325 WEST GAINES STREET
●
ROOM 1114
●
TALLAHASSEE, FLORIDA 32399-0400
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(850) 488-4405
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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
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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