Form Mv-104f.1 - Accident Report For School Vehicles Transporting Pupils/teachers/supervisors

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ACCIDENT REPORT FOR SCHOOL VEHICLES
TRANSPORTING PUPILS/TEACHERS/SUPERVISORS
Continuation Sheet
Page _______ of _______ Pages
Accident Date (Month/Day/Year) County of Accident
Last Name of School Bus Driver
First
M.I.
School Bus Plate Number
ALL PERSONS INJURED OR KILLED
INJURY SECTION
Provide Information for Every Person Injured or Killed in Accident (Continued from MV-104F)
Check proper column(s).See instruction 7 on Page 6.
If Deceased, Enter
Which
Safety
Seated/
Name of All Persons Injured or Killed
Describe Injuries
Veh. Occ.
Equip. Used
Age
Sex
Standing
A
B
C
Date of Death
ATTACH TO COPY 1 OF FORM MV-104F
ACCIDENT REPORT FOR SCHOOL VEHICLES TRANSPORTING
PUPILS/TEACHERS/SUPERVISORS.
MV-104F.1 (6/17)

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