Special Needs Transportation

SPECIAL NEEDS TRANSPORTATION

FINANCIAL SECTION

Board:________________________________________________________________________________

Student's Name:________________________________________________________________________

Street Address: ________________________________________________________________________

Community of Residence:________________________________________________________________

School Name:__________________________________________________________________________

Grade:________________________________________________________________________________

Distance Traveled (one Way):_____________________________________________________________

Transportation Cost:_______________________________Per:__________________________________

Contractor's Name:______________________________________________________________________

Renewal___________________ Extension___________________ Tendered____________________

If tendered: Attach Copy of Tender and Bids

Effective Date:________________________________________________

Vehicle Type:_________________________________________________

Comments:____________________________________________________________________________

_____________________________________________________________________________________

Assistant Director (Finance and Administration)

__________________________________________

__________________________________________
Date

AGREEMENT FOR SPECIAL TRANSPORTATION

YEAR____________

This agreement made this ____________of _____________________.___________________between

_______________________________________, ___________________________________________
Contractor Address

______________________hereinafter called the "Contractor" and _____________________________

hereinafter called "the board". Shall commence _____________________________and shall, subject

to Article 3(a) terminate at the end of the current school year.

The contractor shall during the term of this agreement:

(1) Provide transportation to and from school for pupils designated under section 2 of this contract.
(2) Use a properly licensed motor vehicle or vehicles, and conform with all regulations pertaining
to the transportation of pupils, and maintain such vehicle or vehicles in a clean and sanitary
condition.
(3) At all times, keep the vehicle or vehicles fully licensed as required under the Highway Traffic Act; provide a copy of the policy to the Board prior to the commencement of the service containing an endorsement stating that the Board will be notified by the insurer of any changes in or cancellation of the policy 15 days before changes are made, and provide a renewal certificate prior to the policy expiration date. The insurance coverage shall apply to field and other curricular activities requiring transportation. In the event of an accident causing
personal injury to a pupil, the contractor shall not be relieved from liability by reasons of operating a vehicle off the specified route.
(4) Provide to the Board, letters of police abstract on any driver used to transport students, as requested.

Make no adjustment to the established route without prior approval of the Board.

File with the Board details of vehicle inspection certificate or certificates, name or names of driver, the class license of the driver(s), and medical certificates of the driver(s).

Carry no passenger other than a passenger designated by the Board while transporting handicapped students.

Comply with Board policy, the policy and regulations of the Department of Education and encourage all drivers to attend any seminar the Board may conduct or that may be conducted by a third party on behalf of the Board, with the object of improving school bus safety.

Not assign this agreement without the prior written permission of the Board.

The Board and the Contractor agree that the Board may vary at any time

the route to be followed by any vehicle used in the transportation service and without additional compensation provided that any extension to the regular route is not more than 1.6 kilometers. For the purpose of this sub-paragraph (I), "extension" means the single journey, one way, beyond the regular route.

the points of commencement of the routes of any such vehicles;

the time schedule of any such vehicle, and

the passengers assigned to any such vehicle as long as the capacity of the vehicle is not exceeded.

The Board in consideration of the transportation service provided shall pay the contractor as follows:

Name Address Daily Route

___________________ ___________________ _________________

Special Provisions

Where the service provided hereunder is based on a daily rate, payments will be contingent upon school attendance.

This agreement may be terminated forthwith by the Board where in the opinion of the Board:

The service is no longer required.

The Contractor has failed to fulfill any of the provisions of this agreement.

The safety of any pupil is endangered by the manner in which the vehicle is operated.

Signed, Sealed and Delivered in the presence of:

__________________________________ __________________________________
Witness Contractor

__________________________________
Date

School Board _____________________________________________________________

__________________________________ __________________________________
Witness Authorized Signature

Date__________________________________

DEPARTMENT OF EDUCATION

APPLICATION FOR TRANSPORTATION: STUDENTS WITH SPECIAL NEEDS

TO BE COMPLETED BY THE SCHOOL AS PART OF THE SUPPORT SERVICES PLANNING PROCESS AND FORWARDED TO THE PROGRAM SPECIALIST-STUDENT SUPPORT SERVICES

Student's Name:________________________________________________

Date of Birth:__________________________________________________

Parent/Guardian Name(s):_______________________________________________________________

Residential Address:___________________________________________________________________

Community of school:___________________________Name of school:__________________________

Is student attending his/her neighborhood school ____Yes ____No

If no, explain:_________________________________________________________________________

Distance between addresses above:________________________________________________

Is there student assistant(s) support for this student? ____Yes ____No

Will a student assistant accompany this student while in transit? ____Yes ____No

Would the provision of student assistant support enable this ____Yes ____No

student to access regular modes of transportation?

*Will the pick-up or drop-off points vary from the addresses ____Yes ____No

Given above?

If yes, explain:____________________________________________________________________________________

_________________________________________________________________________________________________

*NOTE: If these arrangements do not create any financial or time changes to the existing transportation routes, all efforts should be made to accommodate the request. If changes are necessary, please ask parents/guardians to make alternate arrangements.

1. Nature of disability:___________________________________________________________________

2. Adaptive Equipment required to accompany the student:

Daily_______________________________________________________________________

Weekly_____________________________________________________________________

Method of transportation and TENDER recommendations (e.g. seating, straps, lifts, position, storage
requirements for the individual's adaptive equipment)

_______________________________________________________________________________________

3. REMINDER: 1. Please ask parent/guardian to sign a Consent for Release of Information if one has not already been completed.

2. Please ask parent/guardian to provide the completed Medical Certificate to the Principal.

4. Explain rationale for requesting special transportation._______________________________________________

5. With guidance/education and/or necessary personal equipment, could this student walk to or ride a regular bus to school? ____Yes ____No

Explain:__________________________________________________________________________________________

_________________________________________________________________________________________________

6. Number of trips Per Day_____________________

TRIPS refers to one way only (e.g. home to school = 1 trip; school to home = 1 trip)

7. If the number of trips exceeds two (2) per day, explain reason.___________________________________

_________________________________________________________________________________________________

NOTE: This can only be granted if circumstances are deemed life threatening for the student.

8. If this student's time for arrival and/or departure vary from the remainder of the school, provide rationale:__

_________________________________________________________________________________________________

NOTE: Transportation schedules should not be a rationale for shortened school day.

9. Presently, could any buses or taxis, which meet the ____Yes ____No

standards recommended pass this student's place of

residence?

If no, could vehicle be adapted to meet the student's ____Yes ____No

Needs? (Please explain below)

If yes, is there room on the bus/taxi to transport the ____Yes ____No

Student?

If yes, are there financial or other reasons (e.g. time) ____Yes ____No

why the student should not use the existing services?

If you have answered yes to either of the four statements, please comment below:

_________________________________________________________________________________________________

10. Estimated length of time between pick-up and drop-off:

15 minutes or less _____

15-30 minutes _____

30-45 minutes _____

45-60 minutes _____

60-90 minutes _____

11. Support Services Planning Team Members:

_____________________________________ _____________________________________
Signature

_____________________________________ ______________________________________
Principal Signature of Principal

PLEASE SEND FORM TO PROGRAM SPECIALIST- STUDENT SUPPORT SERVICES

CONSENT FOR RELEASE OF INFORMATION

I, the undersigned, grant permission for _______________________________(name) to request all

relevant health and school information pertaining to my child_____________________(student's name)

from____________________________(agency). This information is to be used solely to facilitate

support services planning for my child. I understand that this information is to remain confidential and

will be used only by the school/health district to ensure that my child can fully benefit form his/her

school's educational program.

I understand that this consent will remain in effect until revoked by me in writing.

Parent/Guardian Witness

Signature:__________________________ Signature:___________________________

Print Name:________________________ Print Name:_________________________

Relationship to child:_________________ Relationship to child:__________________

Date:_____________________________ Date:_______________________________

PLEASE RETURN TO PRINCIPAL

MEDICAL CERTIFICATE: SPECIAL NEEDS TRANSPORTATION

Approval for special needs transportation should be based on the student's specific needs and the least restrictive mode considered. All efforts should be designed to promote a model of wellness, foster independence, and provide the opportunity for the student to remain with his/her parents.

Special needs transportation should only be considered in the following situations:

1. Where the student has suffers a temporary illness or injury or where he/she is injurious to self or others and where short-term intervention is required and where the student cannot get to and from school with adaptation(s) to the regular modes of transportation presently available.

2. Where the student's disability/condition is permanent and where the interventions available are not sufficient to enable the student to access the regular modes of transportation. For example, a student with multiple handicaps of a physical and cognitive nature.

3. Where the teaching of education or health skills/behaviors must occur before the student accesses the regular mode(s) of transportation. For example, the student must learn the use of assistive devices such as a white cane; perform personal care functions such as catheterization; develop self-regulatory behavioral strategies such as the skills required to avoid physical confrontations.

4. Where school personnel require a period of up to three months for specific training from health care professionals in order to perform functions for a student (for example, gastrostomy feedings).

In order to approve special needs transportation, it is necessary to determine why this student cannot walk to and from school, or use the regular bus system. The following information will assist in this process.

Name::________________________ Date of Birth::________________________

Home Community::________________________ School::___________________

1. Diagnosis:__________________________________________________
2. Functional Status
	Yes	No
a. Is student ambulatory?	_____	____
If yes, is he/she able to be taught to climb stairs?	_____	____
If no, is he/she able to be taught to climb stairs?	_____	____
b. Is student capable of walking 1.6 km to school considering the factors of endurance and time?	_____	____
c. Is the student('s)
(i) having uncontrolled seizures	_____	____
(ii) using a wheelchair for mobility	_____	____
(iii) abusive to self and/or others	_____	____
(iv) unable to recognize danger	_____	____
(v) condition degenerating	_____	____
(vi) having problems with balance and coordination in walking. Thus it unsafe for him/her to Independently ambulate (up to 1.6 km)	_____	____
(vii) other_____________________________	_____	____
3. a. If busing is available, this student could travel	_____	_____
To/from school via this system
And

b. Please list the specific vehicle adaptations or skill (behavioral or physical) required for this student
to get to and from school via a regular bus (e.g. bus with hydraulic lift).

__________________________________________________________________________

c. If regular busing is not available in the student's area, please list the minimum requirements for this
student to get to and from school (e.g. car with specialized restraints).

__________________________________________________________________________

RECOMMENDATION

4. a. This disability is permanent. _____Yes _____No

b. The circumstances described above are such that this student will require temporary
transportation arrangement to and from school for the period from to .

_________________ to ________________
date date

c. This student's condition is not life threatening but _____Yes _____No

he/she should be transported to and from school

(2 trips per day) because of the conditions described

above.

d. This student's condition is deemed life threatening _____Yes _____No

and thus he/she requires transportation for 4 trips

per day (to school, to and from lunch, to home).

e. Other ________________________________________________________________________

_____________________________________________________________________________

I certify that I have examined ___________________and the above information accurately reflects my findings. (name)

_________________________________ ___________________________________

Signature Physician (please print)

_________________________________ ___________________________________

Date Telephone Number

PLEASE RETURN THIS FORM TO: PROGRAMS SPECIALIST-STUDENT SUPPORT SERVICES
NOTE:
MCP DOES NOT COVER THE COST OF MEDICAL CERTIFICATE

PROGRAM SPECIALIST- STUDENT SUPPORT SERVICES FORM

The request for special needs transportation for ________________________________has been
(name of student)

reviewed by me and I recommend the following:

______    Since the request appears appropriate and the application, medical certificate and
               request for release of information are in order, I recommend approval of this
               request.

______ I do not recommend approval.

Reason

___________________________________________________________________________________

____________________________________________________________________________________

Signature:___________________________________________
Program Specialist- Student Support Services

Date: _______________________________________________

This Form Should Be Forwarded To Supervisor, School Transportation, Department Of Education

STANDARDS FOR THE TRANSPORTATION OF STUDENTS WITH SPECIAL NEEDS TO ASSIST WITH SUPPORT SERVICES PLANNING

Remark

Standard sling type wheelchairs are neither designed nor tested for protecting the occupant form a crash in a moving vehicle. Although this is a recognized fact, technology has not provided, to date, safety devices or the federally approved equipment necessary to protect all students with special needs.

The following guidelines are designed to be used when planning for the transportation of students with special needs. If you have questions or concerns re these guidelines, please contact the Occupational Therapist, with the Regional Community Health Board of relevant Health Care Institutions.

Guideline 1:

A. Students who can transfer or be transferred to a passenger seat with federally approved seat belts - hip and shoulder strap, and can maintain their sitting balance, should be transported in this manner.

B. Students should ride in the back seat.

C. Wheelchair/stroller/crutches/lap tray must be secured safely during transportation.

Guideline 2:

A. Students who require postural supports in their wheelchairs and can be accommodated in a federally approved car seat (e.g. Britex, Carrie Car Seat, Orthokinetic travel chair) should be transported in that manner.

B. Students should ride in the backseat.

C. Wheelchair/stroller/crutches/ lap tray must be secured safely during transportation.

Guideline 3:

Students who cannot be removed from their wheelchair must be transported in a wheelchair accessible van or bus with the following specifications:

A. (i) Student to be restrained in the wheelchair with safety belt attached to the vehicle in conjunction with (ii).

(ii) The wheelchair must be restrained with federally approved devices (e.g. Q restraint in conjunction with (I).

B. All wheelchairs should be placed in the forward or backward position unless alternate restraint methods are provided that meet federal standards. Sideways transportation is unacceptable.

C. All removable items - lap trays, inserts not in use, ramps, etc. must be secured safely within the van/bus during transportation.

D. Standard CSA D409 apply in addition to the above.

Guideline 4:

Students who, for medical reasons, require transportation lying down should be provided with the H strap restraint (e.g. E-Z-ON Vest) and transported in the back seat.

Guideline 5:

Students requiring additional safety straps should be provided with same, as part of the tender. These safety straps should be designed to protect the student and those in his/her immediate environment as necessary.

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