Provider Transportation Webinar (PDF) - Bright from the Start

Transportation
Webinar
Presented by:
Jennifer Bridgeman & Rhonda Parker
Child Care Services Regional Directors

Goals for tonight’s
webinar….
• Become familiar with the Department’s transportation
forms.
• Review and understand how to complete the
transportation checklists.
• Become knowledgeable of changes to requirements when
transporting children on field trips.
Bright from the Start: Georgia Department of Early Care and Learning
Page 2

When transportation rules
are applicable
• 591-1-1-.36(1)(a) Transportation rules apply to all
transportation provided by the licensee or any
person on behalf of the licensee.
▪ Includes:
• Whether or not a fee is charged
• Whether an outside company or another licensed
facility has been contracted to provide
transportation
• Whether another location/site operated by the
same owner provides the transportation
• Whether transportation is routine or non-routine
Bright from the Start: Georgia Department of Early Care and Learning
Page 3

Transportation Rules
• Common Transportation rule violations that
result in enforcement fines:
▪ Not accounting for the loading and unloading of children
on the vehicle
▪ Not documenting and verifying the check of the vehicle to
ensure that all children have gotten off
▪ Ensuring that children are not left unattended on vehicles
or released off the vehicle, when no one is available to
take the child
▪ Not utilizing paperwork to document transportation
provided
Bright from the Start: Georgia Department of Early Care and Learning
Page 4

Types of Vehicles in
Programs
Vehicles without an
alarm
Bright from the Start: Georgia Department of Early Care and Learning
Vehicles with an
alarm
Page 5

School Transportation Form:
*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
MON AM 7:00 am BS
PM
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X
Camryn Jones X
Staff
initials
Arrival
Time
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
Page 6

*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X X
Camryn Jones X X
Staff
initials
Arrival
Time
MON AM 7:00 am BS 7:15 am BS
PM
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
Page 7

*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X X
Camryn Jones X X
Staff
initials
Arrival
Time
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
MON AM 7:00 am BS 7:15 am BS 7:30 am BS Betty Smith
PM
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
Page 8

*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X X
Camryn Jones X X
Staff
initials
Arrival
Time
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
MON AM 7:00 am BS 7:15 am BS 7:30 am BS Betty Smith Laura Waters Patsy Collins
PM
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
Page 9

*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X X
Camryn Jones X X
Staff
initials
Arrival
Time
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
MON AM 7:00 am BS 7:15 am BS 7:30 am BS Betty Smith Laura Waters Patsy Collins
PM 2:30 pm BS
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
Page 10

*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X X A
Camryn Jones X X X
Staff
initials
Arrival
Time
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
MON AM 7:00 am BS 7:15 am BS 7:30 am BS Betty Smith Laura Waters Patsy Collins
PM 2:30 pm BS 2:35 pm BS
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
Page 11

*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X X A A
Camryn Jones X X X X
Staff
initials
Arrival
Time
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
MON AM 7:00 am BS 7:15 am BS 7:30 am BS Betty Smith Laura Waters Patsy Collins
PM 2:30 pm BS 2:35 pm BS 3:00 pm BS Betty SMith
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
Page 12

*New form completed for each route 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
AM ABC Learning Center 7:00 am Eastside Elementary 7:10 am School Staff
PM Eastside Elementary 2:30 pm ABC Learning Center 3:00 pm Center Staff Week of: 4/29/13 – 5/3/13
Vehicle has child safety alarm device: ____ YES _X___NO
Departure
Time:
School Transportation Plan
(use one form per school)
Child’s First & Last Name
Type of
Restraint
Seatbelt =S
Car Seat = C
Booster =B
Hayden Hicks X X A A
Camryn Jones X X X X
Staff
initials
Arrival
Time
Staff
initials
Return
Time:
Staff
initials
Bright from the Start: Georgia Department of Early Care and Learning
Mark for each child:
√= Load/Unload A= Absent
MON TUES WED THURS FRI
AM PM AM PM AM PM AM PM AM PM
L U L U L U L U L U L U L U L U L U L U
FIRST CHECK
Signature of
staff on vehicle-no
child left:
SECOND CHECK
If NO ALARM Signature
of staff not on vehicle -no
child left:
Staff Responsible for Checklist: Betty Smith
____________________________
If applicable,
signature of staff who
reported by phone
that vehicle checked:
If applicable,
name of person
reported to:
Name of Person
Checklist turned
in to:
MON AM 7:00 am BS 7:15 am BS 7:30 am BS Betty Smith Laura Waters Patsy Collins
PM 2:30 pm BS 2:35 pm BS 3:00 pm BS Betty SMith Laura Waters Patsy Collins
TUE AM
PM
WED AM
PM
THU AM
PM
FRI AM
PM
Page 13

Transportation Forms:
School Transportation
Bright from the Start: Georgia Department of Early Care and Learning
Page 14

Field Trip Form for vehicles with No
Alarm.
Field Trip Form:
Bright from the Start: Georgia Department of Early Care and Learning
Field Trip Form
Center Name: ABC Learning Center Center Phone Number: __770-123-4567______________
Date of Field Trip ___5-2-13_________________ Departure Time 9:00 AM/PM Estimated Return Time 2:00 AM/PM
Field Trip Location Memorial Library Address (Street, City, Zip Code)_1234 Peachtree Street, Atlanta, GA 30034____________
Person on vehicle responsible for
Name of Driver Betty Smith Name of Staff Person Responsible for Checklist ____Tara Ross_________________________
checklist
Vehicle Tag Number ___APK178___________________Vehicle has child safety alarm device _____ YES _X___NO
Names of Other Adults Attending Trip____Shamonica Warren_______________________ ______________________________________
IF YOUR CHILD HAS PERMISSION TO ATTEND THIS
FIELD TRIP, PLEASE SIGN AND DATE BELOW.
Times
NOTE ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW.
THEN CHECK ON AND OFF FOR EACH CHILD.
9:00 a.m.
AM / PM AM / PM AM / PM AM / PM AM / PM AM / PM
Restraint Types: Seatbelt = S, Car Seat = C, Booster = B
Initials
TR
Child’s First & Last Name Parent’s Signature Date Restraint
Type ON OFF ON OFF ON OFF
Bobbie Mitchell Barber Mitchell 4-29-13 X
Leslie Warren Cassandra Warren 4-29-13 X
Rachel Thorton Kristie Thorton 4-30-13 X
Riley Thorton Kristie Thorton 4-30-13 X
Jessica Barber Marilyn Barber 5-1-13 X
Justin Register Lauren Register 5-1-13 X
FIRST CHECK: SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING VEHICLE
CHECKED AND NO CHILD LEFT ON VEHICLE AT EACH STOP
SECOND CHECK: SIGNATURE OF STAFF PERSON NOT ON THE VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE
DESIGNATED PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON
VEHICLE.
NAME OF PERSON REPORTED TO:
1. NAME OF PERSON
2.
3.
CHECKLIST
TURNED IN TO:
Page 15

Field Trip Form for vehicles with No
Alarm.
Bright from the Start: Georgia Department of Early Care and Learning
Field Trip Form
Center Name: ABC Learning Center Center Phone Number: __770-123-4567______________
Date of Field Trip ___5-2-13_________________ Departure Time 9:00 AM/PM Estimated Return Time 2:00 AM/PM
Field Trip Location Memorial Library Address (Street, City, Zip Code)_1234 Peachtree Street, Atlanta, GA 30034____________
Person on vehicle responsible for
Name of Driver Betty Smith Name of Staff Person Responsible for Checklist ____Tara Ross_________________________
checklist
Vehicle Tag Number ___APK178___________________Vehicle has child safety alarm device _____ YES _X___NO
Names of Other Adults Attending Trip____Shamonica Warren_______________________ ______________________________________
IF YOUR CHILD HAS PERMISSION TO ATTEND THIS
FIELD TRIP, PLEASE SIGN AND DATE BELOW.
NOTE ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW.
THEN CHECK ON AND OFF FOR EACH CHILD.
9:00 a.m.
AM / PM
9:30 a.m
AM / PM
Restraint Types: Seatbelt = S, Car Seat = C, Booster = B
Times
Initials
TR TR
AM / PM AM / PM AM / PM AM / PM
Child’s First & Last Name Parent’s Signature Date Restraint
Type ON OFF ON OFF ON OFF
Bobbie Mitchell Barber Mitchell 4-29-13 X X
Leslie Warren Cassandra Warren 4-29-13 X X
Rachel Thorton Kristie Thorton 4-30-13 X X
Riley Thorton Kristie Thorton 4-30-13 X X
Jessica Barber Marilyn Barber 5-1-13 X X
Justin Register Lauren Register 5-1-13 X X
FIRST CHECK: SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING VEHICLE
CHECKED AND NO CHILD LEFT ON VEHICLE AT EACH STOP
SECOND CHECK: SIGNATURE OF STAFF PERSON NOT ON THE VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE
DESIGNATED PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON
VEHICLE.
NAME OF PERSON REPORTED TO:
Tara Ross
1. NAME OF PERSON
2.
3.
CHECKLIST
TURNED IN TO:
Page 16

Field Trip Form for vehicles with No
Alarm.
Bright from the Start: Georgia Department of Early Care and Learning
Field Trip Form
Center Name: ABC Learning Center Center Phone Number: __770-123-4567______________
Date of Field Trip ___5-2-13_________________ Departure Time 9:00 AM/PM Estimated Return Time 2:00 AM/PM
Field Trip Location Memorial Library Address (Street, City, Zip Code)_1234 Peachtree Street, Atlanta, GA 30034____________
Person on vehicle responsible for
Name of Driver Betty Smith Name of Staff Person Responsible for Checklist ____Tara Ross_________________________
checklist
Vehicle Tag Number ___APK178___________________Vehicle has child safety alarm device _____ YES _X___NO
Names of Other Adults Attending Trip____Shamonica Warren_______________________ ______________________________________
IF YOUR CHILD HAS PERMISSION TO ATTEND THIS
FIELD TRIP, PLEASE SIGN AND DATE BELOW.
NOTE ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW.
THEN CHECK ON AND OFF FOR EACH CHILD.
9:00 a.m.
AM / PM
9:30 a.m
AM / PM
Restraint Types: Seatbelt = S, Car Seat = C, Booster = B
Times
Initials
TR TR
AM / PM AM / PM AM / PM AM / PM
Child’s First & Last Name Parent’s Signature Date Restraint
Type ON OFF ON OFF ON OFF
Bobbie Mitchell Barber Mitchell 4-29-13 X X
Leslie Warren Cassandra Warren 4-29-13 X X
Rachel Thorton Kristie Thorton 4-30-13 X X
Riley Thorton Kristie Thorton 4-30-13 X X
Jessica Barber Marilyn Barber 5-1-13 X X
Justin Register Lauren Register 5-1-13 X X
FIRST CHECK: SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING VEHICLE
CHECKED AND NO CHILD LEFT ON VEHICLE AT EACH STOP
SECOND CHECK: SIGNATURE OF STAFF PERSON NOT ON THE VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE
DESIGNATED PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON
VEHICLE.
NAME OF PERSON REPORTED TO:
Tara Ross
Tara Ross
1. Patsy Collins NAME OF PERSON
2.
3.
CHECKLIST
TURNED IN TO:
Page 17

Field Trip Form for vehicles with No
Alarm.
Field Trip Form
Center Name: ABC Learning Center Center Phone Number: __770-123-4567______________
Date of Field Trip ___5-2-13_________________ Departure Time 9:00 AM/PM Estimated Return Time 2:00 AM/PM
Field Trip Location Memorial Library Address (Street, City, Zip Code)_1234 Peachtree Street, Atlanta, GA 30034____________
Person on vehicle responsible for
Name of Driver Betty Smith Name of Staff Person Responsible for Checklist ____Tara Ross_________________________
checklist
Vehicle Tag Number ___APK178___________________Vehicle has child safety alarm device _____ YES _X___NO
Names of Other Adults Attending Trip____Shamonica Warren_______________________ ______________________________________
IF YOUR CHILD HAS PERMISSION TO ATTEND THIS
FIELD TRIP, PLEASE SIGN AND DATE BELOW.
Bright from the Start: NAME Georgia OF PERSON Department REPORTED of TO: Early Care and Learning
NOTE ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW.
THEN CHECK ON AND OFF FOR EACH CHILD.
9:00 a.m.
AM / PM
9:30 a.m
AM / PM
1:30 pm
AM / PM
Restraint Types: Seatbelt = S, Car Seat = C, Booster = B
Times
Initials
TR TR TR
AM / PM AM / PM AM / PM
Child’s First & Last Name Parent’s Signature Date Restraint
Type ON OFF ON OFF ON OFF
Bobbie Mitchell Barber Mitchell 4-29-13 X X X
Leslie Warren Cassandra Warren 4-29-13 X X X
Rachel Thorton Kristie Thorton 4-30-13 X X X
Riley Thorton Kristie Thorton 4-30-13 X X X
Jessica Barber Marilyn Barber 5-1-13 X X X
Justin Register Lauren Register 5-1-13 X X X
FIRST CHECK: SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING VEHICLE
CHECKED AND NO CHILD LEFT ON VEHICLE AT EACH STOP
SECOND CHECK: SIGNATURE OF STAFF PERSON NOT ON THE VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE
DESIGNATED PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON
VEHICLE.
Tara Ross
Tara Ross
1. Patsy Collins NAME OF PERSON
2.
3.
CHECKLIST
TURNED IN TO:
Page 18

Field Trip Form for vehicles with No
Alarm.
Field Trip Form
Center Name: ABC Learning Center Center Phone Number: __770-123-4567______________
Date of Field Trip ___5-2-13_________________ Departure Time 9:00 AM/PM Estimated Return Time 2:00 AM/PM
Field Trip Location Memorial Library Address (Street, City, Zip Code)_1234 Peachtree Street, Atlanta, GA 30034____________
Person on vehicle responsible for
Name of Driver Betty Smith Name of Staff Person Responsible for Checklist ____Tara Ross_________________________
checklist
Vehicle Tag Number ___APK178___________________Vehicle has child safety alarm device _____ YES _X___NO
Names of Other Adults Attending Trip____Shamonica Warren_______________________ ______________________________________
IF YOUR CHILD HAS PERMISSION TO ATTEND THIS
FIELD TRIP, PLEASE SIGN AND DATE BELOW.
Bright from the Start: Georgia Department of Early Care and Learning
Times
NOTE ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW.
THEN CHECK ON AND OFF FOR EACH CHILD.
9:00 a.m.
AM / PM
9:30 a.m
AM / PM
1:30 pm
AM / PM
2:00 p.m.
AM / PM AM / PM AM / PM
Restraint Types: Seatbelt = S, Car Seat = C, Booster = B
Initials
TR TR TR TR
Child’s First & Last Name Parent’s Signature Date Restraint
Type ON OFF ON OFF ON OFF
Bobbie Mitchell Barber Mitchell 4-29-13 X X X X
Leslie Warren Cassandra Warren 4-29-13 X X X X
Rachel Thorton Kristie Thorton 4-30-13 X X X X
Riley Thorton Kristie Thorton 4-30-13 X X X X
Jessica Barber Marilyn Barber 5-1-13 X X X X
Justin Register Lauren Register 5-1-13 X X X X
FIRST CHECK: SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING VEHICLE
CHECKED AND NO CHILD LEFT ON VEHICLE AT EACH STOP
SECOND CHECK: SIGNATURE OF STAFF PERSON NOT ON THE VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE
DESIGNATED PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON
VEHICLE.
NAME OF PERSON REPORTED TO:
Tara Ross Tara Ross
Tara Ross
1. Patsy Collins NAME OF PERSON
2.
3.
CHECKLIST
TURNED IN TO:
Page 19

Field Trip Form for vehicles with No
Alarm.
Bright from the Start: Georgia Department of Early Care and Learning
Field Trip Form
Center Name: ABC Learning Center Center Phone Number: __770-123-4567______________
Date of Field Trip ___5-2-13_________________ Departure Time 9:00 AM/PM Estimated Return Time 2:00 AM/PM
Field Trip Location Memorial Library Address (Street, City, Zip Code)_1234 Peachtree Street, Atlanta, GA 30034____________
Person on vehicle responsible for
Name of Driver Betty Smith Name of Staff Person Responsible for Checklist ____Tara Ross_________________________
checklist
Vehicle Tag Number ___APK178___________________Vehicle has child safety alarm device _____ YES _X___NO
Names of Other Adults Attending Trip____Shamonica Warren_______________________ ______________________________________
IF YOUR CHILD HAS PERMISSION TO ATTEND THIS
FIELD TRIP, PLEASE SIGN AND DATE BELOW.
Times
NOTE ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW.
THEN CHECK ON AND OFF FOR EACH CHILD.
9:00 a.m.
AM / PM
9:30 a.m
AM / PM
1:30 pm
AM / PM
2:00 p.m.
AM / PM AM / PM AM / PM
Restraint Types: Seatbelt = S, Car Seat = C, Booster = B
Initials
TR TR TR TR
Child’s First & Last Name Parent’s Signature Date Restraint
Type ON OFF ON OFF ON OFF
Bobbie Mitchell Barber Mitchell 4-29-13 X X X X
Leslie Warren Cassandra Warren 4-29-13 X X X X
Rachel Thorton Kristie Thorton 4-30-13 X X X X
Riley Thorton Kristie Thorton 4-30-13 X X X X
Jessica Barber Marilyn Barber 5-1-13 X X X X
Justin Register Lauren Register 5-1-13 X X X X
FIRST CHECK: SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING VEHICLE
CHECKED AND NO CHILD LEFT ON VEHICLE AT EACH STOP
SECOND CHECK: SIGNATURE OF STAFF PERSON NOT ON THE VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE
DESIGNATED PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON
VEHICLE.
NAME OF PERSON REPORTED TO:
Tara Ross Tara Ross
Tara Ross
Patsy Collins
1. Patsy Collins NAME OF PERSON
2.
3.
CHECKLIST
TURNED IN TO:
Patsy Collins
Page 20

Transportation Forms:
Field Trip Form
Bright from the Start: Georgia Department of Early Care and Learning
Page 21

Home Transportation Form:
*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
Pick-Up
Address
Drop-Off
Address
Michael Peterson S 889 Hall Street 123 ABC Street AM Center Staff
O
N
Pick Up
Time
I
N
I
T
I
A
L
S
Drop
Off
Time
I
N
I
T
I
A
L
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
123 ABC Street 889 Hall Street PM Cynthia Peterson
Michael Peterson Sr.
Cameron Peterson B 889 Hall Street 123 ABC Street AM
Center Staff
123 ABC Street 889 Hall Street PM
Anna Billings B 763 Butler Ave 123 ABC Street AM
123 ABC Street 763 Butler Ave PM
AM
PM
AM
PM
AM
PM
AM
Cynthia Peterson
Michael Peterson Sr.
Center Staff
Susan Billings
Page 22

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Michael Peterson S 7:30
am
Cameron Peterson B 7:30
am
Anna Billings B 7:30
am
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
Pick-Up
Address
Drop-Off
Address
O
N
Pick Up
Time
I
N
I
T
I
A
L
S
O
F
F
Drop
Off
Time
I
N
I
T
I
A
L
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
B
S 889 Hall Street 123 ABC Street AM Center Staff
123 ABC Street 889 Hall Street PM Cynthia Peterson
Michael Peterson Sr.
B
S
889 Hall Street 123 ABC Street AM
Center Staff
123 ABC Street 889 Hall Street PM
Cynthia Peterson
Michael Peterson Sr.
B
S
763 Butler Ave 123 ABC Street AM
Center Staff
123 ABC Street 763 Butler Ave PM
Susan Billings
Transported
children listed here
(first and last
names)
AM
PM
AM
PM
AM
PM
AM
Page 23

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Michael Peterson S 7:30
am
Cameron Peterson B 7:30
am
Anna Billings B 7:30
am
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
B
S
B
S
B
S
Pick-Up
Address
Drop-Off
Address
O
N
Pick Up
Time
I
N
I
T
I
A
L
S
O
F
F
Drop
Off
Time
I
N
I
T
I
A
L
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
889 Hall Street 123 ABC Street AM √ 7:45 B
S
Center Staff
123 ABC Street 889 Hall Street PM Cynthia Peterson
Michael Peterson Sr.
889 Hall Street 123 ABC Street AM √ 7:45 B
S
Center Staff
123 ABC Street 889 Hall Street PM
Cynthia Peterson
Michael Peterson Sr.
763 Butler Ave 123 ABC Street AM
Center Staff
123 ABC Street 763 Butler Ave PM
Transported
AM
PM
AM
PM
AM
PM
AM
Susan Billings
Page 24

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Michael Peterson S 7:30
am
Cameron Peterson B 7:30
am
Anna Billings B 7:30
am
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
B
S
B
S
B
S
Pick-Up
Address
Drop-Off
Address
O
N
Pick Up
Time
I
N
I
T
I
A
L
S
O
F
F
Drop
Off
Time
I
N
I
T
I
A
L
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
889 Hall Street 123 ABC Street AM √ 7:45 B
S
Center Staff
123 ABC Street 889 Hall Street PM Cynthia Peterson
Michael Peterson Sr.
889 Hall Street 123 ABC Street AM √ 7:45 B
S
Center Staff
123 ABC Street 889 Hall Street PM
Cynthia Peterson
Michael Peterson Sr.
763 Butler Ave 123 ABC Street AM √ 7:50 B
S
Center Staff
123 ABC Street 763 Butler Ave PM
Susan Billings
Transported
children listed here
(first and last
AM
PM
AM
PM
AM
PM
AM
Page 25

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Michael Peterson S 7:30
am
Cameron Peterson B 7:30
am
Anna Billings B 7:30
am
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
B
S
B
S
B
S
Pick-Up
Address
Drop-Off
Address
O
N
Pick Up
Time
889 Hall Street 123 ABC Street AM √ 7:45 B
S
I
N
I
T
I
A
L
S
O
F
F
Drop
Off
Time
I
N
I
T
I
A
L
S
√ 8:25 B
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
Center Staff
123 ABC Street 889 Hall Street PM Cynthia Peterson
Michael Peterson Sr.
889 Hall Street 123 ABC Street AM √ 7:45 B
S
√ 8:25 B
S
Center Staff
123 ABC Street 889 Hall Street PM
Cynthia Peterson
Michael Peterson Sr.
763 Butler Ave 123 ABC Street AM √ 7:50 B
S
√ 8:25 B
S
Center Staff
123 ABC Street 763 Butler Ave PM
Susan Billings
Transported
children listed here
(first and last
names)
AM
PM
AM
PM
AM
PM
AM
Page 26

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
RETURN TIME TIME INITIAL
8:25 AM BS
RECORD TIME VEHICLE RETURNS TO FACILITY AFTER EACH TRIP.
PM
FIRST CHECK SIGNATURE
A
SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING
M
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE.
P
M
SECOND CHECK SIGNATURE
A
FOR VEHICLES WITHOUT AN ALARM: SIGNATURE OF STAFF PERSON NOT ON
M
THE VEHICLE VERIFYING VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
P
M
A
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE DESIGNATED M
PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON VEHICLE.
P
M
A
M
IF APPLICABLE: NAME OF PERSON REPORTED TO:
P
M
A
M
NAME OF PERSON CHECKLIST TURNED IN TO:
P
M
Medical Facility Used by Center
Memorial Life Hospital
Name and Address of Insurance Company
Insured by Us; 777 Regency Blvd., Atlanta, GA 30303
Bright from the Start: Georgia Department of Early Care and Learning
Page 27

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
RETURN TIME TIME INITIAL
8:25 AM BS
RECORD TIME VEHICLE RETURNS TO FACILITY AFTER EACH TRIP.
PM
FIRST CHECK SIGNATURE
A Betty Smith
SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING
M
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE.
P
M
SECOND CHECK SIGNATURE
A
FOR VEHICLES WITHOUT AN ALARM: SIGNATURE OF STAFF PERSON NOT ON
M
THE VEHICLE VERIFYING VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
P
M
A
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE DESIGNATED M
PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON VEHICLE.
P
M
A
M
IF APPLICABLE: NAME OF PERSON REPORTED TO:
P
M
A
M
NAME OF PERSON CHECKLIST TURNED IN TO:
P
M
Medical Facility Used by Center
Memorial Life Hospital
Name and Address of Insurance Company
Insured by Us; 777 Regency Blvd., Atlanta, GA 30303
Bright from the Start: Georgia Department of Early Care and Learning
Page 28

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
RETURN TIME TIME INITIAL
8:25 AM BS
RECORD TIME VEHICLE RETURNS TO FACILITY AFTER EACH TRIP.
PM
FIRST CHECK SIGNATURE
A Betty Smith
SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING
M
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE.
P
M
SECOND CHECK SIGNATURE
A Patsy Collins
FOR VEHICLES WITHOUT AN ALARM: SIGNATURE OF STAFF PERSON NOT ON
M
THE VEHICLE VERIFYING VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
P
M
A
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE DESIGNATED M
PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON VEHICLE.
P
M
A
M
IF APPLICABLE: NAME OF PERSON REPORTED TO:
P
M
A Patsy Collins
M
NAME OF PERSON CHECKLIST TURNED IN TO:
P
M
Medical Facility Used by Center
Memorial Life Hospital
Name and Address of Insurance Company Insured by Us; 777 Regency Blvd., Atlanta, GA 30303
Bright from the Start: Georgia Department of Early Care and Learning
Page 29

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Michael Peterson S 7:30
am
3:30
pm
Cameron Peterson B 7:30
am
3:30
pm
Anna Billings B 7:30
am
3:30
pm
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
B
S
B
S
B
S
B
S
B
S
B
S
Pick-Up
Address
Drop-Off
Address
O
N
Pick Up
Time
889 Hall Street 123 ABC Street AM √ 7:45 B
S
123 ABC Street 889 Hall Street PM √ 3:30 B
S
889 Hall Street 123 ABC Street AM √ 7:45 B
S
123 ABC Street 889 Hall Street PM √ 3:30 B
S
763 Butler Ave 123 ABC Street AM √ 7:50 B
S
123 ABC Street 763 Butler Ave PM
AM
√ 3:30 B
S
Transported
children listed here
PM
AM
PM
AM
PM
AM
I
N
I
T
I
A
L
S
O
F
F
Drop
Off
Time
I
N
I
T
I
A
L
S
√ 8:25 B
S
√ 8:25 B
S
√ 8:25 B
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
Center Staff
Cynthia Peterson
Michael Peterson Sr.
Center Staff
Cynthia Peterson
Michael Peterson Sr.
Center Staff
Susan Billings
Page 30

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Michael Peterson S 7:30
am
3:30
pm
Cameron Peterson B 7:30
am
3:30
pm
Anna Billings B 7:30
am
3:30
pm
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
B
S
B
S
B
S
B
S
B
S
B
S
Pick-Up
Address
Drop-Off
Address
O
N
Pick Up
Time
889 Hall Street 123 ABC Street AM √ 7:45 B
S
123 ABC Street 889 Hall Street PM √ 3:30 B
S
889 Hall Street 123 ABC Street AM √ 7:45 B
S
123 ABC Street 889 Hall Street PM √ 3:30 B
S
763 Butler Ave 123 ABC Street AM √ 7:50 B
S
123 ABC Street 763 Butler Ave PM
AM
√ 3:30 B
S
Transported
children listed here
(first and last
names)
PM
AM
PM
AM
PM
AM
I
N
I
T
I
A
L
S
O
F
F
Drop
Off
Time
I
N
I
T
I
A
L
S
√ 8:25 B
S
√ 8:25 B
S
√ 8:25 B
S
√ 4:00 B
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
Center Staff
Cynthia Peterson
Michael Peterson Sr.
Center Staff
Cynthia Peterson
Michael Peterson Sr.
Center Staff
Susan Billings
Page 31

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
Day of the Week: M T W Th F S Su Today’s Date: __9/1/12_______
Name of Driver: Betty Smith____________________ Name of Staff Person Responsible for Checklist: Betty Smith_____________
Vehicle Tag Number: APK178 Vehicle has child safety alarm device: ____ YES __√__NO
Names of Other Adults on Vehicle:
____________________________________ ____________________________________ ____________________________________
NOTE: ALL DEPARTURE/ARRIVAL TIMES AND INITIAL BELOW. THEN CHECK ON AND OFF FOR EACH CHILD.
NOTE: A NEW FORM MUST BE USED EACH DAY. ONE FORM PER ROUTE AND/OR TRIP.
Child’s First &
Last Name
(Each child listed individually)
Revised 1/29/13
Restraint
Type
Seatbelt = S
Car Seat = C
Booster = B
Depart
Time
Michael Peterson S 7:30
am
3:30
pm
Cameron Peterson B 7:30
am
3:30
pm
Anna Billings B 7:30
am
3:30
pm
Bright from the Start: Georgia Department of Early Care and Learning
I
N
I
T
I
A
L
S
B
S
B
S
B
S
B
S
B
S
B
S
Pick-Up
Address
Drop-Off
Address
O
N
Pick Up
Time
889 Hall Street 123 ABC Street AM √ 7:45 B
S
123 ABC Street 889 Hall Street PM √ 3:30 B
S
889 Hall Street 123 ABC Street AM √ 7:45 B
S
123 ABC Street 889 Hall Street PM √ 3:30 B
S
763 Butler Ave 123 ABC Street AM √ 7:50 B
S
123 ABC Street 763 Butler Ave PM
AM
√ 3:30 B
S
Transported
children listed here
(first and last
names)
PM
AM
PM
AM
PM
AM
I
N
I
T
I
A
L
S
O
F
F
Drop
Off
Time
I
N
I
T
I
A
L
S
√ 8:25 B
S
√ 4:10 B
S
√ 8:25 B
S
√ 4:10 B
S
√ 8:25 B
S
√ 4:00 B
S
PERSON(S)
AUTHORIZED FOR
CHILD TO BE
RELEASED TO
Center Staff
Cynthia Peterson
Michael Peterson Sr.
Center Staff
Cynthia Peterson
Michael Peterson Sr.
Center Staff
Susan Billings
Page 32

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
RECORD TIME VEHICLE RETURNS TO FACILITY AFTER EACH TRIP.
SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE.
FOR VEHICLES WITHOUT AN ALARM: SIGNATURE OF STAFF PERSON NOT ON
THE VEHICLE VERIFYING VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE DESIGNATED
PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON VEHICLE.
Medical Facility Used by Center
Name and Address of Insurance Company
IF APPLICABLE: NAME OF PERSON REPORTED TO:
NAME OF PERSON CHECKLIST TURNED IN TO:
Memorial Life Hospital
RETURN TIME TIME INITIAL
8:25 AM BS
4:20 PM BS
FIRST CHECK SIGNATURE
A Betty Smith
M
P
M
SECOND CHECK SIGNATURE
Insured by Us; 777 Regency Blvd., Atlanta, GA 30303
Bright from the Start: Georgia Department of Early Care and Learning
A
M
P
M
A
M
P
M
A
M
P
M
A
M
P
M
Patsy Collins
Patsy Collins
Page 33

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
RECORD TIME VEHICLE RETURNS TO FACILITY AFTER EACH TRIP.
SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE.
FOR VEHICLES WITHOUT AN ALARM: SIGNATURE OF STAFF PERSON NOT ON
THE VEHICLE VERIFYING VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE DESIGNATED
PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON VEHICLE.
Medical Facility Used by Center
IF APPLICABLE: NAME OF PERSON REPORTED TO:
NAME OF PERSON CHECKLIST TURNED IN TO:
Memorial Life Hospital
Name and Address of Insurance Company Insured by Us; 777 Regency Blvd., Atlanta, GA 30303
RETURN TIME TIME INITIAL
8:25 AM BS
4:20 PM BS
FIRST CHECK SIGNATURE
A Betty Smith
M
P Betty Smith
M
SECOND CHECK SIGNATURE
Bright from the Start: Georgia Department of Early Care and Learning
A
M
P
M
A
M
P
M
A
M
P
M
A
M
P
M
Patsy Collins
Patsy Collins
Page 34

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
RECORD TIME VEHICLE RETURNS TO FACILITY AFTER EACH TRIP.
SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE.
FOR VEHICLES WITHOUT AN ALARM: SIGNATURE OF STAFF PERSON NOT ON
THE VEHICLE VERIFYING VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE DESIGNATED
PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON VEHICLE.
Medical Facility Used by Center
IF APPLICABLE: NAME OF PERSON REPORTED TO:
NAME OF PERSON CHECKLIST TURNED IN TO:
Memorial Life Hospital
Name and Address of Insurance Company Insured by Us; 777 Regency Blvd., Atlanta, GA 30303
RETURN TIME TIME INITIAL
8:25 AM BS
4:20 PM BS
FIRST CHECK SIGNATURE
A Betty Smith
M
P Betty Smith
M
SECOND CHECK SIGNATURE
Bright from the Start: Georgia Department of Early Care and Learning
A
M
P
M
A
M
P
M
A
M
P
M
A
M
P
M
Patsy Collins
Patsy Collins
Patsy Collins
Patsy Collins
Page 35

*A new form should be used for each round trip to and
from the facility
Home Transportation Form
Page 1
Date: 9/1/12
Center Name: ABC Learning Center Center Phone Number: 770-123-4567
RECORD TIME VEHICLE RETURNS TO FACILITY AFTER EACH TRIP.
SIGNATURE OF STAFF PERSON ON VEHICLE VERIFYING
VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE.
FOR VEHICLES WITHOUT AN ALARM: SIGNATURE OF STAFF PERSON NOT ON
THE VEHICLE VERIFYING VEHICLE CHECKED AND NO CHILD LEFT ON VEHICLE
IF APPLICABLE: SIGNATURE OF STAFF PERSON WHO REPORTED BY PHONE TO THE DESIGNATED
PERSON THAT VEHICLE WAS CHECKED AND NO CHILD WAS LEFT ON VEHICLE.
Medical Facility Used by Center
Name and Address of Insurance Company
IF APPLICABLE: NAME OF PERSON REPORTED TO:
NAME OF PERSON CHECKLIST TURNED IN TO:
Memorial Life Hospital
RETURN TIME TIME INITIAL
8:25 AM BS
4:20 PM BS
FIRST CHECK SIGNATURE
A Betty Smith
M
P Betty Smith
M
SECOND CHECK SIGNATURE
A Patsy Collins
Insured by Us; 777 Regency Blvd., Atlanta, GA 30303
M
P
M
A
M
P Betty Smith
M
A
M
P Patsy Collins
M
A Patsy Collins
M
P Patsy Collins
M
Bright from the Start: Georgia Department of Early Care and Learning
Page 36

Transportation Forms: Home Transportation
Bright from the Start: Georgia Department of Early Care and Learning
Page 37

Transportation Form
Clarifications
• For a vehicle with an approved child safety alarm, please
note that a second check of the vehicle is not required.
• When a child care program is conducting home transportation,
a new home transportation checklist form is needed for each
route being conducted.
• For school transportation, a separate form must be used for
each school.
Bright from the Start: Georgia Department of Early Care and Learning
Page 38

Transportation Form
Reminders
• Checklists should be completed in black or blue ink so that the form is legible.
• Ensure information is complete at the top of the forms. (Driver name, week, pickup,
delivery, etc.)
• Make sure staff are signing on the correct line for documentation. Ex. AM route
only – sign AM route line, not PM route.
• Sign with complete signature indicating first and second checks of the vehicle
have been conducted.
• The name of the person responsible for the checklist, should be someone that is
on the vehicle.
• Second checks should be completed by someone who was not on the vehicle.
Bright from the Start: Georgia Department of Early Care and Learning
Page 39

Contact Information:
Child Care Consultant of the Day -
Main# 404-657-5562
www.decal.ga.gov

Questions/
Answers