MIS Form #406 2026

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The document is a form used by the District School Board of Pasco County for reporting and investigating student injuries or accidents. It outlines the necessary information to be collected, including student details, accident specifics, and actions taken. The form must be completed by a school administrator or designee within three business days of an incident and submitted to Risk Management for record-keeping and risk assessment purposes.

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Click ‘Get Form’ to open the MIS Form #406 in the editor.
Begin by filling out the STUDENT INFORMATION section. Enter the student's name, student number, gender, home address, school, grade, and age. Ensure all fields are accurately completed.
In the ACCIDENT INFORMATION section, provide details about the time and date of the injury/accident. Indicate who reported the incident and list any witnesses present at the scene.
Describe the events leading up to the injury in detail. Include specifics about any injuries sustained and whether first aid was administered.
Complete any additional fields regarding medical treatment received and ensure that a Principal or Designee acknowledges with their signature and date.
Once all sections are filled out completely, save your changes and submit the form via fax or email to Risk Management as instructed.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (291 Votes)

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What is an MIS report for FAA?

Annual Management Information System (MIS) Reporting The FAAs drug and alcohol testing regulation, 14 CFR part 120, requires employers to submit an annual report of testing statistics. The specific requirement is described in 14 CFR 120.119(a) and 120.219(b).

What is the 49 CFR Part 40?

49 CFR Part 40, or Part 40 as we call it, is a DOT-wide regulation that states how to conduct testing and how to return employees to safety-sensitive duties after they violate a DOT drug and alcohol regulation. Part 40 applies to all DOT-required testing, regardless of mode of transportation.

What is DOT Rule 49 CFR Part 40 Section 40.25 QA?

40.25 Must an employer check on the drug and alcohol testing record of employees it is intending to use to perform safety-sensitive duties? (1) Yes, as an employer, you must, after obtaining an employees written consent, request the information about the employee listed in paragraphs (b) through (j) of this section.

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What is the 49 Code of Federal Regulations?

The Code of Federal Regulations Title 49 contains the codified U.S. Federal laws and regulations that are in effect as of the date of the publication pertaining to all forms of surface transportation and transportation security, including: pipelines; railroads, both passenger and freight railways; waterways; cars,

What are the Fmcsa rules for alcohol?

Drivers are forbidden to use alcohol, be under the influence of alcohol, or have any measured alcohol concentration, while on duty, or operating, or in physical control of a commercial motor vehicle. Alcohol can only be transported as part of a shipment.

What is an MIS form?

Management Information System reports apply to DOT testing only. The MIS report is submitted on a MIS DATA Collection Form. There are varying requirements for MIS reporting depending on the mode of transportation the employer is regulated by. Transportation modes include FMCSA, FAA, FTA, FRA, PHMSA and Coast Guard.

What is the 49 CFR Part 40 regulation?

The Department of Transportations (DOT) rule, 49 CFR Part 40, describes required procedures for conducting workplace drug and alcohol testing for the Federally regulated transportation industry.

What is MIS data collection form?

This Management Information System (MIS) form is made-up of four sections: employer information; covered employees (i.e., employees performing DOT regulated safety-sensitive duties) information; drug testing data; and alcohol testing data.

MIS Form #406 2026

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