Brown County > Form > School Bus Incident Report Form

Date of Violation:

Time of Violation:

Day of week:

Violator's License Plate Number:

State of Violator's License Plate (i.e. Wisconsin, Michigan, etc):

Vehicle Color:

Vehicle Type:

Vehicle Make:

Vehicle Model:

Happened ON Street:

# Feet to cross street:

Direction to Cross Street:

Cross Street:

Driver Sex:

	Female
	Male
	Other
	Unknown

Driver Race:

Approximate age of driver:

Driver hair color:

Was the school bus stopped:

	Yes
	No

Were the school bus lights activated at least 100 feet before stopping the bus:

	Yes
	No

Do you think the passing vehicle had enough time and distance to stop 20 feet from you after you had stopped:

	Yes
	No

Was the stop arm activated:

	Yes
	No

Speed limit on the roadway:

Approximate speed of the vehicle:

Did driver indicate in any way that he/she saw the bus:

	Yes
	No
	Unsure

If yes, explain:

Did vehicle slow while approaching the bus:

	Yes
	No

Direction of Travel of the bus:

Direction of travel of passing vehicle:

Highway Type:

	Divided
	Not Divided

Total number of lanes on roadway:

	2
	4

Weather Conditions:

Road conditions:

Light conditions:

	Day
	Night

Traffic conditions:

	Light
	Heavy

Were school bus flashing lights ans stop arm checked and working properly before and after the incident:

	Yes
	No

Describe in detail the incident as it occured:

Bus company name:

Bus company code. This code was given to each bus company to assure that he submitted report is from a valid driver. Get this code from your bus company:

By entering my name on this form I am verifying that I am the witnessing bus driver and that the information that I am presenting is voluntarily given, is true and correct to the best of my knowledge.

Bus driver's full legal name:

Bus driver contact phone number:

Date and time of online report:

Contact email:

To complete this process, fax a diagram drawn on the bus company letterhead to the Sheriff's Office at: 920-448-4387

Be sure to note date and time of the violation:

	fax sent
	fax pending