
    That occurrence in a sequence of events which usually produces unintended injury, death or property damage.
    District Number
    This number should be the district number.
    School Bus
    A bus that is sold, or introduced in interstate commerce, for purposes that include carrying students to and from
    school or related events, but does not include a bus designated and sold for operation as a common carrier in urban
    transportation (School Bus Defined in Code of Federal Regulations, Title 49, Transportation and by Section 1006.25,
    Florida Statutes).
    There are four types of school buses:
    TYPE A -- A conversion or body constructed and installed upon a van-type compact truck or front-section vehicle,
    with a gross weight rating of 10,000 pounds or less, designed for carrying more than 10 persons.
    TYPE B -- A conversion or body constructed and installed upon a van or front-section chassis, or stripped chassis,
    with a vehicle weight rating of more than 10,000 pounds, designed for carrying more than 10 persons.
    Part of the engine is beneath and/or behind the windshield and beside the driver's seat. The entrance
    door is behind the front wheel.
    TYPE C -- A body installed upon a flat back cowl chassis with a gross vehicle weight rating of more than 10,000
    pounds, designed for carrying more than 10 persons. All of the engine is in front of the windshield and the
    entrance door is behind the front wheels.
    TYPE D -- A body installed upon a chassis, with the engine mounted in the front, midship, or rear, with a gross
    vehicle weight of more than 10,000 pounds, designed for carrying more than 10 persons. The engine may
    be behind the windshield and beside the driver's seat; it may be at the rear of the bus, behind the rear
    wheels, or midship between the front and rear axles. The entrance door is ahead of the front wheels.
    Bus Number
    This number should be the number painted on the front, back, or side of the bus.
    Driver Information
    The person driving the school bus and his/her driver's license number. All license numbers should have 12 or 13
    characters; 1 alpha followed by 11 or 12 numerals.
    Intersection
    An area which (1) contains a crossing or connection of two or more roadways not classified as driveway access and
    (2) is embraced with the prolongation of the lateral curb lines or, if none, the lateral boundary lines of the roadways.
    Where the distance along a roadway between two areas meeting these criteria is less than 10 meters (33 feet), the
    two areas and the roadway connecting them are considered to be parts of a single intersection. (Classification of
    Motor Vehicle Traffic Accidents, ANSI D16.1, American National Standards Institute.)
    Loading and Unloading Zone
    Any place the school bus stops to load or unload pupil passengers.
    Pupil
    A person who attends an educational institution.
    On Board Accidents
    Anytime injuries occur when the bus is in motion and not involved in other accident types specifically identified.
    ESE 256 DOE Page 3 of 3

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