Private motor truck council of Canada


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PRIVATE FLEET SAFETY AWARD APPLICATION

Note: Information provided is to be based on fleet activity for the period ending December 31, 2017.

Submission Deadline: April 30, 2018

Company Information

Person Submitting Entry

Company Executive, President or Owner to verify that all information contained in the entry is true and correct to the best of their knowledge.

By submitting this entry form the person named below consents to the release of this information and verifies that all information enclosed is true and correct and acknowledges that, at the discretion of the judges, it may be necessary to provide additional documents and information in order to assist with adjudication.

Attach a copy of the fleets CVOR for the past three (3) years or equivalent provincial safety rating and USA profile, if applicable or fax a copy to 905-827-8212. Entries must include all three CVORs or equivalent documents to qualify. (25 points)

Operations & Company Profile

Number of Drivers

Describe Your Business And Operations

Fleet Size By Vehicle Type

Type Company Owned / Leased Owner Operator

Area of Operations

Radius of operations % Radius of operations %

Annual Distance Traveled

Accident Preventability

Who in your company is responsible for determining accident preventability?

Management (25 points)

Do you have a Statement of Policy addressing motor vehicle safety?   Yes No
   
Do you have a company manual providing safety rules and safe operating procedures?   Yes No
  
Briefly describe what tools and other programs you use and how you convey your message to your driver group.

Safety Performance Management (25 points)

Do you have a safety incentive program?   Yes No

Criteria & Definitions (25 points)

Fleet Accident/Incident - any unplanned or unexpected event involving a vehicle or trailer when the driver is at the controls or has responsibility for the vehicle, AND which results in contact with another vehicle, a pedestrian or an object. An event meeting this description is an accident/incident regardless of whether there is property damage, personal injury or where the event occurred.

Non-Preventable Vehicle Accident/Incident - is one in which the driver did everything within his/her control to avoid the accident/incident and the circumstances causing the accident/incident could not have been foreseen.

Preventable Vehicle Accident/Incident - is one that does not meet the definition of non-preventable vehicle accident/incident.

Severity - is the term used to quantify an accident/incident that has the potential to cause or which results in severe injury, death, significant property damage or adverse media attention. The term severity is independent of preventability.

High Severity Accident/Incident - the following are some examples:

  • a person is injured or is treated away from the accident/incident scene as a result of the event
  • a fatality to any party occurs
  • any vehicle involved in the accident/incident needs to be towed
  • adverse media attention results from coverage of accident/incident

Low Severity Accident/Incident - is one that does not meet the definition of a high severity accident/incident. Using the definitions provided above, enter below the number of fleet accidents/incidents primarily attributed to each category.

Do not leave blank spaces - enter zero or N/A as appropriate.

Accident / Incident Type Number Of Non-preventable Fleet Accidents / Incidents Number Of Preventable Fleet Accidents / Incidents
High Severity Low Severity High Severity Low Severity
Rollovers
Jackknifes
Rear Ended Other Vehicle
Merge
Lane Change
Left Turn
Right Turn
Backing
Animal Strike
Uncoupling
Head-On Collision
Trailer Disconnects from 5" Wheel
Hit While Stopped
Other
Totals
Grand Total # Accidents / Incidents

Vehicle Accident/Incident Fleet Rate:
(number of accidents/incidents) X (1,000,000) = rate / 1million kilometers
(number of fleet kilometers driven)