5320-E

STUDENT CONDUCT ON SCHOOL BUSES EXHIBIT

SCHOOL BUS INCIDENT REPORT

ROXBURY CENTRAL SCHOOL

Main Street Roxbury, NY 12474

Student’s Name	Student’s Address	Phone Number
School	Class/Grade	Date of Incident
Bus Driver	Bus Number	Trip	A.M. P.M.

Dear Parents: The purpose of this report is to inform you of a disciplinary incident involving the student on the school bus, which may have jeopardized the safety and well-being of all students. You are urged to both appreciate the action taken by the driver and to cooperate with the corrective action initiated today by the School District.

INFRACTION

o Improper Boarding/ o Failure to Remain Seated o Lighting Matches/Smoking on Bus

Departing Procedures o Rude. Discourteous and o Refusing to Obey Driver

o Spitting/Littering Annoying Conduct o Destruction of Property

o Bringing Articles o Fighting/Pushing/Tripping o Unnecessary Noise

Aboard Bus of o Hanging Out of Window o Tampering with Bus Equipment

Injurious or o Throwing Objects In or Out o Other Behavior Relating to Safety, Objectionable Nature of Bus Well-Being and Respect for Others

Specific Details:

o PREVIOUS WARNING o REPORTED FIRST OFFENSE

o REPORTED SECOND OFFENSE o REPORTED THIRD OFFENSE

DISCIPLINARY ACTION

Bus riding is a privilege which may be revoked. Parents are urged to appreciate the disciplinary action taken and to discuss this to prevent further occurrence.

Authorized Signature Title Date

Adoption date: May 13, 1998