VER.12.13
9. Are Motor Vehicle Records (MVR) checked annually for all employees
who drive as part of their job? Yes No
If yes, please clarify the following:
• MVR’s verified at time of hire? Yes No
• MVR’s verified every six months after hire? Yes No
• Copies of MVR’s maintained in personnel files? Yes No
10. Have any of the drivers had a speeding violation in the last three (3) years? Yes No
If yes, please list how many: _________
11. Does the insured operate a landfill? Yes No
12. Does the insured operate a recycling center? Yes No
13. Does the insured specialize in removal of residue from incinerator plants? Yes No
14. Does the insured specialize in the collection of scrap metal? Yes No
15. Does the insured specialize in the collection of manure from farms? Yes No
16. Does the insured primarily provide a one time on demand service to pick
up or haulaway junk such as, but not limited to: household junk (appliances,
furniture, carpet, etc), office junk (computers, printers, furniture, etc), or
general junk (construction debris, etc)? Yes No
17. Does the insured engage in storm debris or construction or debris clean up? Yes No
18. Are more than 5% of receipts from HazMat or Hazardous Materials (Solids,
liquids or gases that can harm people) clean up or removal? Yes No
19. Is there a formal safety program in place? Yes No
20. Is there a formal return to work/modified duty program in place? Yes No
21. Is there a formal pre-hire drug testing program in place? Yes No
22. Is there a formal post-accident drug testing program in place? Yes No
23. Please indicate the business operations and percentage done in each:
Residential Waste Hauling _____% Commercial Waste Hauling _____%
Construction Waste Hauling _____% Hazardous Waste Hauling _____%
Medical Waste Hauling _____% Landfill Operation _____%
Recycling Center _____%
