Notification of Bus Incident Bus Safety Act 2009 (Vic), Bus Safety Regulations 2010 (Vic) Obligation to report incidents Under section 65 of the Bus Safety Act 2009 (Vic), accredited and registered bus operators must notify the Safety Director of prescribed bus incidents in accordance with the Bus Safety Regulations 2010 (Vic). Failure to do so attracts a penalty of 50 penalty units. If you have not done so already, the first step in reporting an incident is to contact the Transport Safety Victoria duty officer by telephone on 1800 301 151. Name of bus operator (required) Accreditation/Registration number (required) What happened? Provide a description of events leading up to the incident and the incident itself. (required) Maximum 1,000 characters Vehicle registration number (required) When did the incident happen? (required) Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJunJulAugSepOctNovDec Year 20162017 Hour 000102030405060708091011121314151617181920212223 Minute 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 If the incident relates to a positive drug or alcohol reading as a result of a random check by the bus operator, go to question 12 Where was the bus travelling from? Where was the bus travelling to? What services attended? Ambulance Police Fire brigade Other (specify) Please specify other services: What type of incident was it? Collision Bicycle Bus Car Infrastructure Motorbike Person/s Tram Train Truck Other (specify) Please specify other collision type: Slip, trip or fall Alleged assault Implosion, explosion or fire Security, theft or threat Mechanical failure Object thrown at the bus Failure to comply with legislative requirements, vehicle specifications, bus standards or codes of practice Divergence from the highway (highway means road or road related area) Other (specify) Please specify other incident type: Type of bus service (tick appropriate box) Commercial bus service Route Tour and charter Courtesy bus service Demand responsive Commercial minibus service Route Tour and charter Demand responsive Community and private bus service for or in connection with the activities of Educational body Religious body Sporting body Philanthropic body Social body Welfare body Health body Local Hire and drive Non-commercial courtesy Courtesy using a 10, 11 or 12 seat bus Where did the incident happen? (Location, including building number, street name and suburb/town as applicable) Were any persons killed or seriously injured as a result of the incident? No Yes Please provide details below (enter numbers in the correspondent boxes): Fatalities Number of Adult Child (under 18) Unknown Employees Fatalities - Adult - Employees Passengers Fatalities - Adult - Passengers Fatalities - Child - Passengers Fatalities - Unknown - Passengers Others Fatalities - Adult - Other Fatalities - Child - Others Fatalities - Unknown - Others Serious injuries Number of Adult Child (under 18) Unknown Employees Injuries - Adult - Employees Passengers Injuries - Adult - Passengers Injuries - Child - Passengers Injuries - Unknown - Passengers Others Injuries - Adult - Others Injuries - Child - Others Injuries - Unknown - Others Was there a loss of control of the bus or significant damage to property? No Yes Specify the details (choose which applies) Loss of control of bus Significant damage to property Was an alcohol and/or drug test conducted on the driver/employee? No Yes Alcohol result Negative Positive Drugs result Negative Positive Has or will the bus operator convene an investigation into the incident? No Yes Acknowledgment By completing this section, I acknowledge that (tick both boxes below): (required) The information provided in this notification is true and correct; and I understand it is an offence under section 66 of the Bus Safety Act 2009 (Vic) to provide any false or misleading information and that penalties apply. Name (required) Position title (required) Contact number (required) Contact email (required) In case the contact name for further inquiries from TSV is not the same as above, complete the section below: Alternative contact name Alternative contact number Save and exit You can save your responses and return to the form later to finish it off. Enter your email in the box below and click Save and Exit. An email will be sent which will allow you to return to this form later to finish off your answers. Save and Exit Email What happens next? You may be required to provide more information. If this is the case, TSV will contact you. Transport Safety Victoria contact details Incident telephone 1800 301 151 PO Box 2797 Melbourne VIC 3001 121 Exhibition Street, Melbourne VIC 3000 Fax 03 9655 6611 Email firstname.lastname@example.org Website transportsafety.vic.gov.au Disclaimers Transport Safety Victoria (TSV) collects and holds the personal information provided in this application to assist the Director, Transport Safety (Safety Director) to administer the Bus Safety Act 2009 (Vic) and Bus Safety Regulations 2010 (Vic). TSV is committed to protecting personal information in accordance with its obligations under the Bus Safety Act 2009 (Vic). The personal information provided in this report may be disclosed to other government agencies in accordance with the Bus Safety Act 2009 (Vic) and the Transport Integration Act 2010 (Vic). It is an offence under the Bus Safety Act 2009 (Vic) to give information that is false or misleading in relation to a report. The individuals whose personal information is collected on this report have a right to seek access to this personal information and to seek correction of any error in the personal information held. All individuals whose personal information is included with this report should be informed of this fact. For more information on privacy please refer to TSV's privacy statement at transportsafety.vic.gov.au/privacy.