eLaws | eCases | State of New York |
 New York Codes Rules Regulations (Last Updated: March 27,2024)
 TITLE 17. Department of Transportation
 Chapter VI. Transportation Regulations
 Subchapter H. State Public Transportation Safety Board
 Part 990. State Public Transportation Safety Board

  Sec. 990.20. Appendixes

Latest version.
  • (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: ________