N.Y. Comp. Codes R. & Regs. tit. 17, § 990.20
(a) Appendix A.
NYS PUBLIC TRANSPORTATION SAFETY BOARD RAIL TRANSIT OPERATOR ACCIDENT REPORT
PROPERTY NAME:
ACCIDENT DATE _ / _ / _ TIME OF ACCIDENT ____
ACCIDENT CRITERIA: _ COLLISION _ GRADE CROSSING _ DERAILMENT
_ EVACUATION _ MULTIPLE INJURY _ FATALITY
LOCATION OF ACCIDENT:
LINE LANDMARK CITY COUNTY
TRAIN OPERATOR INFORMATION:
NAME: __________ DOB: _ / _/ _
TRAIN VEHICLE INFORMATION:
TRAIN # _______ CAR OR ENGINE # ________
OTHER VEHICLE INFORMATION:
YEAR _ MAKE/MODEL ________
WITNESS NAME, PHONE #: WITNESS NAME, PHONE #: WITNESS NAME, PHONE #: ACCIDENT DESCRIPTION: LAW ENFORCEMENT AGENCY INVESTIGATING ACCIDENT:
___________ ______ ( _ ) ____ PROPERTY OFFICIAL FILING THIS REPORT TITLE PHONE #
DATE OF REPORT: ________
(b) Appendix B.
NYS PUBLIC TRANSPORTATION SAFETY BOARD TRANSIT BUS OPERATOR ACCIDENT REPORT
PROPERTY NAME:
ACCIDENT DATE _ / _ / _ TIME OF ACCIDENT ____
ACCIDENT CRITERIA:
_ MECHANICAL FAILURE _ FIVE OR MORE INJURIES _ FATAL _ FIRE
LOCATION OF ACCIDENT:
STREET CITY
COUNTY ____________
BUS DRIVER INFORMATION:
NAME: __________ DOB: _ / _ / _
DRIVER'S LICENSE ID# _______ STATE OF REGISTRATION _______
PROPERTY VEHICLE INFORMATION:
YEAR __ MAKE/MODEL _______
# OF OCCUPANTS IN VEHICLE AT TIME OF ACCIDENT _
OTHER VEHICLE INFORMATION:
YEAR _ MAKE/MODEL ________
# OF OCCUPANTS IN VEHICLE AT TIME OF ACCIDENT _
WITNESS NAME, PHONE #: WITNESS NAME, PHONE #: WITNESS NAME, PHONE #: ACCIDENT DESCRIPTION: LAW ENFORCEMENT AGENCY INVESTIGATING ACCIDENT:
___________ ______ ( _ ) ____ PROPERTY OFFICIAL FILING THIS REPORT TITLE PHONE #
DATE OF REPORT: ________