Bus Evacuation Form

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MUSKOGEE COUNTY HEAD START
EMERGENCY BUS EVACUATION DRILL TRAINING
(This form should be kept on file for one year)
DATE__________DRILL STARTING TIME_________DRILL ENDING TIME____________
DRILL CONDUCTED BY________________________________________________________
A School bus emergency evacuation drill is to be conducted in accordance with Head Start
regulation 45 CFR 1310.21.
It is recommended that a bus evacuation drill be conducted during the first week of school, then
monthly. MCHS will do monthly drills, and immediately if a different bus is used on that route.
BUS NUMBER_______________
ROUTE IF APPLICABLE____________________
NUMBER OF STUDENT PARTICIPANTS___________
(A LIST OF STUDENT NAMES WILL BE ATTACHED TO THIS FORM)
SPECIAL NEEDS PROCEDURES_______________________________ For children
requiring individual assistance and special planning for evacuation, training will be conducted
involving the child, Para-Aide, Driver and Monitor. After this training, this child will be
included in the required evacuation training for all children.
THIS REPORT VERIFIES THAT STUDENTS (REFERRED ABOVE) RECEIVED
INSTRUCTION ON SAFE BUS RIDING PRACTICES AND EMERGENCY BUS
EVACUATION PROCEDURES AS REQUIRED BY 45 CFR 1310.21
School Bus Driver in Attendance___________________________________
School Bus Monitor in Attendance__________________________________
Administrators, Teachers and Others in Attendance______________________________
Comments_____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
08/2013
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