Preliminary Accident/Incident Report
INITIAL INFORMATION
Employee Name:
*
Date:
*
mm/dd/yyyy
Time:
Day of Week:
Bus Number:
*
Route Number:
*
Address:
Zip Code:
City:
Type of Trip:
--None--
Normal Run
Late Run
Field Trip
Athletic 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?
Yes
No
Date Filed:
mm/dd/yyyy
Preliminary Accident Report Copy Retained in Dispatch by:
Dispatcher name retaining report
Date Dispatch Received Copy:
mm/dd/yyyy