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Bus Safety Report
1. (School District)
SCHOOL BUS CONDUCT REPORT
DEAR PARENT OR GUARDIAN:
THE PURPOSE OF THIS REPORT IS TO INFORM YOU OF AN INCIDENT INVOLVING YOUR CHILD’S CONDUCT ON THE SCHOOL BUS. WE URGE YOU TO
REVIEW THIS FORM CLOSELY AND APPRECIATE THE ACTION TAKEN BY THE DRIVER TO ASSURE THE SAFETY AND WELL BEING OF ALL STUDENTS.
PLEASE CONTACT US IF YOU HAVE ANY QUESTIONS AND SIGN THIS FORM ON THE LINE INDICATED. YOUR CHILD WILL NEED TO RETURN THE
SIGNED FORM TO THE DRIVER IN ORDER TO RIDE THE BUS. WITH YOUR HELP, WE ARE CONFIDENT THAT WE CAN HELP YOUR CHILD LEARN FROM
THIS EXPERIENCE AND MAINTAIN A SAFE RIDE FOR EVERYONE.
TRANSPORTATION DEPARTMENT STAFF – (Area Code) (Phone Number)
STUDENT’S
NAME:___________________________________________SCHOOL:_______________________________________GRADE______________________
DATE:___________________________________________BUS#:_____________________DRIVER:___________________________________________
THE FOLLOWING SAFETY RULES (circled) HAVE NOT BEEN FOLLOWED AND HAVE CREATED UNSAFE CONDITIONS
ON THE BUS.
Students;
1. who are not at assigned bus stop on time. (1)
2. who litter on the school bus. (1)
3. who bring glass containers/objects on the bus. (1)
4. who fail to stay off the roadway and use proper boarding/departing procedures. (2)
5. who fail to get on or off at the designated stop. (2)
6. who make unnecessary loud, boisterous sounds, yell, are rude, discourteous or annoying. (2)
7. who fail to remain seated and facing forward at all times except when moving to and from the jump seat. (2)
8. who eat/drink on the bus without the driver’s permission. (2)
9. who threaten others. (3)
10. who cross in back of the bus instead of the front. (3)
11. who have part(s) of their body hanging out of the windows. (3)
12. who use improper language/profanity/gestures. (3)
13. who throw objects in, at or out of the bus. (3)
14. who engage in behavior that abuses the safety, well being and respect of others on the bus or at the bus stop. (3)
15. who push/trip/kick/hit.(3)
16. who disobey instructions of and/or show disrespect to the driver. (4)
17. who spit or bite. (7)
18. who bring illegal/dangerous articles/substances and or weapons on the bus. (7-17)
19. who light matches, uses lighters or possess or use tobacco products. (7-17)
20. who destroy property. (7-17)
21. who tamper with bus equipment. (7-17)
22. who engage in sexual misconduct/harassment. (7-17)
23. who fight or engage in violent behavior. (7-17)
24. who threaten another person with bodily harm. (7-17)
25. who assault another person. (10-17)
26. whose behavior requires the bus driver to pull the bus over in order to preserve safety (will automatically be suspended for 10 days).
27. Other_______________________________________________________________________________________________________________________
Details_____________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
0-2 points – Warning POINTS RECEIVED ______________
3-5 points - One-day Suspension
6-8 points - Three-day Suspension SUSPENSION NOTICE ______________
9-16 points - Five-day Suspension #OF DAYS OFF BUS ______________
17-20 points - Ten-day Suspension RETURN DATE ______________
21-39 points - Suspension for 90 school days *
40+ points - Suspension for 180 school days * ACCUMULATED POINTS ______________
NOTE: 3 TO 10 DAY SUSPENSIONS MAY RESULT IN MANDATORY PARENT MEETING.
*School Board hearing necessary for reinstatement of bus privileges
DRIVER CONTACTED PARENT DATE________________TIME________________
WHEN YOUR CHILD IS SUSPENDED, HE/SHE MAY NOT RIDE ANY OTHER BUS. BUS RIDING IS A PRIVILEGE, WHICH MAY BE
REVOKED. PLEASE HELP YOUR CHILD APPRECIATE THE IMPORTANCE OF THEIR BEHAVIOR AND THEIR IMPACT ON SAFETY
TO PREVENT A FURTHER OCCURRENCE.
X_____________________________________________X_________________________________X________________________________
PARENT SIGNATURE DRIVER SIGNATURE SUPERVISOR SIGNATURE
WHITE COPY: TRANSPORTATION DEPARTMENT PINK COPY: PARENT COPY YELLOW COPY: SCHOOL COPY