Notification of Bus Incident by Operator Bus Safety Act 2009 (Vic), Bus Safety Regulations 2020 (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 2020 (Vic). Failure to do so attracts a penalty of 50 penalty units. This form is to be used to notify incident under Category 1 and 2 and must be completed within 72 hours of the incident. Note: For category 1 incidents, the first step in reporting an incident is to contact the Transport Safety Victoria duty officer by telephone on 1800 301 151. What category of incident are you reporting? (required) Category 1 Category 2 Accredited/registered operator number (required) Name of bus operator (required) When did the incident happen? (required) Day Month Year Hour Minute Verbal notification date, time and name of TSV officer? Day Month Year Hour Minute Where did the incident happen? (Location, including building number, street name and suburb/town as applicable) Where was the bus travelling from? Where was the bus travelling to? What type of incident was it? (tick appropriate box(es)) Collision Bicycle Bus Car Infrastructure Motorbike Person Tram Train Truck Other (specify) Please specify other collision type: Alleged assault Alleged drug/alcohol affected driver Alleged drug/alcohol affected passenger Anti-social behaviour to driver Breach of road rules by driver Child left on bus Divergence from the highway (highway means road or road related area) Implosion, explosion or fire Injury to employee other than driver Medical episode driver/passenger Mechanical failure Object thrown at the bus Rear door boarding Roll-away Slip, trip or fall Security, theft or threat Other (specify) Please specify other incident type: Was there a loss of control of the bus? No Yes Was there damage to property? Major Minor None Type of bus service (tick appropriate box(es)) Commercial bus service (specify): Route Courtesy School bus Local Tour and charter Demand responsive V/Line Rail replacement Commercial minibus service Route Tour and charter Demand responsive Community and private bus service for or in connection with the activities of Educational body Philanthropic body Health body Religious body Social body Sporting body Welfare body Rail replacement Local Hire and drive Non-commercial courtesy Courtesy using a 10, 11 or 12 seat bus Vehicle registration number (required) Route number (if applicable) What services attended? None Ambulance Taken to hospital Yes No Police Fire brigade Other (specify) Please specify other services: Did the incident result in any of the following? (type the number in the appropriate box) Fatalities Serious injuries Minor injuries N/A Was an alcohol and/or drug test conducted on the driver/employee? No Yes If Yes, what were they tested for and what was the result? Alcohol Negative Positive Drugs Negative Positive What happened? Provide a description of events leading up to the incident and the incident itself. (required) 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 What happens next? You may be required to provide more information. If this is the case, TSV will contact you. Contact the incident team Incident telephone 1800 301 151 Email email@example.com 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.