Fleet Safety Contest Forms - North Carolina Trucking Association

Transcription

Fleet Safety Contest Forms - North Carolina Trucking Association
Fleet Safety Contest
NORTH CAROLINA TRUCKING ASSOCIATION
CONTEST YEAR 2015
REPORTING REQUIREMENTS FOR THE NORTH CAROLINA TRUCKING ASSOCIATION FLEET SAFETY CONTEST:
1. Member in good standing of North Carolina Trucking Association.
2. FMCSA Satisfactory Safety Rating.
3. Report North Carolina and Overall Operational miles & DOT Recordable Accidents (only North Carolina Miles &
Accidents to be reviewed).
4. Carrier Profile & DOT Accident Register for reporting year. Report shall show the total number of NC DOT Recordable
Accidents in as defined in FMCSR 390.5.
5. Frequency rates shall be expressed in terms of the number of accidents per 1 million vehicle-miles as determined by
the following formula:
Frequency = Number of accidents x 1,000,000
Vehicle-Miles
6. The formula for figuring local drivers mileage: For every hour worked equals 40 miles.
Example: One week (40 hours x 40 miles) equals 1600 miles for that week.
7. Interpretations – Any contestant having a question as to whether or not a particular incident should be counted as an
accident may request an interpretation and ruling by the NCTA Safety & Human Resources Council. Requests for
interpretations must be accompanied by complete information regarding the incident so that an accurate and proper
ruling can be made.
8. Carrier Profile – Contestants should attach a copy of their Carrier Profile for the entire calendar year as well as a copy
of their DOT recordable accident register. In the event of an audit a Motor Carrier Profile for the entire calendar year
will be required.
To determine a tie in cases where there are zero recordable accidents the carrier with the highest mileage will prevail.
All carriers that have zero recordable accidents will receive a plaque
Company Information:
Do you conduct Safety Meetings with your drivers? Yes
No
If yes what is the frequency? _____________________________________________________________
Do you have a Safety Director and/or a Safety Department?
Yes
No
What Officer does The Safety Function Report to? ____________________________________________
Do you provide your drivers with any type of Defensive Driver Training?
Yes
No
If yes what is the course? ________________________________________________________________
Do you have a company maximum speed limit?
Yes
No
If yes, what is it and how is it enforced? ____________________________________________________
NAME OF COMPANY ______________________________________________________________________________
STREET ______________________________________________________________________________
CITY __________________________________________STATE _______________ ZIP ____________
CONTACT NAME __________________________PHONE # __________________EMAIL_____________________
CONTEST DIVISION - Check one. No competition will be held in any division with less than two (2) entries. Contestants in
any such division will be notified.
____ Under 5 Million Miles
_____ 5 Million to 10 Million Miles
____ 10 Million to 25 Million Miles _____ Over 25 Million Miles
CONTEST REPORT
Report Frequency Rate to 2 decimal places rounding off as applicable
OVERALL VEHICLE MILES
TOTAL ACCIDENTS
FREQUENCY RATE
LINE-HAUL/OTR
LOCAL
TOTAL
NC VEHICLE MILES
NC TOTAL ACCIDENTS
NC FREQUENCY RATE
LINE-HAUL/OTR
LOCAL
TOTAL
Report NC miles and accidents for this division for previous year
Previous Year Accidents____________ Previous Year Mileage____________ Previous Year Frequency______
THE FOLLOWING CERTIFICATION MUST BE SIGNED BY AN EXECUTIVE OFFICER OF THE COMPANY
I hereby certify that the above information is correct to the best of our knowledge and belief. I agree that an audit of the
records may be made prior to the announcement of any award to this company. It is understood that we must currently
have a Satisfactory rating with the USDOT, Federal Motor Carrier Safety Administration.
Failure to consent to an audit or rendering of records will therefore make the contestant ineligible for any award for
the contest year
_____________________________________________
________________________________________________
(Signature)
(Title)
th
Return completed forms by May 15 2015
North Carolina Trucking Association
10900 World Trade Blvd.
Raleigh, North Carolina 27617-4202
Julie Alascio (919) 281-2745