Voluntary Car Scheme Toolkit

Transcription

1 East Sussex Voluntary Car Scheme Toolkit Forms Pack Important Disclaimer Please be advised that the information and forms provided in this pack are not a substitute for legal or financial advice, if in doubt please seek the services of a professional legal or financial advisor. RVA have provided the following information and forms in good faith for illustrative purposes only. Every effort has been made to ensure that they are correct at time of press however we cannot be held responsible for any errors, inaccuracies, omissions or change made after this time. Users using them do so at their own risk Charity No Company Registration:

2 Useful Forms: This document contains some sample forms that be helpful when setting up a voluntary car scheme, it is not an exhaustive list and depending on the type of scheme that you set up you may need more. For example you may want a more structured approach with regard to your volunteers and the paperwork would need to reflect this. For more help you can contact Rother Voluntary Action, Hastings Voluntary Action, 3VA, Action in Rural Sussex or the Volunteer Centre East Sussex. Contact details for these organisations can be found within the Volunteer Car Scheme Toolkit. The documents that we have included are:- Transport Audit Template Transport Needs Questionnaire Application form to become a volunteer driver Letter to GP to inform of volunteering Letter to insurance company Letter to insurance company in case of problems Expenses claim form Client Registration form Client Risk assessment form Guidelines on seat belts and child restraints Rother on 1 Buckhurst Rd Bexhill on Sea, East Sussex TN40

3 1QF TEL: udit Template n be used to list the transport services in your local area and brief details about each service... Destination Days of the week Timings Who can use the service? Notes

4 Transport needs questionnaire Individual Passenger Survey This transport questionnaire has been developed to find out which places you struggle to get to. If you do not have any transport needs but you know someone who does, then please give them a copy of this form or fill in for them with their permission. 1. Name of the village or town where you live? 2. What is your gender? Male Female 3. What age are you? < Do you have any long-standing illness, disability or infirmity which affects your ability to travel? Yes No 5. How often do you have access to the following types of vehicle (please tick for each type)? Car as driver Car as passenger Other vehicle Day time only Evening only Weekend only All the time Never It varies 6. How often do you have access to public transport? (please tick) Every hour in each direction Mon-Fri between 8am-6pm Every two hours in each direction Mon-Fri between 9am-3pm Once a day or more in each direction Mon-Fri Less than once a day No access to public transport services Please state if there is anywhere you would like to get to but you cannot currently get there: The place I can t get to is: The place is located in: The frequency, day and time I need to get there is:

5 8. Please state why you are unable to access each of these services? (Name a maximum of 4 reasons) There is no bus or train service available to get me there Place 1 Place 2 Place 3 Place 4 The bus stop is too far for me to walk I am unable to board buses or trains easily The departure or return times are not suitable Other reason (please state) Have you any further comments to add about your transport needs? Would you be able to give some time to a voluntary car scheme? Yes No If Yes what could you offer?

6 Thank you for participating in this survey. APPLICATION FORM TO BECOME A VOLUNTEER DRIVER Full Name: Present address: Date of Birth: Previous address (eg) within the last 5 years: Continue on a separate sheet if necessary From: From: To: Daytime Telephone Number: Best time to ring: Evening (if different): Car Details: Make and Model of car:.. *Estate/hatchback/saloon *please circle as applicable Registration Number:...*Three door/five door *please circle as applicable Engine Capacity:..... Can the vehicle take a folded wheelchair Yes No Names and addresses of insurance company: Do you hold a full driving licence? Renewal date: Yes/No Do you hold a fully comprehensive insurance? Yes/No Renewal date: Do you have a valid MOT certificate if required? Yes/No Renewal date: Do you have any endorsements: Yes No (if yes please give details) Previous voluntary work/relevant experience (if any)

7 Times available to drive (please tick all appropriate): Am Pm Evening Mon Tues Wed Thurs Fri Sat Sun Please give the name and address of 2 referees personally known to you of whom neither should be relatives: Name: Name: Address: Address: Do you have any disability or health problems which may affect your voluntary driving? E.g. back problems Have you ever been convicted of any criminal offence at any time? Yes No Rehabilitation of Offenders Act 1974 (Exemption) Orders 1975 &1986. The provisions relating to the non-disclosure of criminal convictions do not apply to the voluntary work for which you are applying. Therefore, it is necessary for you to disclose any criminal convictions even of, under the Rehabilitation of Offenders Act they would otherwise be regarded as spent. Disclosing an offence will not necessarily prevent you from volunteering. If yes. Please give details of the conviction (s) and date (s) Charges Pending Data protection Further info I wish to apply to become a voluntary driver. The information I have given is correct at the date of this application Signed: Date: OFFICE USE ONLY: Date Interviewed: By: Documents Checked: Driving licence: Vehicle Insurance: MOT certificate:

8 LETTER TO G.P. TO INFORM OF VOLUNTEERING Date: Dear Dr. Re: (name of driver) Date of birth.. The above mentioned has *applied to become / is currently a volunteer car driver for our voluntary car scheme. The (name of scheme) is a voluntary organisation and we provide voluntary car drivers for people who have no other means of transport. As the person mentioned above is over the age of 70 and many of the passengers are older / disabled people who may require assistance from the driver, I would very much appreciate you taking the time to tear off the return slip at the bottom of this letter, indicating whether you are aware of any health impediment which may adversely affect them from acting as a volunteer in this capacity. I would be grateful if you could return your reply it to me in the stamped addressed envelope provided Yours sincerely, (name of co-ordinator / scheme representative) I, the above mentioned authorise you to give this information to the (name of scheme) Signed (by driver) Please print name To :. car scheme co-ordinator, Driver name Address. (please tick) I am not aware of any health problems, which will prohibit the above patient for carrying out duties as a volunteer car driver. I do not think that the above patient would be suitable as a volunteer car driver Signed.... Date....

9 LETTER TO INSURANCE COMPANY Name: Address: Date: To: (Insurance Company) Re: (Policy Number).. I intend to undertake voluntary work and, from time to time, I will use my vehicle to carry passengers or to carry out other duties, as requested. I will receive a mileage allowance for these journeys to cover the running costs of my vehicle in accordance with Section 1(4) of the Public Passenger Vehicles Act 1981, which exempts me from both Passenger service Vehicle and Hackney Carriage / Private Hire Car Licensing laws. Such expenses will be claimed strictly on a non-profit basis. I should be grateful if you would confirm that my existing policy covers me for such volunteer driving -please use the 'tear off' slip below. Please also confirm that my insurance policy contains a clause indemnifying the agencies with which I am a volunteer against third party claims arising out of the use of my vehicle for such voluntary work. Yours faithfully, (Policy Holder) From: (Insurance Company) Re: Policy Number..... Policy Holder / Driver. This is to confirm that your insurance policy covers voluntary driving (for Which a mileage allowance may be received). This also confirms that the above policy contains a clause Indemnifying the agencies with which you are a volunteer against third party claims arising from the use of the vehicle on such voluntary work. ISSUED BY.. OFFICIAL STAMP DATE

10 REPLACEMENT LETTER TO INSURANCE COMPANY IN CASE OF PROBLEMS Address: Date: To: (Insurance Company) Re: (Policy Number)..... I intend to undertake voluntary work and, from time to time, I will use my vehicle to carry passengers or to carry out other duties, as requested. I may receive a mileage allowance for these journeys to cover the running costs of my vehicle in accordance with Section 1(4) of the Public Passenger Vehicles Act 1981, which exempts me from both Passenger Service Vehicle and Hackney Carriage / Private Hire Car Licensing laws. Such expenses will be claimed strictly on a non-profit basis, within the mileage rate limits set by HM Revenue & Customs. I should be grateful if you would confirm that my existing policy covers me for such volunteer driving -please use the 'tear off' slip below. Yours faithfully, (Policy Holder) From: (Insurance Company). Re: Policy Number Policy Holder / Driver. This is to confirm that your insurance policy covers voluntary driving (for which a mileage allowance may be received). ISSUED BY.. DATE OFFICIAL STAMP

11 EXPENSES CLAIM FORM (Name of Care Group) Name:. Month Ending: Address: Vehicle Registration:.. Please return this form to:- Name:. Address:.. It is important for the committee to know the true cost of the journeys undertaken so please claim all your expenses. If you do not wish to keep the money you can donate it back to the Scheme. Travel Expenses Date Client To From Mileage Cost Other Expenses (please include any receipts) Date Item Cost Please supply details of any changes to your details e.g. address, telephone number, vehicle, insurance company, driving license, MOT certificate. I certify that this claim is correct and I hold a current driving license, current insurance policy and, if applicable, MOT relating to my vehicle. I agree to maintain the vehicle in a roadworthy condition and I have not incurred any endorsements that I have not previously notified you of in writing. Signed Date

12 CLIENT REGISTRATION FORM Date: Time: Name of Caller: Address: Person taking call: Telephone Number: Location: Date and Time of journey: Frequency (if applicable): Mileage: ---- p per mile: Admin: Parking: Total cost: Any special information: Transport Destination: Wheelchair user: Purpose: Waiting time/second driver: In receipt of Social Security Benefits: Child (under 8 years should be accompanied): Those in receipt of Social Security Benefits can claim for travel and parking. A receipt will be required. Reason for using scheme? Have you called us before?

13 How did you hear about us? Journey allocated to: Caller notified: Caller referred to other agencies? Feedback from volunteer: CLIENT RISK ASSESSMENT FORM When taking on a new Client the Co-ordinator will need to make an assessment as to whether it is right for the car scheme to assist. This information can also be used as a risk assessment This judgement is based on three things: Is the service provided by the car scheme appropriate for the potential Client s needs? Is the volunteer at risk by dealing with the potential client? Is the request within the capacity of the car scheme? When a new Client is interviewed for the first time, it is useful to ask certain questions which the Co-ordinator can form an opinion. The interview can be carried out over the telephone or ideally in person. An explanation should be given that this is a formality with all new clients. Name... Date of Birth. Address Telephone Number... Emergency Contact Name and Number GP Name and Address Risk Assessment Does passenger need assistance walking from their front door Yes No Does passenger need assistance getting into the car Yes No Does passenger need to sit in the front seat of the car Yes No Does passenger use a wheelchair Yes No If yes, type of wheelchair... Does the passenger have a blue badge? Yes No Has the Client got any health problems that the car scheme should be aware of? For example Seeing/Speaking/Hearing/Memory? Any specific medical condition the driver needs to be aware of?

14 Does a Carer/relative/friend need to accompany the Client? Yes No If yes does the carer/relative/friend have any special requirements e.g. wheelchair user?..... Any further information (please list anything that will assist the driver when he picks the passenger up) PLEASE NOTE - This information is strictly confidential and to keep this information on file you do need to ask for the potential Clients permission. The information should be kept safe and locked away. Does the client give their permission for this information to be kept? Yes No Seat belts and Child Restraints for Community Car Schemes It is the duty of each scheme to ensure suitable child restraints are provided and used, the scheme can t claim exemption for being a taxi. Parents or guardians can provide their own or the scheme can do this. All drivers should know how to fit any child car seat, as the table below shows, the driver is responsible for children under the age of 14. New Rules Front Seat Rear Seat Who is Responsible Driver Child under 3 years of age Child aged 3 11 and under 1.35 metres (approximately 4ft 5in in height) Seat belt must be worn if fitted Correct child restraint must be used Correct child restraint must be used - Driver Correct child restraint must be used. If not available in a taxi, may travel unrestrained Correct child restraint must be used where seat belts fitted. Must use adult belt if: - in a taxi, the correct child restraint not available - on a short and occasional trip, the correct child restraint not available Driver Driver

15 - two occupied child restraints prevent fitment of a third Child 12 or 13, or over 1.35 metres (approximately 4ft 5in in height) Adult passenger Seat belt must be worn if fitted Seat belt must be worn if fitted Adult seat belt must be worn if fitted Seat belt must be worn if fitted Driver Passenger Child restraints are divided into categories, according to the weight of the children for whom they are suitable. These correspond broadly to different age groups, but it is the weight of the child that is most important when deciding what type of child restraint to use. Some child restraints are capable of being converted as the child grows and, therefore, fit into more than one group or stage. Baby seats must not be used where an activated airbag is fitted. Child Restraints Baby Seats / Stage 1 = Groups 0 and 0+ Seat Facing Rear-facing Weight and Age For children up to 13kgs (approx age birth to 9-12 months) Typical Examples Child Seats / Stage 2 = Group 1 Forward-facing For children 9kgs to 18kgs (approx age 9 months to 4 years) Booster Seats / Stage 3 = Group 2 For children 15kgs and up (from approx 4 years)

16 Booster Cushions / Stage 4 = Group 3 For children from 22kgs (from approx 6 years) The legal penalty for drivers who do not comply with the regulations is a 30 fixed penalty notice rising to a maximum of 500 if a case goes to court. In addition to the legal penalties, failure to wear a seat belt or failure to ensure that a child passenger uses an appropriate child restraint or wears a seat belt according to the legal requirements described above, could affect any claims against your motor insurance cover. Information supplied by the Community Transport Association