XXV. Fleet Safety Written Program

Transcription

1 XXV. Fleet Safety Written Program 25-1

2 September 8, 2011 Dear IEC Members: The Fleet Safety Written Program was developed by IES (Integrated Electrical Services) and approved by the IEC National Safety Committee to be included the IEC Safety Manual Guidelines. The program was carefully prepared to increase awareness of the hazards involved in driving a vehicle to perform normal work duties. The program describes procedures that can be taken to control the hazard. Each member should make its own decision on adoption of this policy. If adopted, it must be followed. The program would then apply to those choosing to adopt it. Safety is good for everyone Harvey Hammock Harvey Hammock IEC Safety Committee Chairman 25-2

3 Fleet Safety Program Table of Contents Page I. STATEMENT OF MANAGEMENT POLICY FOR FLEET SAFETY II. ACCOUNTABILITY POLICY A. Responsibilities B. Safety Committee/Accident/Violation Review Board C. Available Resources D. Accident/Violation Accountability Evaluation E. Accident Classification III. VEHICLE POLICIES AND PROCEDURES A. Vehicle Inspection & Maintenance B. Use of Company Vehicles for Personal Trips C. Use of Personal Vehicles for Company Business IV. DRIVER AUTHORIZATION A. New Driver Authorization Procedures B. Existing Driver Authorization Procedures V. MVR PROGRAM A. MVR/Driver Eligibility and Points Classification B. Re-qualification VI. RISK TRANSFER A. Financial Responsibility for Personal Vehicles B. Use of Transportation Services VII. ADMINISTRATION & RECORDKEEPING A. Vehicle Records B Driver Records / Training and Accident Scene Reporting Checklist C. MVR Driver Consent Form D. Cell Phone Use Policy E. MVR Notice of Adverse Action Form F. Company Vehicle Use Agreement G. Personally-Owned Vehicle Business Agreement

4 H. Monthly Vehicle Inspection Report I. Driver Orientation Quiz J. Bayou City Productions Drivers Safety Video Order Form K. Vehicular Accident Report

5 I. Statement of Management Policy for Fleet Safety People are our most important resource, and their safety is one of our principal responsibilities. Safety must be a key part of all of our lives. The ultimate goal of our Fleet Safety Program is zero preventable accidents each year. This safety program has been developed in recognition of the responsibility of management to establish procedures for the prevention of accidents. Companie's safety objectives are to: Provide an accident and injury-free work environment Reduce costs associated with vehicle accidents Comply fully with all local, state, and federal laws and regulations The achievement of these objectives is based upon the full cooperation and active participation of all company employees in this Fleet Safety Program. The efficiency of any company can be measured by its ability to control unnecessary losses. A vehicle accident resulting in personal injury, property damage, or equipment loss represents needless waste. It is important that all supervisors recognize their responsibility to control these losses and that they take all necessary steps to do so. All employees must accept the responsibility of preventing accidents and agree to the safe operation of the company owned vehicles and personal vehicles while on company business. We must be so successful in our safety efforts that the elimination of vehicle accidents is not just an objective, but a way of life. Company President 25-5

6 II. Accountability Policy A key to the success of the Fleet Safety Program is holding personnel responsible for the vehicle safety results within their control. Supervisors are individually responsible for the vehicle safety results within their direct control. For example, the Regional Operating Officer is responsible for preventable accidents within his or her respective regions, the Company President or designated official is responsible for all preventable accidents that occur within his or her Company and the Supervisor is responsible for employees driving vehicles under his or her control. Further, each driver is personally responsible for any preventable accidents he or she may incur per the Accident Accountability Evaluation below. A. Responsibilities 1. Site Supervisor is responsible for compliance by all employees with all Vehicle Safety Policies on their project at all times 2. Company President or designated official is to confirm that all drivers in his or her work force are qualified to operate company vehicles. 3. Drivers shall follow the Vehicle Safety Policies at all times. They shall not use a company vehicle for personal business other than as specifically allowed in writing by the Company. They shall do daily visual inspections of their vehicle to evaluate their ability to safely operate the vehicle. B. Safety Committee/Accident/Violation Review Board All incidents involving a motor vehicle shall be investigated and reviewed by the safety committee during their regularly scheduled meetings. This process is not to be used to assess blame. It is used to identify specific causes, control measures, and driver improvement goals. C. Available Resources Contact the Safety Department for training assistance or additional resources. D. Accident/Violation Accountability Evaluation Each time a driver is involved in a preventable accident while acting in the course and scope of his/her employment, appropriate disciplinary actions will be taken as specified below. After every accident regardless of who is at fault a MVR will be obtained within 3 working days and a drug screen will be required within 8 hours for the driver, as a precautionary procedure in the event of future litigation. Drivers operating personal vehicles on company business who are no longer eligible for insurance coverage or who fail to maintain insurance coverage for any reason will either be reassigned to a non-driving position if available, or, if a non-driving position is not available, the driver will be terminated. 25-6

7 E. Accident Classification POINT SCORE 1. Non Preventable resulted from causes beyond the control of the driver 0 2. Preventable driver failed to do everything reasonable to prevent the accident 3 Preventable Factors From the listing below, add all applicable points to the 3 base points for a preventable accident and record the point total on the next page. Use these preventable factors when either they are the cause of the accident or contribute to the severity of the accident. 1. Driving aggressively or discourteously 1 2. Failing to reduce speed and/or be alert when approaching an intersection at which the driver was not required to yield 1 3. Failing to make proper allowance for an adverse light, road, weather, vehicle load or traffic conditions 1 4. Operating a vehicle with defective equipment 1 5. Failing to properly adjust vehicle mirrors, seat, headrest or sun visor 1 6. Failing to secure loose objects inside the vehicle 1 7. Failing to heed warning labels of medications 1 8. Fatigue, falling asleep at the wheel 2 9. Exceeding posted speed limit Lack of proper type or valid license, or failing to comply with license restriction Failing to maintain sufficient clearance when operating vehicle Following too closely (tailgating) Failing to signal intentions Overloading vehicle or not following operating manual Operating vehicle in an unsafe manner Improperly backing the vehicle Disregarding stop signs or signals Making an improper turn, lane change or other movement errors Driving on the wrong side of the road Failing to yield the right-of-way or other failure to yield error Committing involuntary manslaughter or criminally negligent homicide Attempting to elude a law officer, or hit/run Operating a vehicle while operator s license is suspended or revoked Operating vehicles under the influence of alcohol or drugs 12 TOTAL PREVENTABILITY POINTS 25-7

8 Total Points Corrective Action 3 through 5 Driver will receive a letter of reprimand. 6 through 8 Driver will receive a letter of reprimand and be suspended without pay for one day and must successfully complete a driver improvement course. 9 through 11 Driver will receive a letter of reprimand and be suspended without pay for two days and must successfully complete a driver improvement course. 12 Plus Driver will either be reassigned to a non-driving position if available, or, if a nondriving position is not available, the driver will be terminated. Prior to reinstatement to a driving position, driver will be required to successfully complete a driver improvement course and follow the procedures as outlined in the Re-qualifying section of this policy. Any driver that accumulates 6 or more points within a 36 month period of time must successfully complete a driver improvement course within 60 days of notification by the Company Safety Committee and provide a written certificate of completion to the Company Safety Committee. III. Vehicle Policies and Procedures The following policies and procedures apply to each vehicle. A. Vehicle Inspection & Maintenance Daily Pre-Trip Inspections Each driver is responsible to conduct a visual pre-trip inspection of his or her vehicle prior to the first trip of his or her work shift. Drivers should walk around the outside of the vehicle and note any defects or damage related to windows, mirrors, body and bumpers, lights, etc. Inside the vehicle the driver will note any defect or damage to the seats, seat belts, interior lights, engine warning lights, rearview mirror, emergency equipment, etc. While underway, the driver will also note any operational defects including engine performance, brakes, emergency brake, noticeable exhaust fumes, lights, transmission operation, steering responsiveness, etc. The driver is to report any deficiencies to his or her designated supervisor, manager, or maintenance personnel immediately. That person is to evaluate the defects or damages, and provide for prompt repair. A vehicle with serious operational or safety defects will be placed out of service immediately and a substitute vehicle obtained or other arrangements made until repairs are completed. Monthly Vehicle Inspections The driver will inspect each vehicle at least once every month for critical items and a written, signed and dated form will be kept in the driver s file to document each inspection. A vehicle with serious operational or safety defects will be placed out of service immediately and a substitute vehicle obtained or other arrangements made until repairs are completed. 25-8

9 Vehicle Service Intervals Vehicle service intervals will be determined by the vehicle manufacturer s specifications. For example, oil changes and fluid level checks will be made every 3,000 to 5,000 miles by a qualified auto or truck mechanic. The mechanic will be asked to provide an overall inspection of the vehicle and note or repair any defect found. A written, signed, and dated record of theses inspections and maintenance work will be obtained and kept in the vehicle file. A vehicle with serious operational or safety defects will be placed out of service immediately and a substitute vehicle obtained or other arrangements made until repairs are completed. B. Use of Company Vehicles for Personal Trips Company vehicles are to be used only for authorized company business. Each driver has to complete a Company Car Use Agreement. This agreement then must be placed in the driver s file. Under certain conditions, select employees may be allowed to drive the company vehicle home at night and on weekends. Any other personal use must be approved in writing by the Company President. The use of company vehicles is restricted to authorized drivers of the company only. Nonemployees such as spouses, children, other relatives, or friends are not authorized to drive company vehicles at any time. C. Use of Personal Vehicles for Company Business Designated employees may be called upon to drive their personal vehicles on company business. As a reminder, normal home to work commuting is not part of an employee s principal work activities and such time is not counted as hours worked or compensated. The following procedures have been adopted in order to minimize the potential for losses arising out of claims involving vehicles that are not owned by the company but used for company business. 1. Use of personal vehicles in conjunction with any activity that relates to company business must be reviewed and approved by the Company President. 2. All drivers of personal vehicles on company business must provide evidence that they have auto liability insurance with the amounts of coverage as required by the state in which the vehicle is operated. A certificate or proof of auto insurance must be obtained and given to management upon hire and as the policy renews. This proof should be kept in the driver s file. 3. In addition, those drivers who operate their vehicle on company business once a month or more frequently will need to complete the Personally Owned Car Business Agreement. This agreement must be placed in the driver s file. 4. Different insurance carrier requires different limits of property damage and personal injury liability insurance. Please check with your carrier to see which limits are required for personal use. Most carriers require $100,000 / $300,000. IV. Driver Authorization Because the quality of job performance affects the success of the entire fleet operation and directly influences the fleet safety performance, every effort should be made to select and retain the most qualified available person for each job. The following procedures will authorize new and existing drivers, whether they drive company vehicles or drive their personal vehicles on company business, more 25-9

10 frequently than once a month. A. New Driver Authorization Procedures Proper selection of drivers requires that the following conditions be met: 1. Each authorized driver will be required to sign the MVR Driver Consent Form and other required consent forms to permit the Company to complete required motor vehicle background checks. 2. The driver s ability to meet these requirements should be determined using various sources and techniques. This is true whether the candidate is to drive a company vehicle or drive their personal vehicle on company business. The following process is to take place: a. Orientation The company shall conduct a complete review of the Fleet Safety Program with any newly assigned driver. The driver must watch the Fleet Safety Video and successfully complete the written comprehension test scoring of at least 80%. b. Valid License A current and valid driver s license from the state of residence and be compatible with the type(s) of vehicle(s) driven must be presented. A photocopy is to be made upon hire and retained in the driver s file. (A reasonable time frame may be granted for drivers with out-of-state licenses to become re-licensed in the current state, not to exceed state requirements.) c. MVR Review Motor Vehicle Records reviews will be completed annually to verify current licensing status as well as past driving violations or accidents. The MVR will be evaluated and the driver ranked by the companies Safety Department using consistent and objective acceptability criteria. d. Other Criteria A driver under the age of 21 is not authorized to conduct any of the following driving tasks: Operate heavy vehicles or trucks Operate vehicles placarded for the transport of hazardous materials such as flammable, explosive or toxic cargo B. Existing Driver Authorization Procedures 1. Valid License All employees who may be assigned to drive a company vehicle or operate their personal vehicle on company business must possess a valid license appropriate for the vehicle they will be operating. A license check will be made annually for each authorized driver and a photocopy placed in the driver s file. 2. MVR Review On an annual basis, during the month of July, MVRs will be reviewed for drivers using consistent and objective acceptability criteria. After any vehicle accident the driver s MVR will be checked and filed in a secure location. V. MVR Program Motor Vehicle Records (MVRs) will be required on all applicants for positions involving use of a company vehicle as well as those who will use a personal vehicle to conduct company business once a month or more. The MVR will be reviewed for acceptability using objective criteria prior to assigning driving responsibilities. MVRs will also be required and reviewed for these employees on an annual basis thereafter during the 25-10

11 month of July, using the same acceptability criteria. A. MVR/Driver Eligibility and Points Classification: (Companies policy is based on the below point system.) company will review MVRs and assign a point system based on the Accident Classification Point System Point Totals Fleet Drivers 6 or less Approved Drivers 7 through 11 At-Watch Drivers 12 or more At-Risk Drivers Eligible to operate a company vehicle or a personal vehicle on company business. The driver s Company President s approval is required before the person can be assigned driver eligibility. A justification letter and documentation shall be placed in the driver s file. Drivers will also be required to complete classroom driver improvement training which may include behind-the-wheel coaching to improve current driving behavior and habits. The person is ineligible to operate a company vehicle or any vehicle (personal or rental) on company business. Driver eligibility for new employees not eligible to drive under this policy may be reconsidered after 12 months. Current drivers can be requalified in accordance with Section V-B. [Fleet drivers who lose their eligibility will be subject to termination or reassignment to a non driving position.] B. Re-qualification Current fleet drivers who are determined ineligible to operate a company vehicle or a personal vehicle on company business through an accumulation of points may re-qualify after a 6 month period. To re-qualify for driver eligibility: 1. Employees should submit a request to their immediate manager. If the manager agrees that reinstatement of driver eligibility is appropriate, the manager should send a request for requalification to the company Safety Director. Documentation related to the re-qualification request will be retained in the driver s file. 2. Reinstatement of driver eligibility requires Company President approval. 3. Before being allowed to resume driving duties a current MVR (within 30 days) will be evaluated after approval of the request for re-qualification. 4. Drivers will also be required to complete driver improvement training which may include behind-the-wheel coaching to improve current driver behavior and habits. This training must be completed prior to resuming driving duties. VI. Risk Transfer Financial responsibility for the actions or inactions of others is to be transferred to those that have the most control over a loss exposure. A. Financial Responsibility for Personal Vehicles The Company s commercial automobile policy does not provide liability coverage for people using his or her own vehicle, even though the person may be driving their vehicle on company 25-11

12 business. Employees using their personal vehicle are responsible for liability arising out of the operation of their vehicle. All drivers that drive their personal vehicles on company business, regardless of how far or how often, are required to provide proof of insurance for auto liability coverage. B. Use of Transportation Services COI s will also be required prior to using any transportation vendors, in the areas of auto liability, general liability and workers compensation insurance. Written agreements with these vendor arrangements, such as contracts and purchase orders, will also be closely reviewed prior to signing them to avoid inappropriate assumption of risk. We will rely on the advice of our legal counsel and our insurance agent in determining adequate limits of liability and contractual language prior to entering such arrangements. VII. Administration & Recordkeeping A. Vehicle Records Up-to-date records are an essential part of a complete vehicle maintenance program. Record keeping forms should serve one of four purposes showing vehicle s maintenance needs, indicating a schedule of work to be done, encouraging the driver to maintain good vehicle maintenance habits and record completed maintenance and costs. The usual types of records which cover these requirements include: 1. Monthly Vehicle Inspection Report 2. Vehicle History Folder provides a complete history of the costs of maintenance, parts, and labor associated with the vehicles 3. Confidentially of Records Every accident involving injuries or property damages could be the subject of litigation; therefore, to protect the Company and employee involved in an accident, all reports and records generated under the Accountability Policy, MVR Program, and reports and records of the Safety Committee on the causes of an accident and remedial action shall be considered Confidential and not released to third parties without the consent of the Company and/or it's attorneys in any legal action resulting from an accident. These provisions are not for the purpose of concealing facts but to allow the Company to freely investigate matters of potential litigation and to take remedial action for the benefit of all employees without waiving possible legal privileges." 25-12

13 B. Driver Records New Driver Orientation, Training and Accident Scene Reporting Checklist Subject: Completed Trainer Date Training Work Standards Employee Initials Pre-Trip Inspections Employee Initials Equipment Familiarization Employee Initials Accident Scene Reporting Follow Up Accident procedures & reporting Watched the Fleet Safety Video and completed the written comprehensive test Use of emergency equipment Employee Initials Duties & Responsibilities Sign Driver Agreement Motor Vehicle Record Accountabilities Determination of preventable accidents Disciplinary Procedures Driver license check & photocopy Exterior visual Inspection Procedures Interior visual Inspection Procedures Safety Equipment Checks Reporting Defects Securing Cargo Emergency Equipment First Aid Kit Fire extinguisher Flares or reflective triangles Protect the scene to prevent further damage and Call proper authorities Contact your Company Safety Director and immediate Supervisor after the accident Protect the scene to prevent further damage Exchange information, secure names, and telephone numbers of witnesses Take pictures per the instructions on the camera Never admit guilt and always be courteous Complete written accident report within 8 hours of the accident and forward to your company Safety Director. Be sure all lines on the accident report are completed. All incidents involving vehicles shall be reported by the company Safety Director, regardless of severity. Use of accident reporting kit found in glove compartment Determination of accident preventability Employee Initials Driver Name (Print) Driver Signature Date Signed Instructor Name (Print) Instructor Signature Date Signed 25-13

14 C. MVR Driver Consent Form I acknowledge that the information contained in the company s Fleet Management Program has been reviewed with me, and I have watched the Driver Safety Video and successfully completed the written comprehensive test. As a driver of a company vehicle or a personal vehicle for company business, I understand that it is my responsibility to operate the vehicle in a safe manner and to drive defensively to prevent injuries and property damage. I also understand that my employer will periodically review my Motor Vehicle Record to determine continued eligibility to drive a company vehicle or a personal vehicle on company business. In accordance with the Fair Credit Reporting Act, I have been informed that a Motor Vehicle Record will be annually obtained on me for continued employment purposes. I agree that the Company has the right at any time to inspect my company provided vehicle. I acknowledge the receipt of the above disclosure and authorize my employer or its designated agent to obtain a Motor Vehicle Record report. This authorization is valid as long as I am an employee or employee candidate and may only be rescinded in writing. Employee s Name (printed) Driver s License Number State Issued Employee s Signature Date Reviewer s Signature Date D. Cell Phone Use Policy Employees who have access to a cellular telephone while operating a vehicle should remember that their number one priority is driving safely and obeying the rules of the road. To insure you arrive to your destination safely, (company name) is requiring you do the following: 1. Find a safe place to pull off of the roadway and place your call. 2. If you receive a call while driving, let the call go to the voice mail, and answer when safe. Alternatively, (company name) will permit drivers using hands-free telephones to accept calls while driving. Drivers using hands-free telephones must find a safe place to pull off of the roadway to place calls I, (Employee Name printed), have read and understood the above cellular telephone policy. Employee Signature: Date: cc: Candidate or Driver file 25-14

15 E. MVR Notice of Adverse Action Form Name: Date: Address: City, State, Zip: Re: Notice of Adverse Decision Dear : Thank you for inquiring with our agency about the [enter position applicant applied for] position. Based in whole or in part on your Motor Vehicle Report (MVR), you do not qualify for this position. The factors that contribute to this decision were based on our company guidelines, specifically for drivers of company vehicles or personal vehicles to be used for Company business that do not allow for any one or a combination of the following driver infractions that you have on your driving record: [enter the applicant s infraction(s)]. The following consumer reporting agency furnished this information: [Enter name and address of agency] The consumer-reporting agency did not make this decision concerning your inquiry for employment and cannot provide you with the specific reason(s) why this decision was made. However, you have the right to obtain, under Section 612 (15 USCS 1681-j(1)) of the Fair Credit Reporting Act, a free copy of the consumer report directly from the consumer reporting agency within 60 days of your receipt of this letter by calling You also have the right to dispute the accuracy or completeness of any information in a consumer report furnished, with the consumer reporting agency, under Section 611 (15 USCS 1681-i) of the Fair Credit Reporting Act. We regret that [we are not able to offer you the position, but we wish you the best in all your future endeavors] - [you are no longer eligible to operate a company vehicle or personal vehicle on company business.] Sincerely, (Authorized Representative) Cc: Candidate or Driver file 25-15

16 F. Company Vehicle Use Agreement Employee Name & ID# (printed) Driver s License # and State Issued 1. Any driver shall be properly licensed to operate the type of vehicle assigned and driven. 2. It is Company policy that employees and passengers riding in the vehicle must wear seat belts while the vehicle is in motion. 3. The vehicle shall be maintained according to Company standards by completing section H. s form (Monthly Vehicle Inspection Report) The driver is responsible for reporting all mechanical problems to their supervisor immediately. 4. The driver is responsible for reporting all accidents, no matter how minor, immediately to their supervisor. 5. The driver will notify management at least 30 days prior to renewal of registration and state inspection. 6. The driver must have a valid driver s license for the type of vehicle to be operated, follow all license restrictions, and keep the license(s) in the drivers possession at all times while driving. If my driver s license is suspended, revoked or terminated for any reason I will notify management. 7. The employee s spouse and children are not allowed to operate the vehicle. Employee Initial 8. The employee is responsible for ensuring safe and secure parking for the vehicle at all times. 9. Hitchhikers are not permitted in the vehicle at any time. 10. The employee is responsible for all traffic and parking violations arising from the use of the Company vehicle. Should the Company be required to pay any fine after the employee terminates employment, the terminated employee shall reimburse the company within 30 days after written notice. 11. Personal use must have prior written approval by Company President. 12. Before making any modifications, or adding accessories, the driver must get management s approval. 13. Radar detectors are not allowed. Employee Initial G. Personally Owned Vehicle Business Agreement Authorization to use a personally owned vehicle for Company business is granted under the following conditions and above conditions initialed: 1. It is Company policy that employees and passengers riding in the vehicle must wear seat belts while the vehicle is in motion. 2. Any driver shall be properly licensed to operate the type of vehicle assigned and driven. 3. I will provide a Proof of Insurance upon hire and then at the beginning of each new policy period. The vehicle operated in as required by state will have the legal limit of insurance. 4. The driver shall provide a copy of the insurance certificate to management. The Company will insure that the policy does not have a business use exclusion. 5. The Company shall be informed of all vehicle accidents or moving violations while the vehicle is driven on company business. 6. The Company is authorized to review the MVR, prior to, annually, and during employment. The MVR must meet Company standards. 7. The owner of the vehicle is responsible for all mechanical repairs. 8. Drivers are not allowed to operate vehicles at any time while under the influence of alcohol or drugs. 9. The Company may terminate this agreement at any time, for any reason. Drivers will comply with all state & federal laws and regulations at all times. I have read, understand, and agree to comply with the Fleet Safety Policy and conditions for the Company Vehicle Use Agreement and Personally Owned Vehicle Business Agreement

17 Employee Signature Date 25-17

18 H. Monthly Vehicle Inspection Report This form must be completed and turned in with your time sheets or mailed by the last Friday of each month for all company vehicles and personal vehicles operated for Company business. Vehicle #: Date Mileage Assigned Driver Received By Inspection Items Problem OK Brakes a. Parking b. Fluid level c. Grinding or steering pull Comments: Tires a. Proper inflation b. Excessive wear c. Spare Comments: Engine a. Oil b. Coolant c. Transmission d. Any fluid leaks e. Washer fluid f. Gauges, warning lights g. Exhaust system Comments: Electrical a. Turn signals b. Brake lights c. Interior lights d. Headlights e. High/Low beams f. Hazard warning g. Parking lights h. Tail lights i. Horn j. Trailer brakes (if required) 25-18

19 Monthly Vehicle Inspection Report (cont d) Electrical (continued) Inspection items Problem OK Comments: Glass a. Wiper blades b. Glass condition c. Proper wiper operation d. Cleanliness Comments: Body a. Damage b. Mirrors exterior c. Mirrors rear view d. Cleanliness e. Seat belts/shoulder harness f. ID#, Logos, Decals Comments: Safety Equipment a. First-aid kit b. Travel hitch (if required) c. Warning devices d. Insurance card/registration e. Accident reporting kit f. Camera g. Fire extinguisher (if required) Comments: Failure to submit, incomplete or falsify information on this report can result in loss of driving privileges. Employee Signature: Date: Fleet Manager: Date: 25-19

20 I. Driver Orientation Quiz Please select the correct answer for each question. 1. Who is allowed to operate a company vehicle? a. Any properly licensed family member of the employee b. Any company employee c. Authorized company employees d. All of the above 2. How often will MVR s be reviewed? a. Monthly b. Annually c. Semi-annually d. After an accident e. Both b and d f. Both a and d 3. While driving a van in ideal conditions, what is the recommended following distance from the vehicle in front? a. 1 second b. 2 seconds c. 3 seconds d. 4 seconds 4. When parking, you should; a. Avoid backing if possible b. Back into the parking space c. Park in a safe and legal area d. All of the above 5. Collisions with fixed objects are considered; a. Preventable b. Non-preventable 6. Whose responsibility is it to report an unsafe vehicle? a. Driver b. Supervisors c. Safety representative d. Company President 7. What is the number 2 cause of work place fatalities? a. Falls from ladders b. Vehicle accidents c. Electrical shock d. Violence on the job 8. Any company driver whose license has been revoked or suspended must: a. Notify your manager or supervisor within 30 days b. Notify your manager or supervisor immediately, and discontinue driving c. Discontinue driving only if your manager or supervisor requests you to d. Continue driving until you receive a letter from the corp. office 9. If you are involved in an accident, you must report it immediately to: a. The insurance company b. Corp. office c. Immediate supervisor d. All of the above 10. If you receive a call on your cell phone while driving, you should: a. Answer it b. Use a hands free device c. Pull off the road when it is safe and return the call Name: Date: Company: 25-20

21 Score ORDER FORM J. Order Form This order form is for the Drivers Safety video. This video will be supplied on VHS videotape, Computer CD and DVD in English and Spanish. Please mark the number of each that you would like and fax to (281) along with credit card information or mail to the address below with check or credit card. Bayou City Productions, Inc Brittmoore Park Dr. Houston, Texas Please supply your mailing address below. If you have any questions, please call Trish Coyne at Quantity Type Per Unit Cost Totals VHS (English) X $6.75 $ VHS (Spanish) X $6.75 $ CD (English) X $5.00 $ CD (Spanish) X $5.00 $ DVD (English) X $15.00 $ DVD (Spanish) X $15.00 $ Price subject to change Shipping & Handling $ TOTAL AMOUNT $ Credit Card Information: # Date: Company Name: 25-21

22 Mailing Address: City, State, Zip Code Contact Name: Phone # K. VEHICULAR ACCIDENT REPORT Must be completed by a Supervisor or Safety Manager Incomplete forms will delay processing. Please make sure that all blanks have a response. If substance abuse testing occurs, then the form must be completed after all testing is complete. (Print all responses.) Driver Information: Today s Date: IES Company: IES Safety Manager: Driver s Name: Driver s License #: Length of Employment: Driver s Address: City: State: Zip: County: Phone No.: Cell No.: Driver s Date of Birth: Job Title: Used with Permission: Purpose of Use: Unit 1 Vehicle Information (Insured Driver): Vehicle No.: Year: Make: Model: VIN: Insurance Co.: Does the vehicle require towing? Policy No.: ( ) Yes ( ) No Description of damage(s): Unit 2 Vehicle Information : Owner of vehicle: Driver of vehicle: Address: Home No.: Address: Home No: City: State: Cell No.: City: State: Cell No: Zip: County Zip: County: Year: Make: Model: Vin No.: Insurance Co.: Policy No.: Does the vehicle require towing? ( ) Yes ( ) No Towing location: Description of damage(s): Unit 3 Vehicle Information: Owner of vehicle: Driver of vehicle: Address: Home No.: Address: Home No: City: State: Cell No.: City: State: Cell No: Zip: County Zip: County: Year: Make: Model: Vin No.: 25-22

23 Insurance Co.: Policy No.: Does the vehicle require towing? ( ) Yes ( ) No Towing location: Description of damage(s): Unit 4 Vehicle Information: Owner of vehicle: Driver of vehicle: Address: Home No.: Address: Home No: City: State: Cell No.: City: State: Cell No: Zip: County Zip: County: Year: Make: Model: Vin No.: Insurance Co.: Policy No.: Does the vehicle require towing? ( ) Yes ( ) No Towing location: Description of damage(s): ACCIDENT INFORMATION Accident Date (MM/DD/YY): Time of Accident AM PM Accident location: City: State: Zip Code: Type of movement: ( ) Pick-up ( ) Delivery ( ) Personal Time ( ) Other, please explain: ( ) To job site ( ) From job site Weather Condition: ( ) Clear ( ) Cloudy ( ) Rain ( ) Snow ( ) Fog ( ) Sleet ( ) Other, if other explain: Road Surface: ( ) Wet ( ) Dry ( ) Uneven road surface ( ) Ice ( ) Concrete ( ) Asphalt ( ) Gravel ( ) Other, please explain: Lanes divided? ( ) Yes ( ) No Traffic control device? Number of hours on duty at time of accident? Number of hours driving: Give a detailed description of accident. You can use page 3 to draw a diagram of accident: Were there any injuries? ( ) Yes or ( ) No. If yes, to whom? 1. Name of injured party: Telephone Number: Were injuries fatal? ( ) Yes or ( ) No Do injuries require treatment away from accident scene? ( ) Yes or ( ) No Injured party s address: City State Zip Code What vehicle was injured person in? ( ) Unit 1 ( ) Unit 2 ( ) Unit 3 ( ) Unit 4 ( ) Other If other, please explain: Was injured party taken to the hospital? ( ) Yes or ( ) No Name of hospital: Give brief description of injuries: 25-23

24 2. Name of injured party: Telephone Number: Were injuries fatal? ( ) Yes or ( ) No Do injuries require treatment away from accident scene? ( ) Yes or ( ) No Injured party s address: City State Zip Code What vehicle was injured person in? ( ) Unit 1 ( ) Unit 2 ( ) Unit 3 ( ) Unit 4 ( ) Other If other, please explain: Was injured party taken to the hospital? ( ) Yes or ( ) No Name of hospital: Give brief description of injuries: 3. Name of injured party: Telephone Number: Were injuries fatal? ( ) Yes or ( ) No Do injuries require treatment away from accident scene? ( ) Yes or ( ) No Injured party s address: City State Zip Code What vehicle was injured person in? ( ) Unit 1 ( ) Unit 2 ( ) Unit 3 ( ) Unit 4 ( ) Other If other, please explain: Was injured party taken to the hospital? ( ) Yes or ( ) No Name of hospital: Give brief description of injuries: Other Information: Was there any property damage? ( ) Yes or ( ) No If yes, give brief description: Property damage address: City State: Zip: Were the police called? ( ) Yes or ( ) No Did the police respond? ( ) Yes ( ) No Police report #: Officer: Was a citation issued? ( ) Yes or ( ) No If yes, to whom? Citation Description: Was drug testing administered? ( ) Yes or ( ) No Was alcohol testing administered? ( ) Yes or ( ) No Chain of Custody No.: Forward a copy of the following items & place a check mark next to the item to indicate that you have sent it: Witnesses: ( ) Driver logs (If DOT accident) ( ) DVIR ( ) Driver s Manifest ( ) Police Report ( ) Photos ( ) Other Name: Address: Home Phone No.: Work Phone No.: Cell Phone No.: Name: Address: Home Phone No.: Work Phone No.: Cell Phone No.: Other Comments: 25-24

25 Person completing form: Title: Date: 25-25