Preliminary Accident/Incident Report

	Employee Name:*

	Date:*
	mm/dd/yyyy

	Time:

	Day of Week:

	Bus Number:*

	Route Number:*

	Address:

	Zip Code:

	City:

	Type of Trip:
	--None--Normal RunLate RunField TripAthletic Trip

	Time Reported to Dispatch:

	Dispatcher Name:

	PERSONS CONTACTED BY DISPATCH

	Persons Contacted by Dispatch:
	Person Contacted   Time Contacted Responding Supervisor     Atlanta Police - 911     School     School Telephone Number     School Detectives -(404)802-2000     Transportation Asst. Director (Kelvin Curtiss x5515)     Transportation Asst. Director (Luther Evans x5524)     Transportation Asst. Director (Jessie Lovelace x5509)     Transportation Director (John Lyles -(706)527-2712)     Safety Director (Marquenta Sands / Asst. Clarence Jones x2522)     APS Communications Dept.     Deputy Superintendent (Larry Hoskins / Asst. Yvonne Spyres x2503)     Risk Management - Fleet Management (Marcellus Jones x2326)

	REPORT FILINGS

	Report filed with Charlotte Partridge?
	Report filed with Charlotte Partridge? YesNo

	Date Filed:
	mm/dd/yyyy

	Preliminary Accident Report Copy Retained in Dispatch by: Dispatcher name retaining report

	Date Dispatch Received Copy:
	mm/dd/yyyy