DATE OF ACCIDENT:_____________________  LOCATION:______________________________________________________
 
BUS DRIVER NAME:______________________________________
 
BUS #:________________  INTERNAL FILE NUMBER:____________________________________________
 
ENCLOSURES:
 
___ DISPATCH ACCIDENT LOG
___ ACCIDENT SCENE CHECKLIST
___ PASSENGER POSITION CHART
___ PASSENGER INJURY LIST
___ WITNESS STATEMENTS
___ FIELD SKETCH
___ FIELD NOTES
___ NEGATIVES
___ VIDEOTAPE (IF STORED SEPARATELY NOTE WHERE:______________________)
___ NEWSPAPER REPORTS
___ TV NEWS ON VIDEOTAPE  (STORED:______________________________________)
___ POLICE  REPORT (REPORT #:_____________________________________________)
___ BUS MAINTENANCE RECORDS
___ ROUTE SHEET
___ TACOGRAPH
___ CORRESPONDENCE REGARDING ACCIDENT
___ PREVENTABILITY / CONTRIBUTING FACTORS DETERMINATION
___ RE-TRAINING RECORD
___ OTHER PHYSICAL EVIDENCE (DESCRIBE:__________________________________)                                                                                                                 (STORED:____________________________________)
___ OTHER ITEMS (DESCRIBE:_________________________________________________)   
 
Individual responsible for this file and all physical evidence:
 
Name:_________________________________  Position:________________________________
Does any other person have access?  Yes /No  Who?______________________________
Signed:________________________________  Date:____________________________________