TM

Fleet Management Policy (LONG)

Disclaimer:
The information contained in this publication was obtained from sources believed to be reliable. LGRMS make no
representations or guarantee as to the correctness or sufficiency of any information contained herein, nor a guarantee of
results based upon the use of this information and disclaims all warranties expressed or implied regarding merchantability,
fitness for use and fitness for a particular purpose. LGRMS does not warrant that reliance upon this document will prevent
accident and losses or satisfy federal, state and local codes, ordinances and regulations. You assume the entire risk as to
the use of this information.
 Fleet Management Policy (LONG)

Table of Contents
1. Motor Vehicle Safety Policy
2. Organization and Responsibilities
3. Vehicle Use
4. Driver Selection
5. Accident Recordkeeping, Reporting and Analysis
6. Employee Accident Reporting Procedure
7. Accident Review Board
8. Vehicle Selection, Inspection and Maintenance
9. Driver Training
10. Driver Safety Regulations

XI. APPENDIX
1. Vehicle Assignment Agreement
2. Application Addendum for Employment Requiring Driving
3. Guide for Preventable and Non-preventable Accidents
4. Vehicle Inspection Report
MOTOR VEHICLE SAFETY POLICY

1. Policy

Many employees operate entity owned, leased, rental or personal vehicles as part of their jobs. Employees are expected
to operate vehicles safely to prevent accidents which may result in injuries and property loss. It is the policy of (INSERT
Member Name Here) to provide and maintain a safe working environment to protect our employees and the citizens of the
communities where we conduct business from injury and property loss. We considers the use of automobiles part of the
working environment. We are committed to promoting a heightened level of safety awareness and responsible driving
behavior in its employees. Our efforts and the commitment of employees will prevent vehicle accidents and reduce
personal injury and property loss claims. This program requires the full cooperation of each driver to operate their vehicle
safely and to adhere to the responsibilities outlined in the Motor Vehicle Safety Program.

Elements of this program include:

 Assigning responsibilities at all levels of employment.
 Vehicle use and insurance requirements.
 Employee driver's license checks and identification of high risk drivers.
 Accident reporting and investigation.
 Accident Review Board.
 Vehicle selection and maintenance.
 Training standards.
 Safety regulations.

2. Responsibility

Leadership / Management is responsible for successful implementation and on-going execution of this program.
Supervisors and employees are responsible for meeting and maintaining the standards set forth in this program.

3. Scope

This policy applies to employees who operate vehicles on business and will be reviewed by managers and supervisors to
ensure full implementation and compliance.
ORGANIZATION AND RESPONSIBILITIES

1. (Insert Job Title of Entity’s top leader) :

The (Insert Job Title of Entity’s top leader) is responsible for directing an aggressive vehicle safety program.

2. Management will:
a. Implement the Motor Vehicle Safety Program in their areas of responsibility.
b. Establish measurement objectives to ensure compliance with the program.
c. Provide assistance and the resources necessary to implement and maintain the program.

3. Supervisors will:
a. Investigate and report all accidents involving a motor vehicle used in performing business. Forward all
accident reports to the Vehicle Safety Coordinator.
b. Be responsible for taking appropriate action to manage high risk drivers as defined by this program.
c. Provide driver training either internally or through external means for high risk drivers.

4. Vehicle Safety Coordinator:

a. Issue periodic reports of losses for the (Insert Job Title of Entity’s top leader) review.
b. Review motor vehicle accident reports as part of the Accident Review Board.
c. Revise and distribute changes to the Motor Vehicle Safety Program to managers, supervisors and drivers
as necessary.
d. Maintain appropriate records.

5. Drivers will:
a. Always operate a motor vehicle in a safe manner as explained under the section titled, "Driver Safety
Regulations".
b. Maintain a valid driver's license and minimum insurance requirements on personal vehicles used during
business.
c. Maintain assigned vehicles according to established maintenance standards.
VEHICLE USE

1. Entity Owned Vehicles

a. Passenger Cars
Employees authorized by their supervisors will be permitted to operate a passenger car. When the
vehicle is driven for personal use, only the employee or the employee's spouse will be permitted to
operate the vehicle. No one under the age of 21 will be permitted to operate the vehicle.

b. Commercial Vans and Trucks

Employees with appropriate commercial driver's license (if required by the state), authorization from their
supervisor and qualified by state and Federal DOT when applicable will be permitted to operate the
vehicle.

2. Personal Vehicles on Business

a. Employees who drive their personal vehicles on business are subject to the requirements of this program
including:
i. Maintaining auto liability insurance with minimum limits of $__________ for bodily injury and
$_____ for property damage with combined single limit of $______.
ii. Maintain current state vehicle inspections when required.
iii. Maintain their own vehicle in a safe operating condition when driven on business.
iv. Proof of insurance (copy of declaration page) will be sent to ______________
v. Acceptable Motor Vehicle Report (MVR).
vi. No ‘business use’ exclusion on personal insurance policy.

3. Rental Vehicles
a. Rental vehicles will be leased from (INDICATE VENDORS SUCH AS HERTZ, AVIS, ETC..).
b. Collision damage waiver will be refused.

4. Unauthorized Use of Vehicles

Assigned drivers and other authorized employees will not allow an unauthorized individual to operate a
entity vehicle. No exceptions! Disciplinary action may be taken. Additionally, if unauthorized use results in
an accident, the responsible employee will be required to make restitution for the damages.

5. Contractors and Temporary Hire Employees

Contractors and temporary employees will be treated as employees and will comply with the requirements of this
program. Failure to meet all requirements will result in the immediate loss of driving privileges.
DRIVER SELECTION

1. Driver Evaluation:
Employees will be evaluated and selected based on their driving ability. To evaluate employees as drivers,
management will:
a. Review past driving performance and work experience through previous employer’s reference checks. All
new employees and current employees recently assigned to driving duties will be required to complete
the "Application Addendum for Employment Requiring Driving".
b. Review the employee's Motor Vehicle Record (MVR) annually (more frequently if reasons warrant).
c. Ensure the employee has valid driver's license.
d. Ensure the employee is qualified to operate the type of vehicle he/she will drive.

2. Driver Qualification:
Effective driver qualification controls are important elements of a successful motor vehicle safety program.
Management developed and incorporated standards into this program, which reflect the skills necessary for
satisfactory job performance while taking into consideration applicable Federal and state regulations.
a. The entity has implemented three levels of driver qualification criteria. Use of any or all of these criteria is
dependent upon the nature and scope of the driving requirements.
1. State-regulated driver qualification parameters must be met. Regulatory information will be
obtained from applicable state departments of transportation and motor vehicle services.
2. Where applicable, drivers will comply with DOT Commercial Driver License (CDL) regulations.
3. Drivers involved in interstate or foreign commerce in vehicles with Gross Motor Vehicle Weight
Rating (GMVR) of 10,001 pounds or more, designed to transport 16 or more passengers,
including the driver, or used in the transportation of hazardous materials in a quantity requiring
placarding under the DOT Hazardous Highway Administration's Federal Motor Carrier Safety
Regulations.
4. Drivers involved in intra or interstate operations with GMVR of 26,001 pounds or more must
have a CDL license and be enrolled in a DOT Drug and Alcohol Testing Program.

b. The following criteria was established to identify high risk drivers. A driver is unacceptable if the driver's
accident/violation history in the past year includes one or more of the following moving violation
convictions:
1. Driving under the influence of alcohol or drugs (DWI).
2. Hit and run.
3. Failure to report an accident.
4. Negligent homicide arising out of the use of a motor vehicle.
5. Operating during a period of suspension or revocation.
6. Using a motor vehicle for the commission of a felony.
7. Operating a motor vehicle without the owner's authority.
8. Permitting an unlicensed person to drive.
9. Reckless driving.
10. Speeding (3 or more in a 3 year period).
11. Two preventable accidents in a 12 month period.

Drivers who are identified as high risk or in violation may be subject to several actions from management
including, but not limited to:
1. Driver may be required to attend a Defensive or Safety Driving course on their own time & expense.
2. Driver may be required to operate their own personal vehicle on business.
3. Driver may have their driving privileges suspended or revoked.
ACCIDENT RECORDKEEPING, REPORTING AND ANALYSIS

1. This entity considers elimination of motor vehicle accidents as a major goal. To meet this objective, all accidents
will be reported to management, investigated, documented and reviewed by the Entity Accident Review Board.
The investigation identifies need for:
a. More intensive driver training and/or remedial training.
b. Improved driver selection procedures.
c. Improve vehicle inspection and/or maintenance activities.
d. Changes in traffic routes.
e.
2. Motor vehicle accident recordkeeping procedures consist of the following components:
a. Documentation of causes and corrective action.
b. Management review to expedite corrective action.
c. Analysis of accidents to determine trends, recurring problems and the need for further control measures.

3. Responsibility:
Implementation of these procedures remains the responsibility of both the driver and manager.

a. Driver
Since the driver is the first person at the accident scene, he/she will initiate the information-gathering
process as quickly and thoroughly as is feasible.

b. Management
Management will obtain accident data from the driver through the Transportation Accident Report form
and/or by verbal communication. It is important for management to determine the extent of the accident,
especially if it involves injury or death to the driver, passengers, or other parties.
c. Management will immediately proceed with a formal investigation to determine the underlying causes as
well as what can be done to prevent similar occurrences. The accident report will be forwarded to the
insurance claims office along with any additional support data (e.g., witness statements, photographs,
police reports, etc.).

4. Driver Participation In Repair Costs:

If a vehicle is involved in an accident which is determined preventable, driver reimbursement to the entity should
be as follows:
a. The first 50% of the repair cost, up to a maximum reimbursement of $250 per accident, if the vehicle is
repairable, will be charged back to the driver.
b. If the vehicle is a total loss, the driver will be charged $250.

5. Preventable/Non-Preventable Accidents:
The following definitions relate to motor vehicle accidents:
a. A motor vehicle accident is defined as "any occurrence involving a motor vehicle which results in death,
injury or property damage, unless such vehicle is properly parked. Who was injured, what property was
damaged and to what extent, where the accident occurred, or who was responsible, are not relative
factors".
b. A preventable accident is defined as "any accident involving the vehicle, unless properly parked, which
results in property damage or personal injury and in which the driver failed to do everything he/she
reasonably could have done to prevent or avoid the accident".

NOTE 1: A properly parked motor vehicle is one that is completely stopped and parked where it is legal and
prudent to park such a vehicle or to stop to load/unload property. Vehicles stopped to load/unload
passengers is not considered parked.

NOTE 2: Parking on private property will be governed by the same regulations that apply on public streets
and highways. A vehicle stopped in traffic in response to a sign, traffic signal or the police is not considered
parked.

c. The determination of preventability of an accident is the function of the Accident Review Board.

NOTE 3: See attached "Guide for Preventable and Non-preventable Accidents" in Appendix.
EMPLOYEE ACCIDENT REPORTING PROCEDURE

Employees will take the following actions when there are injuries to persons and/or damage to other vehicles or property:
1. If possible, move the vehicle to a safe location out of the way of traffic. Call for medical attention if anyone is
hurt.
2. Secure the names and addresses of drivers and occupants of any vehicles involved, their operator's license
numbers, insurance company names and policy numbers, as well as the names and addresses of injured
persons and witnesses. Record this information on the Accident Report form (in the reporting packet). Do not
discuss fault with, or sign anything for anyone except an authorized representative of (INSERT Member Name
Here), a police officer, or a representative of the (INSERT Member Name Here)
3. Immediately notify the Vehicle Safety Coordinator (INSERT Member Name Here). If any injuries were involved
and the Vehicle Safety Coordinator is not available, contact your supervisor immediately.
4. You will be contacted by the Vehicle Safety Coordinator to advise you how to arrange for repairs to the vehicle.
Do not have the vehicle repaired until you receive authorization from the Vehicle Safety Coordinator.

When there is theft of or damage to your vehicle only:

1. If you did not witness the damage to the vehicle, you must notify the local police department immediately.
2. Immediately notify Vehicle Safety Coordinator (INSERT Member Name Here).
3. You will be contacted by the Vehicle Safety Coordinator to advise you how to arrange for repairs or replacement
of the vehicle. Do not have the vehicle repaired until you receive authorization from the Vehicle Safety
Coordinator.
4. Send a copy of the police report along with a memo outlining any additional information to the Vehicle Safety
Coordinator.
Note: Accident reporting kits: every vehicle should have an accident reporting kit in the glove box. This should
include an accident report form, pen or pencil, and an inexpensive or disposable camera.
ACCIDENT REVIEW BOARD

All vehicle collisions should be analyzed, and a written report submitted to management for review. A determination of
accident preventability should be made. Where the collision was preventable by the entity driver, the driver should be
counseled, given additional training, given time off without pay, placed on probation, transferred to non-driving duties,
disciplined in other ways, or employment (or services for independent contractors) terminated according to corporate,
union, and governmental guidelines.

However, this does not absolve management from improving safety of the work and driving environment. The Vehicle
Safety Coordinator, drivers and management personnel should each participate in the analysis. Management deficiencies
and/or lack of management action should also be part of the accident review. Management has the legal obligation not
only for driver safety but the safety of the general public as well.

To determine preventability an accident review board has been established. Members consists of both management and
field personnel. Their main charge, of the review board, is to determine whether the fleet accident was preventable or non-
preventable and whether or not it is chargeable to the driver.

The attached material, "Guide for Preventable and Non-preventable Accidents", will be used as a guide for this
determination. Majority vote rules.

The committee will report to the Vehicle Safety Coordinator within 3 working days the results of their review. The Vehicle
Safety Coordinator will take the appropriate steps and communicate the results to the affected driver and supervisor.
VEHICLE SELECTION, INSPECTION AND MAINTENANCE

1. Introduction:
Proper selection and maintenance of equipment are important aspects of this program. Reduced operational
costs and accidents from vehicle defects are the direct result of a well implemented maintenance policy.

2. Vehicle Selection:
Selection of vehicles begins with understanding the wrong equipment can result in excessive breakdowns,
create hazards to personnel, incur costly delays and contribute to poor service and customer complaints. The
entity will purchase vehicles designed for their intended use.

3. Vehicle Inspection:
The employee responsible for the vehicle will inspect the vehicle semi-annually using the Vehicle Inspection
Report form (see appendix) and forward the report to the Vehicle Safety Coordinator. More frequent inspections
and reports may be required based on heavy use.

4. Vehicle Maintenance:
Vehicle maintenance can take the form of three distinct programs: preventive maintenance, demand
maintenance, and crisis maintenance. While all three types have their role in the Motor Vehicle Safety Program,
the most cost effective control is preventive maintenance. The groundwork for a good preventive maintenance
program starts with management. A review of manufacturer's specifications and recommendations for periodic
preventive maintenance should be integrated with the actual experience of the vehicles.
a. Preventive maintenance (PM) is performed on a mileage or time basis. Typical PM includes oil/filter
changes, lubrication, tightening belts and components, engine tuneups, brake work, tire rotation, hose
inspection/replacement and radiator maintenance.
b. Demand maintenance is performed only when the need arises. Some vehicle parts are replaced only
when they actually fail. These include light bulbs window glass, gauges, wiring, air lines, etc. Other
"demand maintenance" items involve vehicle components that are worn based on information from the
vehicle condition report. These include tires, engines, transmissions, universal joints, bushings, batteries,
etc. Since these situations are identified through periodic vehicle inspection, they can actually be
classified within the PM program.
c. Crisis maintenance involves a vehicle breakdown while on the road. While situations of this type may
happen regardless of the quality of the PM program, it is an expensive alternative to not having an
effective preventive maintenance program at all. Crisis maintenance situations should be minimized
through proper PM procedures.

5. Recordkeeping:
This entity's vehicle selection, inspection and maintenance program is only as good as its recordkeeping
procedures. Employees will forward all vehicle maintenance records for maintenance performed each quarter to
the Vehicle Safety Coordinator.
DRIVER TRAINING

1. Drivers hired by this entity to operate a motor vehicle will have the basic skills and credentials necessary to
perform this function as confirmed through the driver selection process.

2. New employees, contractor, and temporary hires will receive a copy of this program as part of their initial
orientation. A formal orientation program is established to help assure all drivers are presented with the policy,
understand their responsibilities and are familiarized with their vehicle. Areas that must be addressed, with the
driver, include:
a. Understand, review and given a copy of the Fleet Safety Program.
b. Understand and sign the Vehicle Assignment Agreement.
c. Review individual Motor Vehicle Report (MVR).
d. Understand accident reporting & emergency procedures.
e. Review operation and controls of vehicle being assigned.
f. Inspect vehicle using Vehicle Inspection Form.

A copy of this program will be kept in the vehicle.

3. License Suspension:
Drivers must notify the Vehicle Safety Coordinator if their license is suspended or revoked.

4. Remedial Training:
Drivers may be required to attend a safe driving school (National Safety Council Defensive Driving course of
equivalent) or an alcohol/drug abuse program on their own time and at their own expense if a review of the
driver's MVR indicates:
a. One or more violation convictions within any one-year period, or
b. A conviction for driving while under the influence of alcohol or drugs.
Also, depending on the severity of the conviction, the employee's driving privileges may be revoked and/or may
result in employment termination.
DRIVER SAFETY REGULATIONS

1. Safety Belts:
The driver and all occupants are required to wear safety belts when the vehicle is in operation or while riding in a
vehicle. The driver is responsible for ensuring passengers wear their safety belts. Children under four years of
age or under 40-pounds in weight must be secured in a DOT approved child safety seat.

2. Impaired Driving:
The driver must not operate a vehicle at any time when his/her ability to do so is impaired, affected, influenced by
alcohol, illegal drugs, prescribed or over-the-counter medication, illness, fatigue or injury.

3. Traffic Laws:
Drivers must abide by the federal, state and local motor vehicle regulations, laws and ordinances.

4. Vehicle Condition:
Drivers are responsible for ensuring the vehicle is maintained in safe driving condition. Drivers of daily rentals
should check for obvious defects before leaving the rental office/lot and, if necessary, request another vehicle of
the first vehicle is deemed unsafe by the employee. Drivers are encouraged to rent vehicles equipped with air
bags and ABS brakes, where available.

5. Cellular Telephones /PDA:

Option A): Using a cell phone while driving increases the risk of a crash by four times, and texting
increases crash risk by 23 times. Employees must refrain from using PDAs and cell phones, either
hand-held or hands-free, while operating a motor vehicle. Employees must not initiate or respond to
phone calls, read or respond to text messages or emails while driving a passenger or commercial
vehicle. Employees who need to make an emergency call while on the road must first park the vehicle
in a safe location.

Option B) The following procedures apply to employees driving on business who wish to use cellular telephones
in the vehicle.
a. External speaker and microphone must be included to allow hands-free operation.
b. Phone number memory and programming capabilities are to be included.
c. Drivers are to refrain from placing outgoing calls or responding to pagers while the vehicle is in motion.
d. Incoming calls should be limited.
e. For any vehicle equipped with cellular telephone that does not meet the above equipment specifications,
use of the telephone/pager is authorized when the vehicle is safely parked.
f. Employees are prohibited from using a Walkman or similar device while operating a motor vehicle.

6. Motorcycles:
Employees are prohibited from using motorcycles when traveling on business.

7. General Safety Rules:

 Starting
o Conduct pre-use inspection
o Use seatbelts at all times 7
o Adjust seat & mirrors before starting vehicle
o Allow a 15 second warm up time
o Check for warning lights

 Driving
o Do not drive if drowsy
o Think ahead - anticipate hazards
o Don't trust the other driver to drive properly
o Don't speed or tailgate
o Drive slower in hazardous conditions or hazardous areas
o Pass only in safe areas and when excessive speed is not required
o No loose articles on floor
o Do not read, write, apply make-up, drink, eat or use a phone while driving
o Do not talk on a cell phone while driving
o Stay at least three seconds behind the vehicle ahead
o Do not stop for hitchhikers or to provide roadside assistance
  Backing
o Back slowly & be ready to stop
o Do not back up if anyone is in path of vehicle travel
o Check clearances
o Don't assume people see you
o Get out & check if you cannot see from the driver's seat

 Stopping
o Park only in proper areas, not roadsides
o Use warning flashers & raise hood if vehicle becomes disabled

 Accidents
o Do not admit responsibility
o Notify our company and law enforcement as soon as possible Cooperate with any law enforcement
officers Move the vehicle only at the direction of a law enforcement officer Fill out all sections of the
accident report in the glove box Do not sign any forms unless required by a law enforcement officer
At the scene get the following information:
 Investigating officer name and law enforcement agency
 Make, Model & License Plate number of other vehicles
 Names, addressed and phone numbers of all witnesses
 Name, address & license of other drivers
 Photos of accident using camera in glove box
 all 4 sides of all vehicles
 roads and intersection at the scene
 interior of all vehicles - seating & floor areas

 Employees are not permitted to:

o Pick up hitchhikers.
o Accept payment for carrying passengers or materials.
o Use any radar detector, laser detector or similar devices.
o Push or pull another vehicle or tow a trailer.
o Transport flammable liquids or gases unless a DOT or Underwriters' Laboratories approved
container is used, and only then in limited quantities.
o Use of burning flares will be discouraged. The preferred method is the use of reflective triangles.
o Assist disabled motorists or accident victims beyond their level of medical expertise. If a driver is
unable to provide the proper medical care, he/she must restrict his/her assistance to calling the
proper authorities. Your safety and well-being is to be protected at all times.

8. Entity and Personal Property:

Employees are responsible for entity property such as computers, work papers and equipment under their control.
The entity will not reimburse the employee for stolen personal property.
APPENDIX

Forms/Attachments
 Vehicle Assignment Agreement
 Application Addendum for Employment Requiring Driving
 Guide for Preventable and Non-preventable Accidents
 Vehicle Inspection Report
 Distraction-free driving policy
VEHICLE ASSIGNMENT AGREEMENT

The undersigned hereby acknowledges receipt of a entity-owned or leased automobile. I understand this vehicle is to be
regularly maintained and serviced, according to the service schedule outlined in the Owner's Manual or the instructions
issued by the Vehicle Safety Coordinator, whichever is appropriate.

Further, it is agreed this vehicle will be operated in a safe manner. I agree to wear my seat belt whenever the vehicle is in
motion and will require other occupants to do so. I agree to be responsible for all traffic and parking violations that occur
while the vehicle is assigned to me. I understand articles of this agreement apply regardless of who is operating this
vehicle. I may authorize others to drive this vehicle according to the following guidelines:
 Licensed spouse except if under 21 years of age.
 Licensed employees of (INSERT Member Name Here) or its subsidiaries or affiliates.
 Other licensed drivers as I so designate in emergency situations only.

I agree to promptly report all accidents or incidents resulting in injury or damage to the vehicle or other property, no matter
how slight.

I understand I am required to maintain a valid driver's license. Further, I herewith grant (INSERT Member Name Here) the
right to investigate may motor vehicle driving record any time. My current driver's license is issued from the State of
(STATE NAME) and is No._________. I understand that I am responsible for my own license plate renewal, the cost of
which will be reimbursed by the entity. (Optional)

If my driving record contains two moving violations within one-year period, my record will be brought up before the
Accident Review Board for consideration of remedial training and/or loss of driving privileges.

I will be required to attend a safe driving class on my own time and at my expense, and to provide the Vehicle Safety
Coordinator with confirmation of attendance within thirty days of notification if decided by the review board.

I understand I am not to modify the vehicle in any way without written permission. This specifically applies to the
installation of cellular telephones, radios, CBs, speakers, etc. Further, trailer hitches and towing trailers are specifically
prohibited. Further, I will not take this vehicle out of the United States without written permission from the Vehicle Safety
Coordinator.

I agree to reimburse the entity for damages done to this vehicle because of my negligence. In the event of an accident,
which has been determined to have been my fault by citation, traffic court conviction, by my own admission, or
determination by management, I recognize that I am responsible for the first 50% of the repair cost, up to a maximum
reimbursement of $250 per accident, if the vehicle is repairable. If the vehicle is a total loss, I agree to be responsible for
$250 as reimbursement for the loss.

I understand the operation of this vehicle in a safe operating condition is my responsibility. If this vehicle becomes unsafe,
it is my responsibility to notify my supervisor immediately. I read and agree to the provisions of this Vehicle Assignment
Agreement and the requirements of the Motor Vehicle Safety Program.

____________________________ _____________
SIGNATURE DATE

VEHICLE ASSIGNED: _________________________

VIN NUMBER: _______________________________

PLATE NUMBER: _____________________________

MILEAGE: ___________________________________
OTHER DRIVERS
The undersigned agree to comply with the requirements of this Agreement, The Vehicle Safety Rules and the Vehicle
Safety Program. (This section is to be completed by the employee's spouse and any other employees of the entity who
seek eligibility to operate the entity vehicle.)
Name (Print) Signature/Date License # ST Birthdate SS #
_____________ _______________ _______________ ___ _________ ________________
_____________ _______________ _______________ ___ _________ ________________
_____________ _______________ _______________ ___ _ ________ ________________
APPLICATION ADDENDUM FOR EMPLOYMENT REQUIRING DRIVING

ENTITY ______________________________________________________________________________
ADDRESS _______________________________________________________________________________
NAME _______________________________________ PHONE: ( _____ ) ________________________
First Middle Last
DRIVER LICENSES: (list all licenses held in past 3 years and indicate those that are current)
STATE LICENSE NUMBER CLASS ENDORSEMENT(S) EXPIRATION
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Have you ever been denied, or had revoked or suspended any license, permit, or privilege to operate a motor vehicle?
Yes _____ No _____
If you answered YES to the above questions, give details: (if additional space is needed, attach sheet)
TRAFFIC CONVICTIONS AND FORFEITURES FOR PAST 3 YEARS: (Other than parking)
LOCATION
(CITY & STATE) DATE CHARGE PENALTY
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
DRIVING EXPERIENCE:
DATES
CLASS OF EQUIPMENT FROM TO APROX. NO. OF TOTAL MILES

Automobile _______________________________________________________________________________
Van/Pickup _______________________________________________________________________________
Truck/Tractor _____________________________________________________________________________
Bus _____________________________________________________________________________________
Other (Specify) ____________________________________________________________________________

ACCIDENT RECORD FOR PAST 3 YEARS: (if additional space is needed, attach sheet)
DATE LOCATION NATURE OF ACCIDENT FATALITIES INJURIES
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

GENERAL:
Have you ever been convicted of a felony? Yes _____ No _____
Have you ever been refused bond Yes _____ No _____

If you answered YES to either question, give details: (if additional space is needed, attach sheet)

LIST SPECIAL TRAINING RELATED TO TRANSPORTATION:

(If additional space is needed, attach sheet)

TO BE READ AND SIGNED BY APPLICANT:

This certifies that this application was completed by me, and that all entries on it and information in it are true and
complete to the best of my knowledge. I understand that, if hired, any misrepresentation of information in this application
is cause for immediate dismissal. I authorize (INSERT Member Name Here) to investigate my background to ascertain all
information of concern to my employment history, whether same is of record or not, and release those providing such
information from all liability for any damages resulting from furnishing this information. Further, I understand that I may be
asked to demonstrate my ability to perform the essential functions necessary to complete the job and, if offered the job,
that it may be conditioned on results of a physical examination, and controlled substances and alcohol misuse test.

DATE _____________________ APPLICANT'S SIGNATURE _____________________________________

GUIDE FOR PREVENTABLE OR NONPREVENTABLE ACCIDENTS

An accident is preventable if the driver could have done something to avoid it. Drivers are expected to drive defensively.
Which driver was primarily at fault, who received a traffic citation, or whether a claim was paid has absolutely no bearing
on preventability. If there was anything the driver could have done to avoid the collision, then the accident was
preventable.

An accident is non-preventable when the vehicle was legally and properly parked, or when properly stopped because of a
law enforcement officer, a signal, stop sign, or traffic condition.

If a stationary object is struck, then it is usually a preventable incident. If the driver rear-ends another vehicle then it is
usually a preventable incident. It should be noted there are exceptions to any rule, but they are just that - exceptions!

It should be the objective of any person discussing or judging accidents to obtain as many facts as possible and to
consider all conceivable conditions. Adverse weather conditions, actions of other drivers, or other such excuses must not
influence the judgment of preventability. If procedures, scheduling, dispatching, or maintenance procedures out of the
control of the driver were found to be factors, that should be taken into account. The entity must take responsibility for the
work environment and recognize that drivers cannot control some aspects. It is critical that drivers have the ability to
refuse to operate an unsafe vehicle without reprisal from management.

Professional drivers are expected to drive in a manner which allows them to avoid conflicts when they arise. Whether a
driver has a 25-year safe driving record, or started driving the day before has no bearing on whether an accident is or is
not preventable. Taking a fair attitude does not mean leniency. If an accident is judged non-preventable and the drivers
know the accident could have been avoided, they will lose respect for the safety program.
QUESTIONS TO CONSIDER - GENERAL

When judging or discussing preventable accidents, these are some questions to consider:
1. Does the report indicate that the driver considers the rights of others or is there evidence of poor driving habits
which need to be changed?
2. Does the report indicate good judgment? Such phrases as "I did not see," "I didn't think," "I didn't expect," or "I
thought" are signals indicating there is something wrong. An aware driver should think, expect, and see
hazardous situations in time to avoid collisions.
3. Was the driver under any physical handicap which could have been contributory? Did the accident happen near
the end of a long and/or hard run? Does the driver tend to overeat? Did the driver get sufficient sleep before the
trip? Is the driver's vision faulty?
4. Was the vehicle defective without the driver's knowledge? A gradual brake failure, a car which pulls to the left or
right when the driver applies the brakes, faulty windshield wipers, and similar items are excuses, and a driver
using them is trying to evade responsibility. Sudden brake failure, loss of steering, or a blowout may be
considered defects beyond the driver's knowledge; however, the inspection and maintenance program should
work to prevent these hazards.
5. Would taking a route through less congested areas reduce the hazardous situations encountered?
QUESTIONS TO CONSIDER
SPECIFIC TYPES OF ACCIDENTS

Intersection Collisions
Failure to yield the right-of-way, regardless of stop signs or lights, is preventable. The only exception to this is when the
driver is properly proceeding at an intersection protected by lights or stop signs and the driver's vehicle is struck in the
extreme rear, side, or back.

Regardless of stop signs, stop lights, or right-of-way, a professional driver should recognize that the right-of-way belongs
to anyone who assumes it and should yield accordingly. In addition, a professional driver is expected to know the turning
radius of the vehicle and be able to avoid damaging others. These accidents are normally considered preventable.
1. Did the driver approach the intersection at a speed safe for conditions?
2. Was the driver prepared to stop before entering the intersection?
3. At a blind corner, did the driver pull out slowly, ready to apply the brakes?
4. Did the driver operate the vehicle correctly to keep from skidding?

IF THE ANSWER TO ANY QUESTION IS NO,

THE DRIVER WAS NOT DRIVING DEFENSIVELY AND IS RESPONSIBLE.
Sideswipes

Sideswipes are often preventable since drivers should not get into a position where they can be forced into trouble. A
driver should pass another vehicle cautiously and pull back into the lane only when he or she can see the other vehicle in
the rearview mirror. A driver should also be ready to slow down and let a passing vehicle into the lane. A driver should not
make a sudden move that may force another vehicle to swerve. Unless the driver is swerving to avoid another car or a
pedestrian, sideswiping a stationary object is preventable.

Drivers are expected to be able to gauge distances properly when leaving a parking place and enter traffic smoothly. A
driver is expected, whenever possible, to anticipate the actions of an oncoming vehicle. Sideswiping an oncoming vehicle
is often preventable.

The doors of a vehicle should never be opened when it is in motion. and should not be opened on the traffic side, unless
clear of traffic, when it is parked.

A parked vehicle can be seen from a sufficient distance; therefore, the operator of an approaching vehicle should be
prepared in case the doors of the parked vehicle are opened. This type of accident is non-preventable only when the door
is opened after the driver has passed it.
1. Did the driver look to front and rear for approaching and overtaking traffic immediately before starting to pull away
from the curb?
2. Did the driver signal before pulling away from the curb?
3. Did the driver look back rather than depend only upon rearview mirrors?
4. Did the driver start into traffic only when this action would not require traffic to change its speed or direction in
order to avoid his or her vehicle?

IF THE ANSWER TO ANY QUESTION IS NO,

THE DRIVER WAS NOT DRIVING DEFENSIVELY AND IS RESPONSIBLE.

Skidding
Many skidding conditions are caused by rain, freezing rain, fog, and snow, which all increase the hazard of travel. Oily
road film, which builds up during a period of good weather, causes an especially treacherous condition during the first
minutes of a rainfall.

Loss of traction on a grade can be anticipated, and these accidents usually are preventable. Chains or other suitable
traction devices should be used, if they are available.
1. Was the driver operating at a safe speed considering weather and road conditions?
2. During inclement weather was the driver keeping at least twice the safe following distance used for dry
pavement?
3. Were all actions gradual?
4. Was the driver anticipating ice on bridges, gutters, ruts, and near the curb?
5. Was the driver alert for water, ice or snow in shaded areas, loose gravel, sand, ruts, etc.?
6. Did the driver keep out of other vehicle tracks or cross them at wide angles?

IF THE ANSWER TO ANY QUESTION IS NO,

THE DRIVER WAS NOT DRIVING DEFENSIVELY AND IS RESPONSIBLE.
Pedestrian and Animal Collision
All types of pedestrian accidents, including collision with pedestrians coming from between parked cars, are usually
considered preventable. There are few instances where the action of pedestrians is so unreasonable that the operator
could not be expected to anticipate such an occurrence.

Collisions with animals are normally preventable, unless the movement on the part of an animal was unusual and
unexpected. This is also taking into consideration the fact that the driver was aware of animals in the vicinity.
1. Did the driver go through congested sections expecting that pedestrians would step in front of the vehicle?
2. Was the driver prepared to stop?
3. Did the driver keep as much clearance between his or her vehicle and parked vehicles, as safety permitted?
4. Did the driver stop when other vehicles has stopped to allow pedestrians to cross?
5. Did the driver wait for the green light or stop for the caution light?
6. Was the driver aware of children and prepared to stop if one ran into the street?
7. Did the driver give all pedestrians the right-of-way?
8. Did the driver stop for a school bus which was stopped and properly signaling that passengers were loading or
unloading?

IF THE ANSWER TO ANY QUESTION IS NO,

THE DRIVER WAS NOT DRIVING DEFENSIVELY AND IS RESPONSIBLE.
Parked or Stopped
Accidents occurring when vehicles are properly and legally parked are considered non-preventable. Accidents occurring
while the vehicle was double parked or in a "No Parking" zone are preventable.

IF THE ANSWER TO ANY QUESTION IS NO,

THE DRIVER WAS NOT DRIVING DEFENSIVELY AND IS RESPONSIBLE.

Non-collision Vehicle Damage, Mechanical Failure, and Miscellaneous Problems

The accident should be considered preventable if the investigation shows a mechanical defect of which the driver was
aware, a defect the driver should have found by inspecting the vehicle, or the driver caused by rough and abusive
handling.

When a mechanical failure is sudden or unexpected, not resulting from abuse or ordinary wear, it may be considered non-
preventable. Bad brakes should not be considered a mechanical failure unless the failure was sudden and the driver could
have had no previous knowledge of the condition. However, this type of failure cannot excuse a driver who does not know
how too properly pre-trip inspect the vehicle or is too lazy to do the inspection correctly.

It is a driver's responsibility to keep the cargo in mind and be aware of any sudden vehicle movements which may cause
damage to the cargo. Driving off the highway to avoid a collision may be preventable. Drivers should try not to place
themselves in such a position. "U" turns are a monkey wrench in the smooth flow of traffic. Accidents which occur while
this maneuver is attempted are considered preventable.
1. Could the driver have done anything to avoid the accident?
2. Was the driver's speed safe for conditions?
3. Did the driver obey all traffic signals?
4. Was the driver's vehicle under control?
5. Did the driver follow the routing and delivery instructions?

IF THE ANSWER TO ANY QUESTION IS NO,

THE DRIVER WAS NOT DRIVING DEFENSIVELY AND IS RESPONSIBLE.
VEHICLE INSPECTION REPORT

This report is due during the month of April and October each year. A separate report must be completed for each unit.
After completion this report should be forwarded to: __________________

Date: _________________________________
Vehicle unit number: ____________________ License number: _________ Mileage: __________
Branch and Department number: ___________ Driver: _________________ __________________
Reporting office: ________________________ Department: _____________ __________________
Year: _________________________________ Make: _________________ Model: ___________
Serial number: __________________________

4 cylinder 6 cylinder __________other Cruise Tilt wheel

INSPECT AND CHECK ONE:

Lights

Head: OK Out Back-up: OK Out

Parking: OK Out Side: OK Out
Tail: OK Out Flashers: OK Out
Directional: OK Out

Tires

Front left: Good Fair Poor Front right: Good Fair Poor
Rear left: Good Fair Poor Rear right: Good Fair Poor
Conventional spare: Good Fair Poor Snow tires: Yes No
Mini spare: Yes No Good Fair Poor
Note and explain uneven wear: ________________________________________________________
________________________________________________________________________________

Brakes
Check for master cylinder leaks. If unusual conditions, explain: _____________________________
________________________________________________________________________________
________________________________________________________________________________
Check brake pedal: High Low
Comments: _______________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Check brake fluid: Full Low

Exterior
Paint, overall condition: Good Fair Poor
Chrome, overall condition: Good Fair Poor
Glass, overall condition: No damage Damage
Explanation of overall exterior condition: _______________________________________________
________________________________________________________________________________
Nonstandard ornamentation or equipment? (decals, trailer hitch, etc.) Yes No
If "Yes," describe: __________________________________________________________________
________________________________________________________________________________
Exterior damage? Yes No
If "Yes," note and explain estimated cost of repairs: _______________________________________
________________________________________________________________________________
If "Yes," was claim submitted? Yes No
If "No," why not: __________________________________________________________________
________________________________________________________________________________
Interior
Overall appearance: Clean Worn Dirty
Condition of seats: Good Springs broken Sagging
Condition of upholstery: Clean Worn Dirty Torn Burn holes
Condition of carpets: Clean Worn Dirty Torn
Floor mats: Yes No
Windshield wipers: Good Fair Poor
Knobs, handles, etc.: Good Broken Missing
Accessories:
Flash light: Yes No
Horn working: Yes No
Safety belts: Working Nonworking
Windshield scraper: (if applicable) Yes No
Rear window defroster: Working Nonworking
Accident report kit: Yes No
Driver's manual: Yes No
Condition of trunk: Clean Dirty
Accessories:
Jack: Yes No
Handle and base: Yes No
Lug wrench: Yes No
Flares or reflectors (2-6): Yes No
Page - 3
Under Hood
Engine: Clean Dirty
Note apparent leakage: ______________________________________________________________
_________________________________________________________________________________
Engine oil: Full Low
Condition: _________________________________________________________________________
Mileage of last oil change: _________________ Mileage of last filter change: _________________
Mileage of last lubrication: _________________
Windshield washer fluid: Full Low
Battery water level: Full Low
Non-fillable: Yes No
Transmission fluid condition: Full Low Color: Red Black
Power steering fluid: Full Low
Overall Rating of Car
Excellent Good Fair Poor
Driver's comments: __________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Inspector's comments and recommendations: ______________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Inspector's signature: ________________________________________________________________
Branch/Fleet Coordinator signature: _____________________________________________________
Driver's signature: ___________________________________________________________________
Scheduled completion date of corrective action: ___________________________________________
 DISTRACTION -FREE DRIVING POLICY

Traffic crashes are among the leading causes of death and injuries in Texas. Because (INSERT Member Name
Here) is committed to establishing and following practices that make working here safer, and because we
value the safety and well-being of all employees of [insert COMPANY NAME], we are instituting a distraction-
free driving policy to promote safe driving habits.

Using a cell phone while driving increases the risk of a crash by four times, and texting increases crash risk by
23 times. (INSERT Member Name Here) employees must refrain from using PDAs and cell phones, either hand-
held or hands-free, while operating a motor vehicle(INSERT Member Name Here) employees must not initiate or
respond to phone calls, read or respond to text messages or emails while driving a passenger or commercial
vehicle. (INSERT Member Name Here) employees who need to make an emergency call while on the road must
first park the vehicle in a safe location.

Failure to follow company policy and refrain from talking on the phone, texting or emailing while driving on or
off the job may result in [insert CONSEQUENCES WHICH YOU DEEM APPROPRIATE, SUCH AS
VERBAL WARNING, WRITTEN WARNING, DISMISSAL, OTHER].

MOTOR VE HICLE SAFETY POLICY ACKNOWLEDGEMENT

I have received a written copy of (INSERT Member Name Here)’s distraction-free driving policy. I fully understand
the terms of this policy and agree to abide by them. Sign and print your name, add today’s date, and return this
form to your supervisor.

Employee Signature Date

Employee Name (printed)