3541.35 Appendix 3541.35 AppendixNew Hartford Public Schools
New Hartford, Connecticut
BUS CONDUCT REPORT
Student: ___________________________________ Driver: ______________________________
School: ___________________________________ Contractor: ___________________________
Date of Incident: ____________________________ ___a.m. ___p.m. Phone: ________________
Date of Referral: ___________________________ Best time to call driver: _________________
_____Fighting _____Failure to remain seated _____Failure to sit in assigned seat
_____Smoking _____Refused to identify self _____Unsafe boarding, exit or crossing
_____Damage to bus _____Throwing things on bus _____Failure to exit at assigned stop
_____Disobeying driver _____Eating/drinking on bus _____Interfering with safe bus operation
_____Littering _____Hands/objects out of window _____Loud noises (shouting, screaming)
_____Carrying Weapons _____Causing problem at bus stop _____Complaint by other student
_____Offensive or vulgar language ______Riding other than assigned bus
_____Rude or disrespectful behavior _____Failure to respect other’s rights
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Please fill in all details of incidents. Include past history.
First Offense_____ Second Offense______ Third Offense_____
Details of incident:________________________________________________________________
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Action taken by driver: ___________________________________________________________
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Action taken by school (to be completed by school official handling the case) and returned by mail to the contractor.
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School Official Signature ____________________________________ Date __________________