Vehicle Safety Policy Review Checklist - (UNCW Admin. Form VCB 1.40)

Form VCB 1.40 (10/1/93)

The University of North Carolina at Wilmington
Vehicle Safety Policy Review Checklist

DATE OF REVIEW:______________________ EMPLOYEE'S NAME:______________________________

SOCIAL SECURITY NO: __________________ DEPARTMENT:__________________________________

SUPERVISOR'S NAME:____________________________________________

                                                                                                                TOPIC                                     INITIALS
__________________________________________________________________________
^{1)    DRIVER'S LICENSE}____________________________________________________________________________
^{2)    MAINTENANCE OF VEHICLES}____________________________________________________________________________
3)    TRAINING
____________________________________________________________________________
^{4)    USES OF UNCW VEHICLES}____________________________________________________________________________
^{5)    OPERATION OF UNCW VEHICLES}____________________________________________________________________________
^{6)    ACCIDENT REPORTING}____________________________________________________________________________
^{7)    ENFORCEMENT}____________________________________________________________________________
^{8)    DRIVING HISTORY}

SUPERVISOR: I CERTIFY THAT I HAVE REVIEWED THE MOTOR VEHICLE SAFETY POLICY WITH THIS NEW EMPLOYEE AND WILL SCHEDULE HIM/HER TO ATTEND THE NEXT AVAILABLE VEHICLE SAFETY CLASS AS SCHEDULED BY THE UNCW POLICE DEPARTMENT.	EMPLOYEE: I CERTIFY THAT MY SUPERVISOR HAS REVIEWED ALL SECTIONS OF THE MOTOR VEHICLE SAFETY POLICY WITH ME. I HAVE INITIALED EACH SECTION OF THIS FORM TO INDICATE THAT I UNDERSTAND WHAT IS EXPECTED WHILE OPERATING A UNCW VEHICLE. I UNDERSTAND THAT A SATISFACTORY DRIVING RECORD IS A CONDITION OF CONTINUED EMPLOYMENT.
`____________________________________________ Signature`	_____________________________ `^Signature` _____________________________ `NC Driver's License Number`

Instructions:
A copy of the Vehicle Safety Policy will be issued to each new employee who is required to operate a UNCW vehicle as part of their job description. The immediate supervisor will review each section of the policy with the employee BEFORE allowing the employee to operate a UNCW vehicle. The employee will initial this form next to the topic discussed to indicate understanding. When completed, both the supervisor and employee will sign the bottom. The original will be placed in the employee's departmental driver qualification file, and a copy will be forwarded to the Risk Management Office in the VCBA Office.

Distribution:
* Place original of completed form in employee's driver qualification file maintained by employee's department.
* Forward a photocopy of the completed form to the Risk Management Office (VCBA Office).