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In Sri Lanka, seven road traffic fatalities occur every day, of which 10% are children. The study aimed to determine the incidence of road traffic crashes and injuries; and the knowledge, attitudes and practices on road safety among high school students attending government schools in a suburb of Colombo, Sri Lanka.A descriptive cross sectional study was conducted among 511 students. Students were selected using multistage cluster sampling from 17 clusters with a cluster size of thirty students. Data were collected using a self administered questionnaire.The annual incidence of road traffic crashes among the study population was 174.1 per 1000 students (95% CI: 141.3 to 207.1). The annual incidence of road traffic injury was 105.6 per 1000 students (95% CI: 79.0 to 132.3). Majority of crashes (58.4%; n=52) occurred between 12 noon to 6 pm. Most were involved as pedestrians (29.2%; n=26), or while travelling on a motorcycle (27%; n=24), bicycle (15.7%;n=14) and three wheeler (12.4%; n=11). Sixty percent of those involved in a road traffic crash had sustained an injury. Majority (72.2%; n=39) were minor injuries (contusions and abrasions), but seven students (13%) had suffered a fracture. Most pedestrian related practices and the use of safety devices such as helmets (65.4%; n=334) and seatbelts (69.1%; n=353) were satisfactory. Forty percent (n=206) cross the street while talking on their mobile phone and one fourth (n=128) have driven a motorised vehicle without a valid driving license. Knowledge and practices as bus users was not satisfactory, with 45.6% (n=233) travelling on the footboard and 52.2% (n=267) boarding/disembarking from a bus when it is not at a bus stop.Majority of students sustained road traffic injury as pedestrians or motorcyclists. Therefore measures to improve their safety should be taken, with special focus on educational interventions and law enforcement.