Fillable Driver Accident Review (California State University, Fresno)

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Driver Accident Review (California State University, Fresno)

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CONFIDENTIAL
STATE OF CALIFORNIA
STATE DRIVER ACCIDENT REVIEW
STD. 274 (REV. 5-99)
PLEASE PRINT OR TYPE
SUPERVISOR’S REVIEW - FOR DEPARTMENTAL ACCIDENT PREVENTION
PURPOSE: To have supervisor investigate each driver accident, report facts and circumstances, confirm that the State
vehicle was used on State business, and initiate or recommend action to achieve accident prevention.
HOW: Use sources of information listed on the back of this form. Report on all accidents, regardless of who was hurt,
what property was damaged, or who was responsible. Where State property is all that is damaged and repairs
do not exceed $1,000, a STD. 270 should not be submitted to the Office of Risk & Insurance Management.
(SAM 2430)
WHO: SUPERVISOR who authorized the employee to drive on State business must prepare this report, code the type
of accident, and forward it to the reviewing officer/safety coordinator within five days from the date of the
accident. Attach STD. 274 to the departmental copies of STD. 270 (if applicable). If STD. 270 is not required,
send a copy of STD. 274 to the Office of Risk & Insurance Management, Loss Control Unit.
REVIEWING OFFICER: You are responsible for the quality (accuracy and completeness) of the supervisor’s report and to
initiate follow-up action.
1. DRIVER’S NAME 2. ORGANIZATION UNIT AND DEPARTMENT
3. DATE OF ACCIDENT
4. HOW DID ACCIDENT OCCUR? (SUPERVISOR’S VERSION)
5. WHAT DRIVING RULES, VEHICLES LAWS OR VIOLATIONS CONTRIBUTED TO THE CAUSE OF ACCIDENT?
6. SUPERVISOR’S ACTION TAKEN, OR RECOMMENDATIONS FOR SUPERIORS TO PUT INTO EFFECT. (SEE BACK FOR SUGGESTIONS)
7. SIGNATURE AND TITLE OF SUPERVISOR
8. REVIEWING OFFICER:
DATE
I CONCUR OR I DO NOT CONCUR
MY EVALUATION AND ACTION TAKEN:
WITH SUPERVISOR
9. HOW WAS THE DRIVER INFORMED OF YOUR EVALUATION AND FOLLOW-UP ACTION:
VERBAL DISCUSSION WRITTEN MEMO VERBAL AND WRITTEN
DATE
DATE
10. SIGNATURE AND TITLE OF REVIEWER
Clear
Print
STATE OF CALIFORNIA
STATE DRIVER ACCIDENT REVIEW
STD. 274 (REV. 5-99) (REVERSE)
SOURCES OF INFORMATION INVESTIGATED -- BY SUPERVISOR
IN ADDITION TO STD. 270 PREPARED BY DRIVER
SOME ACTION SUGGESTIONS AND RECOMMENDATIONS
(EXPLAIN ON OTHER SIDE)
DID YOU? YES NO
QUESTION STATE DRIVER
GO TO SCENE OF ACCIDENT
CLOSELY EXAMINE SEAT BELTS AND SAFETY
EQUIPMENT
EXAMINE MECHANICAL DEFECTS
READ POLICE REPORT AND CITATIONS
REVIEW DL-254, ABSTRACT OF LICENSE RECORDS
DEPARTMENT OF MOTOR VEHICLES
REVIEW DRIVER’S FILE -- DEPARTMENT RECORDS
ASK ABOUT ANY DISTRACTIONS OR ATTENTION
DIVERTERS, PRIOR TO ACCIDENT
CONSIDER, WAS OUR DRIVER INFLUENCED BY
FATIGUE, ILLNESS, MEDICINE OR ALCOHOL?
IF YES, EXPLAIN
DRIVER HABITS NEED TO BE OBSERVED IN
TRAFFIC
OUR DRIVER WAS A CONTRIBUTING FACTOR
(memo to driver)
FURTHER TRAINING BE PROVIDED
(when, by whom and type)
DEPARTMENTAL POLICY OR LOCAL RULES BE
MODIFIED
DRIVER BE DISCIPLINED (special action suggested)
ASK ACCIDENT REVIEW BOARD TO ADVISE
SUPERVISOR
NO FURTHER PERSONNEL ACTION BE TAKEN
RECOMMEND REMOVAL FROM DRIVING STATUS
DISCUSS CUMULATIVE DRIVER RECORD
RECOMMEND NEW OR CHANGE OF TRAFFIC FLOW
CHANGE OR IMPROVE EQUIPMENT
ASK FOR EXPERT CONSULTATION
GIVE DATE OF DEFENSIVE DRIVER TRAINING
ORIENTATION - DEPARTMENT POLICIES AND
RULES
CLASSROOM DEFENSIVE DRIVER TRAINING
BEHIND - THE - WHEEL TRAINING
SPECIAL MOBILE EQUIPMENT TRAINING
DATE
SUPERVISOR -- CLASSIFY FOR DEPARTMENTAL REPORTING
TYPE OF VEHICLE ACCIDENT:
COLLISION WITH OTHER VEHICLE
1. Evasive maneuver
2. Lost control
3. Hit other vehicle in rear
4. Hit from rear
5. Proceeding straight
6. Crossed into opposing lanes
7. Changing lanes
8. Making right turn
9. Making left turn
10. Backing
11. Mechanical failure
12. Collision with bicycle
SOLO ACCIDENT
13. Evasive maneuver
14. Lost control
15. Collided with stationary object
16. Backing
17. Runaway vehicle
18. Lost load
19. Mechanical failure
20. Struck or was struck by animal
STRIKING PEDESTRIAN
21. In a crosswalk
22. Not in a crosswalk
23. While backing
MISCELLANEOUS ACCIDENT
24. Explain
WAS ACCIDENT PREVENTABLE BY STATE DRIVER?
Yes No
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Driver Accident Review (California State University, Fresno)

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Completed 18 July 2020

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