U.S. Department of State
OVERSEAS MOTOR VEHICLE MISHAP REPORT
PRIVACY ACT STATEMENT
AUTHORITY: The occupational Safety and Health Act of 1970 (29 U.S.C. 657. 673); Secretary of Labor's Order No.12-71 (36 FR 8754), 8-76 (441 FR 25059), or 9-83 (48 FT 35736) and Code of Federal Regulations,
Occupational Safety and Health Administration, Labor (29 1904, 1-22). The DS-1664, Overseas Motor Vehicle Mishap Report (15 FAM 963) is required whenever a motor vehicle mishap occurs that results in personal injury
(excluding a minor/first aid injury),or vehicle or property damage is excess of $1,000.
PURPOSE: The principle purpose of the Overseas Motor Vehicle Mishap Report is to inform the safety and health official of fatalities, serious injuries or property damage associated with official vehicle operations. Sufficient
details must be provided to help prevent future occurrences. It is also used to insure that supervisors are aware of their safety/health responsibilities.
ROUTINES USES: These reports are used to provide statistical information to the Department of Labor in the Department's Safety and Occupational Health Annual Report. This report is designed to document and measure the
progress of the safety program. Mishap reports are reviewed during program assessments and focus training/assistance efforts on the information contained therein. Sufficient detail is also required to adequately evaluate events
to prevent recurrence.
NOTE: The following categories of mishaps must be reported within 12 hours as per 15 FAM:
* Injury or occupational illness resulting in a fatality, permanent total disability or inpatient hospitalization;
* Property damage of $50,000 or more;
* Operations curtailed or shut down for more than 8 hours;
* Injuries or occupational illnesses, (with lost workdays), involving three or more employees;
* Any environmental contamination.
If a motor vehicle mishap results in injury or death to any employee, including tenant agency employees, family member, contractor, or local national, a DS-1663,
Report of Mishap, is also required for each individual injured or killed in the mishap. A DS-1663 is not required for minor/first aid injuries. Submit the DS-1663
concurrently with the Motor Vehicle Mishap Report.
Mishap Information Blocks:
Agency/Organization - Driver's agency/organization for reporting damaged property
Last Medical Screening - If the driver's only medical screening exam was at the time of hiring, please enter the date hired for the "Last Medical Screening" field.
Last Safe Driver Training - If the official vehicle driver has not attended a SHEM or Post safe driver training session, enter "None" under the "Last Safe Driver
Training" field. Do not include DS-related training in this field.
Last Operator Evaluation - Enter the date of the most recent operator evaluation.
Estimated Vehicle Speed (KPH) - At the time of impact.
Same Day - Identify whether the driver's shift started on the same date as the mishap occurred.
Was this Collision Preventable? - Determine if the official vehicle driver did everything reasonably possible to prevent the collision. Follow the National Safety
Council's Guide to Determine Motor Vehicle Collision Preventability.
Official Vehicle Driver Information Blocks:
Official Vehicle Data Blocks:
"Other" vehicle includes rental vehicles, taxis, or any other non-government-owned vehicle used in the conduct of official government business.
Submit completed DS-1664 (and DS-1663, if applicable) to the Post Occupational Safety and Health Officer (POSHO).
**Be sure to retain an original copy for your files. **
Police Report - If received, please include a copy.
Post - Provide post name for overseas mishaps.
Mishap Date - Provide all dates in mm-dd-yyyy format.
Mishap Time - Provide all times in hh:mm. Check a.m. or p.m.