Fillable Indian Highway Safety Program FY 2018 CPS Annual (Bureau of Indian Affairs)

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Indian Highway Safety Program FY 2018 CPS Annual (Bureau of Indian Affairs)

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Due October 31, 2018
Indian Highway Safety Program
FY 2018 CPS Annual Report
Send completed signed form to:
ojs_indian_highway_safety@bia.gov
Page 1 of 3
Tribe:
Amount Expended:
If grant funds were not fully expended explain why: (REQUIRED) § 1300.35
Targets can be found under Section Three: Targets in the FY2018 Project Agreement
To conduct a minimum of CPS fitting stations.
If no, how many were conducted?
To distribute a minimum of car seats, to include infant, convertible, booster seats, etc.…
Was performance target achieved?
If no, how many were distributed?
To provide a minimum of CPS trainings to Tribal community members (hands on proper
installation and use of seats).
Was performance target achieved?
If no, how many were provided?
To provide a minimum of CPS brochures and handouts to community members.
Was performance target achieved?
If no, how many were handed out?
If targets were not achieved explain why: (REQUIRED) § 1300.35
Was performance target achieved?
attach an additional page if needed
attach an additional page if needed
Project Number:
Grant Award:
PERFORMANCE MEASURES
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Due October 31, 2018
Indian Highway Safety Program
FY 2018 CPS Annual Report
Send completed signed form to:
ojs_indian_highway_safety@bia.gov
Tribe:
Total number of:
Distributed Remaining
Other:
Other:
If car seats were purchased and not distributed provide a plan with dates and locations for future distribution events.
Does the Tribe have a Safety Belt Law?
If yes, is the safety belt law: Effective date of safety belt law:
Does the Tribe have a CPS law?
Effective date of CPS law:
How many Tribal CPS Technicians are on staff?
List Certified Tribal CPS Technician:
Name: Title:
Name: Title:
List CPS event/clinic dates and locations held within the community in FY18 (attach additional page if needed)
Did the CPS grant program partner with other departments to conduct CPS activities?
Did the CPS Grant Program Participate in check points?
If yes, how many?
Did the CPS Grant Program participate in any of the checkpoint mobilizations listed below?
(Check the mobilizations the grant program participated in below)
Don't Shatter the Dream:
If yes, how many?
Click It or Ticket:
Were seats distributed:
Were seats distributed:
If yes, how many?
Drive Sober or Get Pulled Over: Were seats distributed:
If yes, how many?
If yes, which departments did they partner with?
Project Number:
# Awarded
# Purchased
OCCUPANT PROTECTION & CHILD PASSENGER SAFETY (CPS)
(Continued)
OCCUPANT PROTECTION & CHILD PASSENGER SAFETY (CPS)
Date
Location
OCCUPANT PROTECTION & CHILD PASSENGER SAFETY (CPS)
CHECK POINTS/ MOBILIZATIONS
CPS Tech. Name
CAR SEAT AWARDS
Total Cost
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0
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0
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0
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0
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0
0
0
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Due October 31, 20___
Indian Highway Safety Program
FY 20___ CPS Annual Report
Send completed signed form to:
ojs_indian_highway_safety@bia.gov
Page 3 of 3
Equipment Awarded
Other:
Other:
1. What are the CPS grant programs highlights for the FY2018 grant year?
(BIA IHSP highly encourages grant programs to submit photos if available) Attach an additional page if needed
2. What are the grant programs achievements within the FY2018 grant year?
(BIA IHSP highly encourages grant programs to submit photos if available) Attach an additional page if needed
Project Coordinator (Print Name)
# Purchased
EQUIPMENT
# Awarded
Project Coordinator Signature
Date
HIGHLIGHTS & ACHIEVEMENTS
Total Cost
Tribe:Project Number:
18
18
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Indian Highway Safety Program FY 2018 CPS Annual (Bureau of Indian Affairs)

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Completed 19 July 2020

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