Fill - Free fillable Cocc Driving Approval (Central Oregon Community College) PDF form

DRIVING APPROVAL FORM

Our insurance requires that Campus Services check the driving record of any staff member, student or outside person

who will use Central Oregon Community College or rental vehicles for college business.

• Driving approval is required to driv

e college vehicles

or rentals

• Drivers must be 21 years old or older

• An Oregon driver license is required

• A staff member must supervise student drivers

• When multiple vehicles are used, a staff member must

be in the caravan at all times

Vehicle records take approximately 10 days to receive from DMV. Please allow time for us to receive your record. Please

inform us if you have an immediate driving requirement by checking the “Temporary Driving Approval” box below.

Those without an Oregon license who are considered permanent residents will also need to request temporary approval

and will be asked to obtain an in-state license within 10 working days from the date of signature. Failure to meet this

requirement will forfeit the driving approval. Those approved to drive will be notified and only approved drivers will be

permitted to pick up keys to the vehicles.

Please follow the following application instructions:

1. Fill out the form below (Save document to desktop first and re-open from computer in ADOBE)

2. Read through the Vehicle Use Procedures, Fire Safety Training & 15-Passanger Advisory

3. Initial each page

4. Once complete click the submit button at the bottom of the packet and e-mail to kmyers@cocc.edu or print

and drop off the packet at Campus Services, 14 days prior to your trip.

NAME_________________________________COCC ID#_________________ COCC DEPARTMENT: _________________

(LAST, FIRST, MIDDLE)

DATE OF BIRTH _______________ OREGON DL #__________________ (If out of state select Temporary Driving Approval)

SELECT ONE: ___Staff ___ Student ___ Other, If student or other, who is the supervising staff? _____________________

I _________________________, hereby declare that I have had ________ vehicle/motorcycle violations, citations or

warnings in the past consecutive three years. This (these) citations/violations or warnings are:

__________________________________________________________________________________________________.

Temporary Driving Approval will need to be approved by the Director of Campus Services with a 10-day limit.

Will you need temporary driving approval? ____ NO ____YES If yes: I plan to drive a College (or rental) vehicle to

____________________ on the date of _______________ for the _________________ department.

I understand that if I am a permanent resident of Oregon, and do not have an in-state license, an Oregon driver’s license

must be obtained within 10 working days of date of signature. By signing below, I agree that I have read the Vehicle

Use Procedures, Fire Safety Training & 15-Passenger Van Advisory and have asked any questions I might have regarding

their meaning.

Signature ___________________________________________________________________Date __________________

………………………………………………………………………………………………………………………………………………………………………………………

FOR OFFICE USE ONLY:

Temporary Driving Approval signature ______________________________________________ Date _______________

Sent to DMV_____

Revision 5/30/2019

Driver initial: __________

COCC VEHICLE USE PROCEDURES

Approval to drive

• Driving approval is required to drive college vehicles or rentals.

• Drivers must be 21 years old or older.

• An Oregon driver license is required. Out-of-state license holders may be granted one-time only driving approval at the

discretion of the Director of Campus Services.

• Driving approval is valid for two years for staff members and for one year for students.

• A staff member must supervise student drivers. When multiple vehicles are used, a staff member must be in the caravan

at all times.

Reasons for Declining Driving Approval (including but not limited to):

•Two at-fault accidents in the past three years •More than two minor traffic convictions in the past three years •A combination of

one at-fault accident and one minor traffic conviction in the past three years •Operating under the influence of liquor or drugs or with

an unlawful blood alcohol content •Failure to stop or report an accident •Negligent homicide, manslaughter, assault involving the

operation of a motor vehicle •Driving on a suspended or revoked license • COCC Speeding Violation.

If a driver has a DUII on their driving record and has completed a Diversion Program to drop charges, they will need to provide proof

that the DUII charge was dismissed due to the Diversion Program to be eligible to drive COCC vehicles. Until the documentation is

received, the driver will not be able to apply for driving approval until three years after their arrest date. Depending on the severity of

the violations, approval can be granted at the discretion of the Director of Campus Services or the Vice President for Administration.

Reservations

Van reservations are submitted through a Webviewer request. Please check with your administrative assistant to submit these

requests. One-week notice is required for reservations of most fleet vehicles. One-month notice is required for: three or more

vehicles; 15 passenger vans; or the request is for three consecutive days or longer. Requests for vans used throughout the term will

be accepted 2 weeks prior to the start of the term. Department Administrators will be contacted prior to the start of each term to

place requests for scheduled field trips. If the reservation is on a weekend, please ensure arrangements are made to pick up keys

before 4 p.m. on Friday or 1 p.m. during the summer term. Each vehicle has a designated parking spot where it is to remain until your

reservation pick up time. On your return, park the vehicle in its designated spot. Prompt return of the vehicles is mandatory because

vehicles may be scheduled again for another department on the same day. A late drop-off fee of $25 may be charged for vehicles

returned to Campus Services after the return date/time specified in the original reservation request. Please visit our website for

additional

reservation information.

Keys and fuel cards

In most instances, each van key will have its own Pacific Pride and Chevron card for your convenience. Fuel cards will be signed out to

you at pick up. Please verify cards before signing as these will be your responsibility. Please drop off the vehicle keys after each use

to Campus Services. Campus Services will verify the beginning mileage before your arrival. The Campus Services kiosk will be used to

check out the keys and credit cards. Please confirm this information before you leave and if there is a discrepancy please see Campus

Services before you leave with the vehicle. Fuel cards are to be used for COCC or Enterprise vehicle fuel only. Using cards for

unauthorized purchases constitutes fraud and the user will be held liable. The charge for usage of COCC fleet vehicles is $0.82/ mile,

there is a minimum of a $35.00 charge. All vehicles must return with at least ¾ of a tank full, if it is returned under ¾ of a tank there

will be a department charge of $25.

Cancellations

All cancellations or modifications must be made prior to 48-hours in advance of your scheduled rental. If a cancellation is made

within the 48-hour window or there is a no show, the department will be charged $25 per vehicle.

Damage

The student/staff driver’s department may be charged the first $500.00 deductible in certain circumstances. This would be determined

by the insurance carrier. COCC will not assume financial responsibility for damage caused by the negligence of the driver renting a

COCC or rental vehicle. This includes, but is not limited to, situations where the driver was not acting in good faith, had been using the

vehicle for non-COCC related reasons, failed to meet licensing requirements or comply with these regulations. In these cases, the

driver may be required to pay all costs resulting from the accident. Anyone in the vehicle who is charged by public officials for any

non-legal actions will be individually responsible and not covered by COCC or any of its representatives or insurance.

Driver initial: __________

Body damage or accidents in or on the vehicle must be reported within 24 hours to Campus Services and Campus Public Safety. Any

other issues--including vehicle maintenance-- that need attention should be reported to Campus Services within 24 hours. Rarely,

vehicles may be deemed unsafe to drive and must be pulled off the line for immediate maintenance. We will do everything we can to

supply a substitute vehicle on these occasions but we recommended that all vehicle users have a contingency plan in place on the

chance no other vehicle is available.

Cleanliness

Users are responsible for removing all garbage from vehicles and maintaining its cleanliness. Pets, smoking, smokeless tobacco and

alcohol are prohibited in all rental vehicles, COCC or outside rentals. Failure to abide by these rules will result in the department

incurring a $25.00 charge and possible relinquishing of future rental rights.

Weather

All college vans are equipped with a set of tire chains as well as studded tires during the legal period of November 1 to April 1. Use of

chains and choosing to drive in inclement weather is at the user’s discretion. Any financial liability resulting from negligence of the

driver will not be assumed by COCC. By signing this form, you are agreeing that you know how to properly attach chains to tires and

drive appropriately with chains on in inclement weather conditions.

Fleet Track

A GPS tracking device has been installed in the vehicle to monitor speed and location. The College receives weekly reports that include

incidents where a COCC driver has gone over 80 mph or 15 mph over the speed limit in a 2 minute threshold. COCC drivers who

appear on the report for either of these incidents will be notified and receive one verbal warning. If a COCC driver appears on the

report a second time, within a year period, COCC driver privileges will be suspended for one year from the date of suspension. After

the one year suspension, the driver may reapply for approval to drive COCC vehicles.

Emergency Service

In case of emergencies where the vehicle cannot be driven call 541-383-7775 or for after hours and weekends call the Campus Public

Safety, cell phone at 541-383-7272 to relay any problems.

In the event you are involved in an accident with one of the COCC vehicles or a rental vehicle, follow these procedures.

• Do not

move the vehicle or leave the scene of the accident

• Immediately notify local law enforcement and include all pertinent information relative to the accident. Obtain the name,

address, and insurance carrier of the other driver and the names and addresses of any witnesses

• Notify Campus Services and Campus Public Safety

• If possible, take a picture of the damage to the vehicle(s)

• The department using the vehicle is responsible for making sure all the proper forms are completed and appropriate

authorities notified

RESPONSIBILITIES OF OPERATOR

The operator is responsible for:

 Having his/ her driver’s license in his/ her possession at all times

 Abiding by rental regulations, applicable state and local laws

 Permitting only employees, students of COCC, or other persons of official COCC business to be transported in the vehicle

 Properly caring for the vehicle which includes but is not limited to:

• Using recommended grade of gasoline, checking the oil on long trips, reporting needed service or repairs by reporting

this to Campus Services within 24 hours.

• Making sure the vehicle is returned in a clean condition

• Locking the vehicle when it is not in use and placing personal possessions out of sight in vehicle. COCC is not responsible

for stolen items

• Paying any traffic/parking fines incurred during usage

• Using and parking the vehicle in a manner that will not reflect unfavorably on COCC

• Picking up and returning vehicle at the appointed times

• Reporting to Campus Services any damage to the vehicle within 24 hours

• Prohibiting the use or possession of alcoholic beverages or controlled substances in a COCC or rental vehicle

• Not talking or texting on a cell phone while driving

Driver initial: __________

15-PASSENGER VAN ADVISORY

U.S. Department of Transportation Large Van Advisory:

The risk of a rollover crash in a 15-passenger van increases, as the van is more fully loaded. The risk rises as passengers are

added, and once the van has 10 or more passengers, the rollover risk is greatly increased. Placing a load on the roof also contributes

to this increased risk of rollover. These two conditions change the van's center of gravity. As a result, the van has less resistance to

rollover and handles differently from other passenger vehicles making it more difficult to control in an emergency situation. Most

vehicle rollovers are single vehicle crashes in which the vehicle runs off the road and overturns when it strikes a ditch, embankment,

soft soil, or other object.

TIPS FOR PREVENTING ROLLOVER:

Drivers must be well rested and maintain a safe speed for weather and road conditions. Drivers must be especially cautious

on curved rural roads and maintain a safe speed to avoid running off the road. If the van's wheels drop off the roadway, gradually

reduce speed and steer back onto the roadway when it is safe to do so. Roof racks are provided on some vans. Overloading these roof

racks increases the risk of rollover. Do not put heavy objects in the roof racks.

BUCKLE UP FOR SAFETY:

Eighty percent of people killed in rollover crashes in 15-passenger vans were not wearing seat belts. Passengers can

dramatically reduce their risk of being killed or seriously injured in a rollover crash by simply using their seat belts. All vehicle occupants

should always wear seatbelts. Drivers should be responsible for enforcing the use of seatbelts.

OTHER TIPS FOR SAFE DRIVING:

When a 15-passenger van is not full, passengers should sit in seats that are in front of the rear axle. More than 15 people

should never be allowed to ride in a 15-passenger van. Because 15- passenger vans are substantially longer and wider than cars, they:

•require more space and additional reliance on the side-view mirrors for passing •do not respond as well to abrupt steering maneuvers

•require additional breaking time.

FIRE SAFETY TRAINING MATERIAL

Your Guide to SAFE Gasoline and Diesel Dispensing

REMEMBER: GASOLINE IS EXTREMELY FLAMMABLE

EMERGENCY TELEPHONE: DIAL 911

Report emergency to Bend Oil Co. at 382-4751

SAFETY AND EMERGENCY INSTRUCTIONS

NO SMOKING! Before entering the dispensing area, please make sure that all cigarettes, cigars. etc. are out. Extinguish all RV pilot

lights or other flames.

FIRE EXTINGUISHER Break glass to access extinguisher. Pull safety pin and direct nozzle at base of flame, then pull handle.

EMERGENCY SHUT-OFF SWITCH The switch is located near the pump islands and is well marked. Place switch in OFF position. This

switch shuts off all electricity to the dispensing island and stops the flow of gasoline and diesel fuel.

HOW TO USE CARDLOCK EQUIPMENT SAFELY

Please follow these Instructions regarding the proper way to fuel your vehicle:

1. Stop vehicle engine.

2. Insert card with Pacific Pride logo facing you.

3. Remove card.

4. Security#, Enter code number and push enter button.

5. Enter Odometer Reading, Enter mileage or 0 and push button.

6. Pump#, Enter Pump number and push enter button. You have 60 seconds to turn the pump on and start pumping gas.

Slow the fuel flow as the tank nears full. Do not overfill tank.

7. After fueling is complete return nozzle to dispenser.

• Use only containers that are labeled for gasoline. DO NOT USE GLASS OR PAPER CONTAINERS.

• Do not use or store containers near spark, flame or heat.

• Store in cool, well-ventilated area.

• Keep container closed when not in use.

Driver initial: __________

Outlook (On-Campus)

Webmail (Off-Campus)

• Keep out of reach of children.

• Remember that empty containers retain hazardous or explosive vapors.

• USE EXTREME CAUTION WHEN DISPENSING ANY FUEL

CHEMICAL PROPERTIES & PHYSICAL EFFECTS OF GASOLINE AND DIESEL

GASOLINE:

D.O.T. Hazardous class: 3

FLAMMABLE LIQUID UN 1203

A blend of paraffins, naphthalene aromatics, olefins, cycloparafins and hydrocarbons.

• MAY BE HARMFUL OR FATAL IF SWALLOWED.

• AVOID CONTACT WITH SKIN OR EYES.

• AVOID BREATHING VAPORS.

• USE ONLY IN WELL-VENTILATED AREAS.

DIESEL:

D.O.T. HAZARDOUS CLASS:

COMBUSTIBLE LIQUTD NA 1993

A complex mixture of hydrocarbons produced by the distillation of crude oil.

• MAY BE HARMFUL OR FATAL IF SWALLOWED.

• MAY CAUSE SKIN OR EYE IRRITATIONS

EMERGENCY FIRST AID:

EYE CONTACT: Flush with water for at least 15 minutes

SKIN CONTACT: Wash with soap and water

INHALATION: Immediately remove affected person from contaminated area to fresh air. In case of respiratory distress give oxygen or

artificial respiration.

INGESTION: DO NOT INDUCE VOMITING. Get medical attention immediately.

FIRE SAFETY TRAINING

1. Smoking is not permitted at any fueling facility.

2. You must stop the vehicle engine when fueling.

3. The following safety equipment is found at all Pacific Pride sites.

• Fire Extinguishers

• Emergency Stop Buttons {for stopping equipment from dispensing fuel).

• Emergency Shut-off Switch (Located within 75 feet of the island)

• Telephone or Alarm System

4. If a fire should occur at the site, you should dial the emergency number (911) for assistance.

5. If a fuel spill occurs at the site, you should dial the number posted at the site.

6. Gasoline is a hazardous material.

7. Drinking gasoline is harmful.

8. In case of contact with skin, you should thoroughly wash with Soap & Water.

9. Do not induce vomiting if gasoline is swallowed

10. Use only containers that are labeled for gasoline.

11. Portable containers of less than 12 gallons must be placed on the ground before filling.

TO SUBMIT YOUR APPLICATION

o Automatically send by clicking here SUBMIT

• If on COCC computer select “Default e-mail application” and

it will

open a new message from your outlook.

• If not on COCC computer select Use Webmail and follow prompts.

• Once submitted your will receive an e-mail confirmation.

• Submit button will not work if you have not downloaded the document

and opened it up from your desktop.

- Other Options -

o Save document to desktop and attach to e-mail

o E-mail a scanned copy to csands@cocc.edu

o Send hard copies inter office mail

o Drop off at Campus Services

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