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Private passenger vehicles: <br /> A. Use of vehicles: ❑ Business only Ej Business&Pleasure <br /> B. Operated by: 0 Employees only <br /> [I Family ❑ Spouse El Other: <br /> 8. Which of the following safety items do you use? <br /> A. Step Stools? ❑ Yes Z No If Yes, what type: <br /> B. Reflective Tape? Z Yes F-1 No <br /> C. Vehicle Tracking Devices? El Yes Z No If Yes. what type: <br /> D. Accident Cameras? Z Yes F-1 No <br /> 9. Do vou have Drive Cain or any other recording devices on your vehicles? Yes No <br /> F1 Drive Cam Other: (Please specify) Seon <br /> 10, Do you have "1-800-HOW'S MY DRIVING" Program? ❑ Yes Ej No Audited? ❑Yes ❑No <br /> MAINTENANCE INFORMATION <br /> I Do you have a written maintenance program? 1Z Yes [I No If Yes,please attach a copy, <br /> 2. Do you service your own vehicles? Z Yes F-1 No If No, who does? <br /> 3. How many mechanics do you employ? 6 <br /> 4. Do you ever service vehicles of others? El Yes No If Yes, what type? <br /> 5. Do you store vehicles of others? D Yes Z No <br /> 6. If you service or store vehicles of others, what is the maximum value of equipment of others on your premises for each <br /> location outlined above? <br /> 7. Does your vehicle maintenance program include the following: Yes No <br /> A. Service record of each vehicle(Attach copy) ❑ <br /> B. Controlled inspection frequency <br /> C. Daily vehicle condition reports(Attach copy) <br /> How often are these various reports reviewed by management? Weekly <br /> SAFETY INFORMATION <br /> 1. Please provide name,title, phone number, length of time in position,and years of experience of person(s)responsible for <br /> safety. Specify other duties. <br /> Kathy Vi hi. Safety +Training Officer- 17 Years <br /> 217-424-2814 <br /> Do your driver selection procedures include: Yes No Yes No <br /> A. Written application 0 ❑ <br /> B. Reference checks ❑ <br /> C. Written test ❑ Certificates F] <br /> ❑ <br /> D. Road test Certificates El 0 <br /> E. Physical exam: <br /> (1) Pre-employment <br /> (2) Federal DOT requirements <br /> (3) State DOT requirements El <br /> (4) Periodically during employment Specify: Back To Work Fit for Duty <br /> E Drug testing,: Yes Na <br /> (1) Pre-employment <br /> (2) Ongoing <br /> Q <br /> (3) Random F-1 <br /> G. Obtain driver MVR records ❑ F-1 El Pre-employment EJ Post-employment <br /> H Updating MVR records periodically during employment-Specify: <br /> Z� - Manual <br /> Lancer Bus!Long Application(09/13) <br /> Page 6 of']0 <br />