(Company Name)
(Company Logo)
FLEET SAFETY PROGRAM
Please modify this program to fit your specific needs.
These are suggestions only. As with any program – please review with appropriate
Questions?
Contact Neel Horst, Safety Control Consultant
Gunn-Mowery, LLC
nhorst@gunnmowery.com
717-761-4600 ext. 3038
TABLE OF CONTENTS
I. Program Statement 3
II. Program Goals 4
III. Program Responsibilities 4
IV. Authorization of Driving Privileges 5
V. Authorized Vehicle Use 5
VI. Motor Vehicle Record Checks 6
VII. Identification of High Risk Drivers 7
VIII. Management Controls for High Risk Drivers 8
IX. Additional Employee Selection Requirements 8
X. Driver Training 9
XI. Safety Regulations 9
XII. Cell Phone and Electronic Device Policy 11
Vehicle Accident Reporting and Investigation Procedures 12
Vehicle Selection, Inspection & Maintenance 14
CDL Drivers 14
Appendix
Fleet Program Acknowledgment Form
Guide to Preventability
Accident Investigation Form
Accident Reporting Kit (Form)
Road Test Form
MVR Authorization Form
Vehicle Inspection Form
I. PROGRAM STATEMENT
The (Name Company) Fleet Safety Program establishes guidelines and procedures to be followed to protect the safety of individuals operating motor vehicles on company business. Protecting our “Drivers”, their passengers, and the general public is of the highest priority to the Company.
The commitment of management and “Drivers” is critical to the success of this program. I will expect all “Drivers” to operate equipment safely at all times and adhere to all safety policies and procedures implemented by the Company. The prevention of accidents is not someone else’s concern; it is my concern, it is your concern.
This safety program has been developed in recognition of the responsibility of management to establish procedures for the prevention of accidents.
(Name of Company) 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.
______________________________ ____________
President Date
II. PROGRAM GOALS
The primary goal of the Fleet Safety Program (FSP) is to maintain a high level of safety awareness and foster responsible driving behavior.
This program assigns responsibilities and outlines actions/methods that will control, reduce, and minimize manpower and monetary losses resulting from accidents. Since no safety program can have every possible precaution that must be taken or have a rule to eliminate every hazard, common sense and good judgment must be exercised at all times.
Accidents are preventable. The fact that the majority of accidents are the result of an unsafe act should provide an incentive to become more safety conscious.
III. PROGRAM RESPONSIBILITIES
Company President = Name here
The company president is responsible for directing the vehicle safety program.
Fleet Safety Coordinator (FSC) = Name here
Implement the FSP and ensure accountability for program requirements.
Review “Driver” MVR’s and authorize driving privileges.
Maintain a list of authorized drivers.
Maintain a file for all drivers with applicable forms/documentation.
Maintain Driver Qualification Files for drivers subject to DOT requirements.
Review motor vehicle accident reports.
Maintain records and issue periodic reports of losses for the president’s review.
Maintain List of Approved Drivers.
“Drivers”
Operate motor vehicles in a safe manner.
Follow all applicable traffic laws and regulations.
Abide by “Driver” Safety Regulations outlined in the Fleet Safety Program.
Maintain a valid “Driver’s” license and adhere to license restrictions.
Participate in company-sponsored activities or programs designed to improve driver safety.
Report all unsafe conditions pertinent to the vehicle for which they are assigned
Report all vehicle accidents (vehicle, cargo, personal injury, and property), no matter how minor, to the appropriate supervision or FSC.
Complete the Driver History Form, and provide signed permission for the company or its designated representative to obtain “Motor Vehicle Records.
Sign the Fleet Safety Program Acknowledgement Form.
Maintain vehicles according to established maintenance standards.
IV. AUTHORIZATION OF DRIVING PRIVILEGES
The Fleet Safety Coordinator will not assign or allow the use of a “Motor Vehicle”, if:
The “Driver” does not have a valid operator’s license (Photocopy of “Driver’s” license is to be maintained in file by the FSC).
The “Driver’s” MVR fails to meet acceptability standards.
The “Driver’s” license is suspended or revoked for any reason.
In addition, a “Driver” will be subject to termination if his/her license is revoked, unless a suitable non-driving job in the company is available; or the employee may be subject to other disciplinary action if his/her license is only temporarily suspended.
AUTHORIZED VEHICLE USE
Authorized Use of “Company Vehicles”
Employees of (Name Company) may only operate “Company Vehicles” which have been approved by the FSC. Family members, non-employees, or unauthorized employees are not allowed to operate any “Company Vehicle”.
All “Company Vehicles” are to be used for company business purposes only, and no personal use of vehicles is allowed.
OR
Employees of (Name Company) may only operate “Company Vehicles” which have been approved by the FSC. Non-employees, or unauthorized employees are not allowed to operate any “Company Vehicle”.
Spouses of authorized drivers assigned to passenger vehicles may use company vehicles on a limited basis and for emergency use if pre-approved by the FSC. All spouses must meet the qualification criteria specified in section VI (Motor Vehicle Record Check) before being approved for company vehicle use.
All “Company Vehicles” are to be used for company business purposes only. Personal use of vehicles is allowed if pre-approved by the FSC.
B. Unauthorized use of “Company Vehicles”
If a “Driver” allows an unauthorized individual to drive a “Company Vehicle”, disciplinary action may be taken, up to and including suspension of driving privileges or dismissal of the “Driver”.
If the unauthorized use results in an accident, in addition to whatever disciplinary action may be taken, the responsible employee may be required to make restitution for the physical damages to the “Company Vehicle”.
C. Personal Vehicle Use for Company Business
Any person, using their personal vehicle for company business must meet the following criteria:
Maintaining automobile liability insurance limits (put limits here)
Provide a certificate of insurance with limits of liability of at least (put limits here). The company must be named as additional insured on the driver’s liability insurance policy.
Verification of insurance coverage must be given to the FSC.
Maintaining current state vehicle inspection if the state requires one.
Maintaining a current driver’s license. The FSC must copy of the license at least annually. Any change in license status must be reported to the FSC.
Maintaining their “Non-Company Vehicle” in safe operating condition.
Satisfy the company driver qualification requirements.
Follow all safety regulations in section XI.
USE OF A MOTORCYLCE FOR COMPANY BUSINESS IS PROHIBITED.
VI. MOTOR VEHICLE RECORD CHECKS
Initial MVR Checks
Employee Applicants
If an employee applicant is to be a “Driver”, the FSC will obtain a completed Driver History Form (See Appendix) from the applicant. The FSC will obtain a current MVR before the applicant is permitted to drive a company vehicle.
Each employee-applicant is to be informed by the FSC that employment is conditional upon receipt of a satisfactory MVR; that is, an MVR not meeting the definition of a “High Risk Driver”.
Existing Employees
If an existing employee is changing from a non-driving position to a position requiring driving on company business, the employee must complete and sign a Driver History Form.
The form and current MVR must then be reviewed by the FSC for acceptance prior to granting a change in job status. The FSC will obtain a current MVR and review it for acceptability before the employee is permitted to drive a company vehicle.
Periodic MVR Checks
The FSC will obtain MVRs at least once every 12 months for all existing “Drivers”. In addition, the Company maintains the right to conduct periodic and random reviews of MVRs at its discretion, MVRs should be ordered as follows:
Annually for employees who operate a company vehicle
As needed to determine the current MVR status for any employee who has accumulated driver points, is involved in an accident, or for other reasons.
Documentation
Once Driver MVRs have been obtained and reviewed, a copy of the “Driver’s” MVR, should be kept in each “Drivers” file. If the MVR shows that the employee is either “on probation” or is “high risk” and has lost his driving privileges, the employee will be notified in writing of his status.
VII. IDENTIFICATION OF HIGH RISK DRIVERS
Motor Vehicle Record Evaluation Criteria
Studies conducted on vehicle accidents have shown a direct correlation between past driving performance and accident experience. The drivers that were involved in these vehicle accidents had more than one vehicle accident and/or violation during the thirty-six months preceding their accidents. Obtaining a current Motor Vehicle Record (MVR) of the driver is one of the best indicators to tell what kind of a risk a person presents to an organization when behind a wheel in a motorized vehicle.
With all new drivers, MVRs should be ordered for each State in which the applicant has held an operator's license. The check on MVRs should at a minimum go back three (3) years and be used as part of the overall Driver Selection Program. MVRs should also be ordered and reviewed annually for all drivers.
Note: CDL license holders driving commercial vehicles require a longer review history. Please consult DOT regulations for current requirements.
All Drivers are required to fill out the MVR Request Form (see attached form).
The following is the criteria used to categorize violations:
TYPE A VIOLATION - Includes (but is not limited to) DWI, DUI, OWI, OUI, Refusing Substance Test, Reckless Driving, Manslaughter, Eluding a Police Officer, Assault with a motor vehicle, Leaving the scene of an accident, Three or more incidents of the same kind, any Felony, Drag Racing, License Suspension, and Driving while License Suspended. Any driver with these types of violations is a major concern.
TYPE B VIOLATION - Includes all at fault vehicle accidents.
TYPE C VIOLATION - Includes all moving violations not classified as Type A or Type B. (Speeding, Improper lane Change, Failure to Yield, running Red Lights or Stop Lights, etc.)
TYPE D VIOLATION - Includes all non-moving violations (Illegal Parking, Vehicle Defects, etc.)
The following criteria should be used in evaluating MVRs.
High Risk Driver: Applicant Declination, Termination, or Reassignment to a Non -Driving Position:
* One or more Type A Violations in the preceding 36 months.
* Two or more Type B Violations in the preceding 36 months.
* Three or more Type C Violations in the preceding 36 months.
* One Type B Violation and two Type C Violations in the preceding 36 months.
Probation: The employee will be warned that additional violations may place him in the High Risk Driver category.
* One Type B Violation in the preceding 36 months.
* Two Type C Violations in the preceding 36 months.
* One Type C Violation and two Type D Violations in the preceding 36 months.
* Three Type D Violations in the preceding 36 months
VIII. MANAGEMENT CONTROLS FOR HIGH RISK DRIVERS
If an employee is identified as a “High Risk Driver”
The FSC must suspend all company driving privileges. The “High Risk Driver” will NOT be authorized to drive a motor vehicle at any time on company business. This may result in the FSC either transferring the employee to a non-driving position, if such a position exists, or the employee may be subject to dismissal procedures.
The employee may reapply for company driving privileges after one year of suspension. The application should be made to the Company President. If approved, the employee’s driving status will change from suspension to probation.
IX. ADDITIONAL EMPLOYEE SELECTION REQUIREMENTS
In addition to the information specified above, “Driver” applicants must meet the following qualifications:
Applicants must be 18 years old (unless otherwise specified by DOT or other regulations/requirements).
2. May be required to pass a driving/road test in the vehicle they will operate.
3. Have a valid “Driver’s” license including appropriate designations for applicable vehicles.
4. Complete the application for employment and Authorization for MVR.
5. Have a valid CDL and associated medical certification if required by the type of vehicle
driven.
X. DRIVER TRAINING AND PERFORMANCE EVALUATION
1. Drivers hired by this company to operate a motor vehicle will have the basic skills and credentials necessary to perform this function as confirmed through the driver selection process. The FSP is responsible for assessing vehicle driving skills.
Certain types of vehicles or vehicles requiring towing of trailers require specialized skills. Additional training may be required for these vehicles as determined by the FSP. These vehicles include:
Vehicle type
Vehicle type
Vehicle type
Vehicle type
2. New employees, contractor, and temporary hires or other drivers will receive a copy of this program as part of their initial orientation. A copy of this program will be kept in the vehicle.
3. All drivers will be required to complete a “Defensive Driving Course” (National Safety Council Defensive Driving course of equivalent):
Upon hire
After an “at fault accident” (see Accident Reporting section)
As part of their removal from “Probationary Status” under the MVR review process.
4. Performance Evaluation - Every year, formal driving evaluation will be conducted for each employee driving company vehicles to monitor compliance with this policy and utilization of defensive driving principles. The evaluation should utilize appropriate documentation and be conducted by the FSC or their designee.
SAFETY REGULATIONS
Vehicle Safety Belts
The “Driver” and all Occupants are required to wear safety belts when operating or riding in a “Motor Vehicle”.
Impaired Driving
A “Driver” may not operate a “Motor Vehicle” at any time, when his/her ability is impaired, affected, or influenced by alcohol, illegal drugs, medication, illness, fatigue or injury.
The company’s Drug and Alcohol Policy and associated DOT Drug and Alcohol Program requirements also apply.
Traffic Laws
All “Drivers” are required to abide by all federal, state, and local motor vehicle regulations, laws, and ordinances.
Vehicle Condition
Each “Driver” is responsible for ensuring that the “Motor Vehicle” is in safe driving condition.
Periodic vehicle inspections can reveal defects and/or the potential for unsafe conditions before they can cause or contribute to serious vehicle damage or personal injury. Regardless of the size and type of vehicle, inspections should be conducted both by the driver and by the manager/supervisor.
Appropriate steps will then be taken to correct the unsatisfactory conditions.
Additional Safety Rules
Do not pick up hitchhikers
Do not use any radar detector, laser detector, or similar device
Do not tailgate. Adjust your speed for road and weather conditions.
Do not stop anywhere except as authorized. Remain on assigned travel routes.
Do not push or pull another vehicle, or tow a trailer without authorization
Do not transport flammable liquids and gases unless a DOT or UL Approved container is utilized and properly secured.
Do not assist disabled motorists or accident victims beyond the level of their medical training: EMT, CPR, Basic First Aid, etc. If a driver is not qualified to provide the above services, he/she must restrict his/her assistance to calling the proper authorities.
Be courteous. If a problem arises, get the person’s name, employer’s name and phone number. Someone from our office will deal with the problem.
Motorcycles:
Employees are prohibited from using motorcycles when traveling on company business.
Drivers must notify the Vehicle Safety Coordinator if their license is suspended or revoked.
Company and Personal Property:
Employees are responsible for company property such as equipment under their
control. The company will not reimburse the employee for stolen personal property.
Violations
The driver assumes full responsibility for any violations, including traffic, parking, etc., arising out of the use of the Company vehicle. If the Company should be required to pay any fine after the custodian terminates employee with the Company, the custodian agrees to reimburse the Company within 30 days of written notice.
CELL PHONE and ELECTRONIC DEVICE POLICY
SAFETY FIRST. Calls will not be initiated while driving. Drivers will safely pull to the side of the road and well away from traffic before using the cell phone. Traffic citations and/or accidents deemed to be caused by the use of the cell phone would be entirely the responsibility of the employee and may result in disciplinary action up to and including termination.
Hands-Free Device. A hands-free device must be used when receiving calls. Calls should not be received or engaged in when the driver deems the situation to be hazardous (demands complete attention such as heavy traffic, backing, poor weather, etc.)
Texting/Emailing. Texting or emailing will not be engaged in at any time while the vehicle is being operated.
Personal Electronic Devices. Electronic devices (including but not limited to laptops, DVD players, MP3 players, etc.) are not to be used during driving because of the distraction they cause.
Other/Vehicle Provided Electronic Devices. Equipment such as navigation devices, radios, and other devices used for company communication may be used if the driver deems the situation is safe to use them.
All devices must meet applicable DOT regulations for applicable vehicles.
OR
No Cell Phone Use Policy
The use of cell phones is not permitted while driving on company business, nor at any time while driving company-owned vehicles.
If the driver needs to engage in a cell phone conversation, the driver must pull off the road and make the call after the vehicle is safely parked.
All cell phones should be equipped with message receiving capability to allow drivers to receive messages and return calls when safely parked.
Cell Phone Use by CMV Drivers
The U.S. Department of Transportation (DOT) ,as of January 3, 2012, implemented a hand-held cell-phone ban.
The rule which was issued by the Federal Motor Carrier Safety Administration (FMCSA) prohibits interstate commercial motor vehicle (CMV) drivers from using hand-held cell phones while driving.
Under the rule, CMV drivers will not be able to hold, dial, or reach for a hand-held cell phone, including those with push-to-talk capability. Hands-free phone use is allowed, as is the use of CB radios and two-way radios.
Specifically, the rule prohibits drivers from:
• Using at least one hand to hold a mobile phone to conduct a voice communication;
• Dialing or answering a mobile phone by pressing more than a single button, and
• Reaching for a mobile phone in a manner that requires the driver to maneuver so that he or she is no longer in a seated, belted, driving position.
Drivers will not be able to use hand-held phones while temporarily stopped due to traffic, a traffic control device, or other momentary delays, but they will be able to use them after moving the vehicle to the side of the road and stopping in a safe location.
Drivers who violate the ban will face federal civil penalties of up to $2,750 for each offense and disqualification for multiple offenses. Companies that allow their drivers to use hand-held cell phones while driving will face a maximum penalty of $11,000.
XIII. “DRIVER’S” VEHICLE ACCIDENT REPORTING PROCEDURES
When an accident occurs it is important that it is promptly reported and investigated to expedite prompt handling of claims and to identify accident causes for correction.
Accident Reporting
1. Notification - All accidents must be reported immediately to the FSC for further direction as needed. An accident is any occurrence involving a Company owned or operated vehicle which results in death, injury, or property damage and should be reported regardless of:
what property was damaged
the severity of the property damage
where the accident occurred, or
2. At the scene of the accident:
Take precautions to prevent further accidents or injuries.
Exchange information with other parties involved to include:
a. Location, times, and date
b. Make, model, type, and license number of vehicle
c. Registered owner of second vehicle
d. “Driver’s” name, age, and address
e. All occupants’ names and addresses
f. Names of persons injured and the extent of injuries
g. Name of police station to which accident was reported
h. Name(s) and badge number(s) of police officer(s) at the scene
i. Name of insurance carrier of second vehicle
j. Name, address, and phone number(s) of all possible witnesses
k. Estimate of damage to second vehicle, as well as noting visible damage, parts, etc.
A company-designated representative will make every effort to visit the accident scene to help gather the above noted information. If the “Driver” hits an unattended vehicle, he/she should leave his/her name, the company name, and the company phone number on the windshield of the vehicle.
Please refer to the attached “Accident Reporting Kit”. A copy of this kit should be kept in each vehicle along with a disposable camera (or cell phone camera).
Accident Investigation Report
Completing the Accident Investigation Report- The Supervisor of the Driver and the FSC are responsible for completing the Accident Investigation Report (See Appendix) for all "Accidents”. This report should be completed as soon after the accident as is reasonably feasible. The report should be filled out with the assistance of the “Driver” in order to get the details of the accident. All vehicle accidents, no matter how minor, must be investigated and reported.
Accident Investigation Review
The Company President is responsible for reviewing the completed Accident Investigation Report Form and initiating any actions to prevent the reoccurrence of similar accidents by this “Driver” or any other company “Driver.
Preventable/Non-Preventable Accidents
When a driver reports an accident, a designated company official or committee must determine whether the accident was preventable by the driver involved. The determination should use the following definition of a “Preventable Accident” as developed by the National Safety Council.
Preventable Accident Definition
A preventable accident is any occurrence involving a company owned or operated vehicle in which the driver in question failed to exercise every reasonable precaution to prevent the occurrence.
Most physical damage losses also fall under this definition. However, physical damage losses over which the operator has no control, such as minor paint nicks, small dents and scratches from parking lot exposures, and chipped windshields, will not fall under the above definition of accident.
Non-Preventable Accident Definition
The company driver adhered to the definition of a "Defensive Driver" by driving in such a way as to have committed no errors, controlled the vehicle by making proper adjustments for road weather and traffic conditions, and assure that the mistakes of other drivers did not involve the company driver in an accident.
The Guide for Determining Motor Vehicle Accident Preventability should be used as a guide.
Driver Participation in Repair Costs:
If a vehicle is involved in an accident which is determined preventable, driver reimbursement to the company should be as follows:
A. The first 50% of the repair cost, up to a maximum reimbursement of $250 (or put limit here) 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 (or put limit here).
FAILURE TO REPORT AN ACCIDENT UNDER THE PROVISION OF SECTION XIII IS A VIOLATION THAT COULD RESULT IN DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION.
XIV. 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 company will purchase vehicles designed for their intended use and safety of the occupants.
3. Vehicle Inspection:
The employee responsible for the vehicle will inspect the vehicle before each use for proper operation, noticeable damage or defects.
Quarterly inspection using Vehicle Inspection Report form and forward the report to 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 tune-ups, 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, airlines, 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.
D. DOT Regulations may require additional inspections, maintenance and records that must be followed for applicable vehicles.
XV. Commercial Drivers License (CDL)
Some vehicles operated by this company require a CDL license. Only designated employees will be allowed to operate these vehicles.
Authorized CDL employees will be expected to comply with all Department of Transportation (DOT) requirements for maintenance of their CDL license, drug and alcohol testing, and operation of vehicles in addition to the requirements of this policy.
Driver Qualification File Checklist
The following documents are to be included in a DQ file for duration of employment:
Driver-specific application for employment (§391.21);
Original motor vehicle record (MVR) requested from states within 30 days of hire (§391.23);
Road test or road test exception:
Road test form and certificate conducted by your motor carrier (§391.31(g)), or
Road test certificate conducted by another motor carrier within the past 3 years (§391.33(a)(2)), or
Photocopy of a CDL accepted in lieu of road test - not applicable if hired to operate doubles, triples, or tankers. (Note: No subsequent copies of license renewals required.) (§391.33(a)(1));
Background investigations (§391.23):
Drivers hired before October 30, 2004: General employment verifications sent to all former employers for the 3 years prior to the application date or a record of a good faith effort; or
Drivers hired on or after October 30, 2004: Safety Performance History data from all former DOT-regulated employers for the 3 years prior to the application date or a record of a good faith effort. This form must be maintained in accordance with §391.53 (secured, limited access) and may be in a separate Driver Investigation History File; and if applicable, any driver rebuttals to the Safety Performance History data and responses to the rebuttals from the former DOT-regulated employers.
The following documents are to be included in the DQ file for three years from date of execution:
Medical certificate (§391.43(g)) - Note: As of January 30, 2014, the file must contain:
Medical exam certificate, original or a copy, for all non-CDL drivers; or
Medical exam certificate, original or a copy, for CDL drivers whose states have not adopted the rules linking the CDL with the medical examination; or
Current MVR from the state showing medical qualification for CDL drivers whose states have adopted the rules linking the CDL with the medical examination.
If applicable, any letter granting a waiver of a physical disqualification (§391.49(j));
Annual motor vehicle record (§391.25);
Annual review of driving record (§391.25); and
Annual list of violations (§391.27).
The DQ file and Driver Investigation History file are retained for 3 years after a driver leaves your employment.
The following documents are also required and kept in the DQ file, but are not applicable to all drivers:
Longer Combination Vehicle (LCV) Driver-Training Certificate (§380.401); and
Entry-level driver training certificate (§380.509(b)).
Fleet Safety Acknowledgement Form
I hereby acknowledge that I have received and read a copy of the (Name Company) Fleet Safety Program. I agree to comply with the policies and procedures contained in the program.
_____________________________________________ _____________________
Driver’s Signature Date
_____________________________________________
Driver’s Name (Print)
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