CALIFORNIA STATE UNIVERSITY, SACRAMENTO Risk Management Services

Revised July 2016

Sac State Sport Clubs

New Driver Authorization Checklist

In order to become eligible to drive on University/State business, complete all of the following:

Read, understand and sign the Driver Authorization Process (included).

Complete and sign the Vehicle Operation Authorization (VOA) Application (included).

Complete and sign form STD 261 to drive any privately owned vehicle on University business (included).

Complete a Volunteer Identification Form (included).

Complete Defensive Driver Training course. The course is good for 4 years from date of competition. A copy of the certificate of completion must be included when turning in this packet. This course can be completed by accessing LearnerWeb. The instructions to access the training is:

1. Login into My Sac State 2. Access LearnerWeb https://csusac.learnerhall.com/

a. or http://www.csus.edu/aba/ehs/learner-web.html (to review instructions and launch LearnerWeb)

3. Click on Course Catalog 4. Enter in Search box “Defensive Driver” 5. Under Action, select “Launch” for Defensive Driver Training (Online)

Complete CSU Volunteer Driver Application/Declaration (included).

Submit Proof of Vehicle Insurance Card and Driver License to your Sport Clubs Advisor.

Turn in all completed forms to your Sport Clubs Advisor.

For more information on Driving on University Business, please visit our website at http://www.csus.edu/aba/risk-management/

Questions? Please contact your Sport Clubs Advisor

Josh Mandel-Sonner Joshms@csus.edu

(916) 278-6731

1 Revised February 2015

UNIVERSITY DRIVER AUTHORIZATION PROCESS

Employees who are required to operate motorized vehicles on University/State business are required to complete, provide evidence of, certify, maintain, and acknowledge the following:

1. Complete and sign the Vehicle Operation Authorization application. This application requires appropriate authorization and includes acknowledgement and authorization for DMV record checks for the obligation of maintaining a safe driving record. This application also authorizes that employees will be enrolled in the DMV Employer Pull Notification Program. http://www.csus.edu/aba/risk-management/documents/VehicleUseAuthApp.pdf

2. If an employee desires to drive privately owned vehicle on University business must complete the STD 261 form (Authorization to Use Privately Owned Vehicles on State Business) and get proper authorization. This form is to be reviewed and recertified annually and available here: http://www.documents.dgs.ca.gov/dgs/fmc/pdf/std261.pdf

3. Drivers whose position requires a Class A, B or Special Class C driver’s license are required to provide their driving records at the time of the interview.

4. All employees authorized to drive on University business will have their DMV records checked annually by Risk Management Services. Drivers with Out of State Licenses must be able to provide a DMV record from their state every year OR get a California State Driver’s License.

5. All drivers who drive on University business more than once a month or twelve times a year (Frequent Drivers) are required to complete a CSU approved Defensive Driver Training course every four years. This course can be completed Learner Web http://www.csus.edu/aba/ehs/employee-training.html or the Department of General Services website http://www.dgs.ca.gov/orim/Programs/DDTOnlineTraining.aspx

6. All drivers who drive on University business and drives a golf cart, whether on the inner campus or not, must complete the University’s Golf Cart Safety training. This course can be completed on Learner Web http://www.csus.edu/aba/ehs/employee-training.html.

7. Emphasis on pedestrian safety while driving on the inner campus is a priority. Vehicle operations on the inner campus pathways shall be minimized as follows:

a. Vehicle operators shall plan their routes to maximize the use of streets (if the vehicle is street legal) and routes approved for bicycles while minimizing travel in the inner campus pathways (the bicycle-free areas).

b. Pedestrians shall be afforded the right-of-way at all times. c. The speed limit while operating on inner campus pathways: 10 mph d. The speed limit anywhere on campus with pedestrians present: the pedestrian’s speed

plus 1 mph

8. Maintenance and safety inspections as well as dispatch and checking out of University owned vehicles are the responsibility of Facilities Services.

CALIFORNIA STATE UNIVERSITY SACRAMENTO Risk Management Services

2 Revised February 2015

9. Program Center Managers, College Deans, Chairs, and Department Directors have responsibility for identifying which positions require driving as an essential job function. Those position descriptions need to be provided to Human Resources, Faculty and Staff Affairs for inclusion in recruitment notices and job position descriptions.

10. Program Center Managers, College Deans, Chairs, and Department Directors shall not permit unauthorized employees to drive on University business. Managers can verify an employee’s driving status with RMS. Departments need to notify RMS upon an employee’s separation so he/she can be removed from the program.

11. RMS has responsibility to notify Program Center Managers, College Deans, Chairs, and Department Directors of enrolled employees who have records that are questionable so their driving eligibility can be reviewed as well as vehicle driver reports that are reported under the “How’s my Driving?” program.

12. If at any time an employee ceases to drive on University business, it is their responsibility to tell RMS in order for them to be removed from the program. To drive on University business again, the process must be redone.

13. Employees to be authorized and continue to be eligible to drive on University business must: a. Posses and maintain a valid and appropriate State driver’s license (Foreign license are

not permitted). b. Not have received more than two moving violations and/or accidents in the past year.

Nor have more than four DMV points. c. Complete a Vehicle Operation Authorization form with appropriate authorization, which

authorizes and enrolls the employee in the DMV Employer Notice Program. d. Have and maintain a good driving record. e. Complete the CSU approved Defensive Driver Training course, if applicable. f. Complete the Golf Cart Safety training course, if applicable. g. Must be 18 or older. Drivers under age 18 may not drive on University business.

(SAM MM 04-13) h. Students may drive on University business as a volunteer. Register as a volunteer by

filling out this form at: http://www.csus.edu/hr/docs/volunteer_identification_form_1013.pdf Return original form to Human Resources. Department is to keep a copy.

University Driver Authorization Process

I, ____________________________________________ have read and understand the above policy and

process and my obligations that are stated.

Signature: ________________________________________________ Date: _______________________

Original to Risk Management Services, Zip: 6145 Department: Keep Copy www.csus.edu/aba/risk-management

Print Name

Revised February 2015

This form is your request to operate vehicles on University business. You must have your supervisor’s permission to operate any vehicle on University Business. The Use of University and Private Vehicles Policy Guidelines of the California State University (CSU) require the following:

Before operating a vehicle on University business, you must first provide evidence of and certify and maintain the following:

1. Possess and maintain a valid and appropriate State Drivers License (foreign licenses are not permitted). 2. Not have received more than two moving violations and/or accidents in the past year AND have more

than four DMV points on their record. 3. Have and maintain a good driving record. RMS reviews your driving record every year. 4. Enroll in the University’s State of California Department of Motor Vehicles Employer Notice Program.

Completing this form initiates that process. 5. Complete the CSU approved Defensive Driver Training Course, if applicable. Online training is available.

Defensive Driver Training is valid for four years and must be repeated thereafter. (SAM 0751) 6. Complete the Golf Cart Safety training, if applicable. Online training is available. 7. Must be 18 or older. Drivers under 18 may not drive on university business (SAM MM 04-13). 8. Applications must be submitted two weeks before the scheduled driving event. 9. Students may drive on University business as a volunteer. Volunteers will be placed in the Driver

Program for one year and must be renewed annually.

Name: First _____________________________ Middle ________________ Last ________________________________

CA Driver’s License Number: ________________________________________ License Class: A B C

CA Driver’s License Expiration date: _____________________ CSUS ID# (not SSN): ______________________________

University Position: __________________________________ Department: ____________________________________

Agreement, Certification, Release, and Acknowledgement I understand and agree that I must possess and maintain a valid State Drivers License in order to operate vehicles on University business. I further understand that if my job requires vehicle operation, that I must maintain a valid State Drivers License and a good driving record. I hereby authorize the University to obtain my Drivers License information and for California DMV to release this information to my employer. I further acknowledge and agree that my supervisor and manager may be provided with my driving record information. I hereby release and waive any claims against the State of California, the CSU and CSU Sacramento that may be related to the use of this information in my employment. I certify that I am in possession of a valid California or other State Driver’s license. I certify that I have not been issued more than two moving violations or have been involved in more than two motor vehicle accidents (or any combination of the two thereof) during the past twelve month period. Employee Signature: _________________________________________________ Date: _________________________ Authorization Signature: ______________________________________________ Date: _________________________ Program Manager/Dean/Director

Original to Risk Management Services, Campus Zip 6145 Department: Keep Copy www.csus.edu/aba/risk-management Questions? Call Risk Management at (916) 278-6456

CALIFORNIA STATE UNIVERSITY SACRAMENTO Risk Management Services

APPLICATION FOR

VEHICLE OPERATION AUTHORIZATION

Volunteer Identification Form Office of Human Resources / Phone 916-278-6211

INSTRUCTIONS: Please complete form and submit to classification and compensation at Campus Zip 6032 or hand deliver to Del Norte Hall 3rd floor Suite 3005

FAXED FORMS ARE NOT ACCEPTED AT THIS TIME

Volunteer Information Last Name: _____________________ First Name:__________________________ Middle Initial:______________ Phone Number: ___________________________ SacState/EMPL ID: _________________________________ Are you a current Sacramento State: Faculty Staff Student CalPERS Annuitant No Affiliation Are you under age 18? Yes No Date of Birth: (mm/dd/yyyy)____________________________ Social Security Number: ___________________________________ Mailing Address: Street City Zip Code Permanent Address: (If different from above) Street City Zip Code Email Address (optional):

� Emergency Contact: Phone Number:

Please answer the following questions as they relate to your volunteer position: �Are you receiving credit for a certification? Yes No Are you receiving academic or internship credit? Yes No � Are you receiving pay or any other compensation? Yes No � Are you a current contractor or consultant with Sacramento State? Yes No

Description of Volunteer Services- Department/College Supervisor’s Name: Supervisor’s Title: ��Supervisor’s Phone Number: Department Name: Email: _____________________ Campus Zip: ___________ Volunteer Dates: __________through _____________________ Is a professional license or certificate required to perform the duties? Yes No (Specify: _______________________________________)

� Will the volunteer need to drive a University vehicle on University Business? Yes No (Defensive driving course required) �

Volunteer is in a designated “sensitive assignment” as defined within the Volunteer Guidelines and Process Manual Yes No�(Background Check Required) Volunteer Duties:

Volunteer Certification This is to acknowledge that I desire to volunteer my services and perform the duties similar to those listed above. I understand that services rendered by me will be at the direction of the above named supervisor and/or their designee and that I will not be compensated for volunteer services. Further, I understand that I serve at the discretion of my supervisor and/or their designee. Confidentiality of Records: I acknowledge that information contained in Student Financial and Human Resources records for Sacramento State students, employees, volunteers and alumni must be maintained in a confidential manner. I understand that as a volunteer of an office that has access to records in computer information systems or any other source, I am required to maintain this information in a confidential manner. The unauthorized access to, modification, deletion or disclosure of information in any such system may compromise the integrity of the system or otherwise violate individual rights of privacy and/or constitute a criminal act. Distribution and/or reproduction of any record or information outside the intended and approved use is strictly prohibited. Illegal access or misuse of this information is punishable by fine and/or imprisonment. Further, I understand University computer systems are for the use of authorized use only. I acknowledge and agree to the preceding confidentiality. Signature: Date:

Approval (Signatures) _____________________________________________________________ _______________________ Dean/Chair/Administrator Signature Date

HUMAN RESOURCES USE ONLY Reviewed and recommended for service as a volunteer. __________________________________ Initials of Class and Comp Analyst

Approved Denied __________________________________________

___________________________________________________________ ________________________ Associate Vice President, Employee Services/Designee Date Entered by: _______________ Date _______________

09/24/13

CSU Volunteer Driver Application/Declaration

Section I. Additional requirements of All Applicants

1. Copy of your valid Driver's License 2. Proof of the vehicle's liability insurance

Section II. Driver Policies

1. Drivers must have a valid Driver's License 2. Drivers must be 18 years or older to drive CSU owned vehicles, but must be 21 years or older to

drive CSU approved rental vehicles on university approved trips. Drivers must be 18 years or older to drive personal vehicles, with or without passengers.

3. Drivers driving personal vehicles must have the minimum automobile liability insurance coverage required by the state.

4. Drivers are expected to obey all traffic laws including driving at or below the posted speed limit, or at a safe speed based on the conditions

5. Drivers must refrain from distracting behaviors while driving: eating, drinking, using cell phones, adjusting radio channels etc.

6. All travelers must wear seat belts. Number of passengers must not exceed number of operational seatbelts.

7. In the event of a motor vehicle accident, the driver must follow the campus vehicle accident procedures.

Section II. Travel Policies

1. Total daily driving distance not to exceed 800 miles irrespective of the number of approved drivers

2. For trips over 400 miles in one direction, two approved drivers are required for each vehicle. 3. No single driver may drive more than 150 miles without taking a mandatory minimum 15 minute

break. 4. No travel to occur between midnight & 6:00 am. 5. Overnight stay is required if a trip (there and back) is longer than 12 hours unless a club is using

3rd party travel. Section IV. Trip Leader Authority

The Trip Leader is responsible for the safe operation of a vehicle and therefore has the authority to enforce all policies and to ask for compliance from all passengers and drivers.

Section V. Vehicle Declaration (Private Vehicles). (Please initial every statement) _______1. I verify that the vehicle being driven ( Lic. Plate _________________) is adequate for the work to be performed, is equipped with seat belts and is in safe mechanical condition.

_______2. I understand that by driving I am taking responsibility for those whom I am transporting while they are in my vehicle. I further understand that when driving, there is a risk of being involved in a motor vehicle accident and that as a result, one might sustain damage to their property, sustain bodily injury or even death.

Section VI. Driver Agreement/Declaration (Please initial every statement) _______1. I understand the information outlines in Sections I,II,III,IV,V. (I ALSO CERTIFY THE FOLLOWING) _______2. I possess a valid California or other state driver's license _______3. I have not been issued more than three moving violations or have been responsible for more than three accidents (or any combination of more than three) during the past 12 month period) _______4. Within the past 5 years, I have had no DUI convictions, reckless driving convictions or any conviction that has led to a license suspension or revocation. _______5. I understand and agree to abide by all drivers policies listed in Section II _______6. I understand that I must immediately report any accident that I am involved in to the Trip Leader and submit a vehicle accident report. _______7. I understand that I must immediately report any subsequent moving violations, DUI or reckless driving citations to the Trip Administrator (Sport Clubs Advisor).

*Submit this packet and the following items to Student Organizations & Leadership on the 2nd floor of the University Union: - Defensive Driver Training Course Certificate - Copy of current Vehicle Insurance Card - Copy of current Driver License

(Office Use Only) ________Proof of Vehicle Insurance ________Proof of Driver License ________Completion of Driver Packet ________Approved ________Not Approved Signature: _________________________ Date:___________________

Sport Club:_______________________________ Driver Name:_____________________________

Signature:________________________________

Date:____________________________________