Company's Authorized Representative {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Other Job Title: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Information
Owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Company Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
USDOT Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Company Physical Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Provide Mailing Address below {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
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Employee Policy Options
Select Disciplinary Action for each item:
One Quarterly Violation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Two Quarterly Violations {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Three Quarterly Violations {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Four Quarterly Violations {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Five Quarterly Violations {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
One Clean Inspection per Quarter {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
This section of the application will allow you to customize the disciplinary actions that will result from violations of the safety policy. Please ensure that the actions chosen are those that you are willing to ENFORCE with company drivers, otherwise they will present no benefit to the company.
Companies that give bonuses to drivers for clean inspections give drivers a reason to be even more thorough during DVIRs (Driver Vehicle Inspection Reports). Clean inspections help improve safety scores, which will help the company overall.
Enter number of drivers the policy will be distributed to:
Enter number of drivers the policy will be distributed to_ {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Driver Information
Driver {binding ItemNumber}
Driver's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
I don't know driver's DOB. Will add later. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
---To add more drivers click "Add Driver" below.
{ binding firstError.message }
Processing Fees and Delivery Options
Employee Policy Application Processing Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Driver count: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Driver(s) Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Additional Comments: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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There is additional $2 charge per driver for mailed copies.
Driver Mailing Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
SIGNATURE AND TERMS & CONDITIONS
Terms and Conditions
- While having a safety policy on file is a n important step toward safety compliance, it is the enforcement of the policy that may have an impact on safety scores should an FMCSA Audit or Compliance Review take place.
- Federal Applications Processor Hoffenmer offers this safety policy to companies as a template for their Safety Management Controls. However, Federal Applications Processor Hoffenmer cannot and will not guarantee that this policy will be sufficient to cover all aspects of safety management, nor that this template will assist with a company’s safety scores or safety rating.
- A company using this policy is fully responsible for reading the contents of this policy and enforcing the guidelines as set forth.
- Further, by accepting this safety policy, a company agrees to hold harmless Federal Applications Processor Hoffenmer, its subsidiaries and agents for any harm incurred by the acceptance of this policy, or its use or lack thereof.
I HAVE READ AND AGREE TO ABOVE TERMS AND CONDITIONS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Signature Only {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Signature (Type your name) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Today's Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Asst Agent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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