TRANSPORTATION PLAN

Document Sample
TRANSPORTATION PLAN Powered By Docstoc
					  Sample School Transportation Form


  Facility Name: ABC Learning Center______________________________ Phone #: 770-123-4567________Driver Name: Betty Smith
         Pick-up Location & Time     Delivery Location & Time Person to Receive Child        Staff Responsible for Checklist: Betty Smith
  AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am     School Staff                ____________________________
  PM Eastside Elementary 3:00 pm     ABC Learning Center 3:10 pm Center Staff                  Week of: 8/1/12 – 8/5/12
                                                                                                                                                                                                                        Driver and staff
                                                                                                                                                                                                                            person
                                    School Transportation Plan                                                       Mark for each child:                                                                                 responsible
                                                                                                                                                                                                                             names
      Identifying information
                                            (use one form per school)                                   X= Load/Unload                      A= Absent
      for drop off and pick up
      locations and times here                                                                       MON      TUES          WED           THURS                                                   FRI
                                                                                                 AM         PM       AM          PM       AM          PM         AM          PM             AM            PM

                                        Child’s First and Last Name                              L U L U L U L U L U L                                  U      L        U   L       U L U L                  U
                                 Hayden Hicks                                                    X    X   X   X    X       X   A   A    X    X    X     X      A        A   A       A     X     X     X       X
                                 Camryn Jones                                                    X    X   X   X    A       A   X   X    X    X    X     X      X        X   X       X     X     X     X       X
                                 Travis Mitchel                                                  A    A   A   A    X       X   X   X    X    X    X     X      X        X   X       X     X     X     X       X
          Transported
                                 Bella Lewis                                                     X    X   X   X    X       X   X   X    A    A    X     X      X        X   X       X     X     X     X       X        Check on and off
         children listed                                                                                                                                                                                               of vehicle here.
       here (first and last                                                                                                                                                                                            Make sure nothing
             names)                                                                                                                                                                                                    is left blank

                       Departure       Staff      Arrival      Staff      Return       Staff          FIRST CHECK                    SECOND CHECK                      If applicable,                If applicable,          Name of Person
                         Time:        initials     Time       initials    Time:       initials          Signature of             If NO ALARM Signature             signature of staff who           name of person           Checklist turned
                                                                                                     staff on vehicle-no         of staff not on vehicle -no         reported by phone                reported to:                in to:
                                                                                                          child left:                     child left:              that vehicle checked:
MON         AM        7:00 am         BS          7:10 am     BS         7:20 am      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
            PM        2:50 pm         BS          3:00 pm     BS         3:10 pm      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
TUE         AM        7:00 am         BS          7:10 am     BS         7:20 am      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
            PM        2:50 pm         BS          3:00 pm     BS         3:10 pm      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
WED         AM        7:00 am         BS          7:10 am     BS         7:20 am      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
            PM        2:50 pm         BS          3:00 pm     BS         3:10 pm      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
THU         AM        7:00 am         BS          7:10 am     BS         7:20 am      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
            PM        2:50 pm         BS          3:00 pm     BS         3:10 pm      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
FRI         AM        7:00 am         BS          7:10 am     BS         7:20 am      BS         Betty     Smith               Laura Waters                                                                                  Patsy Collins
            PM        2:50 pm         BS          3:00 pm     BS         3:10 pm      BS         Betty     Smith                                                   Betty Smith                    Patsy Collins              Patsy Collins
                              Departure (when vehicle
                              leaves center), arrival (at                                              Signature of person on            If no alarm, signature of              If additional staff not available at
                              locations), and return (to                 Initial each time                                                                                                                                     Identified person
                                                                                                       vehicle who has checked           second person not on vehicle           facility upon return, signature of
                              center) times listed for each              verifying                                                                                                                                             to whom checklist
                                                                                                       vehicle to ensure all             who has checked vehicle to             staff who reported by phone and
                                                                         confirmation of time                                                                                                                                  turned in to
                              trip                                                                     children are off                  ensure all children are off            staff person reported to

  Sample Dated 9/1/12

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:2
posted:11/6/2012
language:Unknown
pages:1