Incident Incident
Date: Time: Date: Time:
Location: County: Location: County:
Violation: Violation:
Vehicle Approached From: Front Back Vehicle Approached From: Front Back
Direction Of Travel: Direction Of Travel:
Description Of Driver: Male Female Description Of Driver: Male Female
Other Details: Other Details:
Vehicle Description Vehicle Description
License Plate Number: License Plate Number:
Make: Model: Color: Make: Model: Color:
Description of Driver: Description of Driver:
Bus Information Bus Information
Driver's Name: Driver's Name:
Bus Number: School District: Bus Number: School District:
On Bus Video of Incident: Yes No On Bus Video of Incident: Yes No
Driver's Signature: Driver's Signature:
Phone Number: Phone Number:
Original document
This is an accessible HTML version. The original PDF is available for download: SHP-459 School Bus Stop Arm Violation Incident Report.pdf.