NEVADA

DEPARTMENT OF CORRECTIONS

 

 

SERIES 200

FISCAL MANAGEMENT

 

SUPERSEDES:

AR 268 (04/24/03 )

ADMINISTRATIVE

REGULATIONS

MANUAL

 

ADMINISTRATIVE

REGULATIONS

268

USE OF

STATE AND PERSONAL VEHICLES

 

 

EFFECTIVE

DATE:

06/01/04

 

 

 

           

 

TABLE OF CONTENTS

PURPOSE      

AUTHORITY

RESPONSIBILITY

DEFINITIONS

APPLICABILITY

PROCEDURES

268.01  STATE VEHICLES

268.02  VEHICLE ACCIDENT REPORTING

268.03  STATE MOTOR POOL VEHICLES

268.04  PERSONAL VEHICLES

268.05  SEAT BELT REQUIREMENTS

268.06  VEHICLE ACQUISITION AND DISPOSAL

268.07  VEHICLE MAINTENANCE

268.08  STATE PROPERTY DAMAGE

268.09  HOME STORAGE OF STATE VEHICLES

REFERENCES

ATTACHMENTS

MANDATORY REVIEW DATE                                04/24/05

 

PURPOSE

 

To implement guidelines for the use of state and personal vehicles in-state and out-of-state for all employees of the Department.

 

AUTHORITY

 

NRS 204.080

NRS 281.160

NAC Chapter 41

SAM 1300 through 1400

 

RESPONSIBILITY

 

All employees of the Department have the responsibility to have knowledge and comply with this regulation.

 

The Department Fleet Manager is responsible for all activities, which involve the Department’s vehicles.

 

The Compliance Unit Supervisor of the Inspector General’s Office is responsible to investigate all incidents involving damage to Department vehicles and state property damage. 

 

The Division Heads/designee are responsible for all vehicles located both in the North and South Administration Offices and Prison Industries.

 

The Inspector General and/or designee are responsible for all vehicles assigned to their offices.

 

The Warden and/or designee is responsible for all of the vehicles located at the Institution, Rural Camps, and Restitution Center.

 

The Lieutenant and/or designee is responsible for all of the vehicles located at Central Transportation offices both North and South.

 

DEFINITIONS

 

MOTOR VEHICLE – To any vehicle designed for over the road, or off road use each.  This will include any vehicle, which requires a license from the Department of Motor Vehicles to operate legally. It also includes but is not limited to off road vehicles, motorcycles and heavy equipment, carts.

 

COMPLIANCE UNIT SUPERVISOR – Staff member designated by the Inspector General to investigate, report and process all claims pertaining to department vehicles and state property.

 

FLEET MANAGER – Staff member designated by the Director to manage and coordinate the Department’s vehicles.

 

PERSONAL VEHICLE – A vehicle owned, operated, and insured by a private person, whether a Department employee, other state employee or individual.

 

STATE ADMINISTRATIVE MANUAL (SAM) – A compilation of policy statements concerning the internal operations of State government based upon statute or other approved regulations.

 

STATE VEHICLE – Agency-owned and operated vehicles as well as State Motor Pool vehicles and other, special vehicles owned or leased by the state for its use.

 

APPLICABILITY

 

This regulation applies to all classified and unclassified employees of the Department and other state employees and persons such as volunteers and contract employees who may be affected by this regulation.

 

PROCEDURES

 

268.01 STATE VEHICLES

 

1.1       In-State Vehicle Operation

 

1.1.1.      Employees of the Department will drive State vehicles for official business. 

 

·         Exceptions must have prior approval of the Director/designee.

 

·         All motor vehicle laws must be complied with.

 

·         Smoking is prohibited in all state vehicles.

 

·         All drivers must use due care in operating state vehicles.

 

1.1.2.      Drivers shall possess and carry a valid operator’s license.

 

·        It is the employee’s responsibility to report to their supervisor any changes to a valid operator’s license such as suspension, revocation, or changes to class or restrictions.

 

1.1.3.      The Fleet Manager or designee in charge of fleet vehicles at each location will   ensure that the vehicles are ready for use. 

 

1.1.3.1 At the end of the trip, the driver must:

 

·        Refuel the vehicle if less than three-quarter of the tank remains;

 

·        If it cannot be fueled because of a late return and no gas can be obtained, the Fleet Manager or designee must be informed as soon as possible the next working day; and

 

·        Remove all personal effects and trash upon returning the vehicle.

 

1.1.4.      A gas credit card, if not located in the vehicle, may be obtained from the   facility/office where the vehicle is assigned for long trips.

 

1.1.4.1 Purchases of gasoline or oil made with cash, a personal credit or debit card will not be reimbursed unless the Chief of Fiscal Services approves exception.

 

1.1.5.      Trip tickets, Form DOC–500, will be maintained by drivers for each department vehicle to account for each mile traveled. Except vehicles assigned to specific employees, i.e. Director Assistant Director IG. Trip tickets will be issued with the vehicle keys. Drivers are to ensure the following:

 

·        All information on the trip ticket completed.

 

·        The remarks section is to be used to note any deficiencies or malfunctions on the vehicle either prior to departure or while in route.

 

1.1.6.      The operator must check the vehicle prior to departure to determine to the extent possible that the vehicle is in safe driving condition.

 

1.1.6.1 If an unsafe condition or mechanical problem is discovered, the vehicle will not be operated, a work order will be completed and the vehicle will be taken out-of-service until repairs are made.

 

1.1.6.2  Upon return the driver will immediately report any mechanical    problems to the Fleet Manager.

 

1.1.7.      When parking a Department vehicle, either on Department premises or in the        community, it is the responsibility of the driver to:

 

1.1.7.1 Roll up all windows, lock all doors and assure the ignition is                         locked and the keys removed from the vehicle.

 

1.1.7.2 Park in designated areas on Department property or in accordance with local ordnances of state laws if parked off Department property.

 

1.1.8    Should a vehicle break down while being operated; the driver will proceed as     follows:

 

1.1.8.1 Drivers are generally expected to change tires and to apply and remove tire chains without assistance.

 

1.1.8.2 If  temporary repairs cannot  be made, the vehicle should be moved off the

roadway, locked, and the driver should proceed to the nearest telephone to call the respective institution/facility or office.

 

 

 

1.1.8.3 If passengers or cargo cannot be left unattended and no telephone is readily available, i.e., a cell phone, the driver will attempt to request a passing motorist to relay the message for assistance. Vehicle radios are to be used if available.

 

1.1.8.4 If roadside assistance (excludes major repairs) is needed after hours the Western Energetix fuel card provided to each department vehicle may be utilized. This is to include towing and roadside assistance not to. If roadside assistance exceeds 250.00 a written explanation must be submitted to the Fleet Manager as soon as practical.

 

1.1.9        If a vehicle should breakdown outside the Carson City, Reno, Las Vegas   Metropolitan areas, a purchase requisition number must be obtained from the institution/facility or office where the vehicle is assigned before repairs are authorized.

 

1.1.10  Any repairs made to the vehicle must be reported to the institution from where the vehicle originated.

 

1.1.11    The Fleet Manager or designated employee in charge of fleet vehicles at the institution/facility is responsible for key control for the vehicles.

 

1.1.12    The Fleet Manager or designated employee responsible for the vehicles must verify all vehicles are equipped with a Form DMV‑1 and a Risk Management packet for accident reporting purposes.

 

1.1.13    Certain inmates, by virtue of their work assignments, may be required to drive a state vehicle. In such cases, the following procedures apply:

 

·        To operate any vehicle on public roads streets or highways   inmates must have a valid operator’s license in their possession.

 

1.2       Out-of-State Vehicle Operation

                          

1.2.1    State vehicles operated by Department employees out-of-state must comply with the provisions as outlined in Section 1.1 – In-State Operation, of this procedure

 

1.2.2    Prior to beginning the trip the driver must obtain prior written approval to travel      out-of-state from the Director and/or designee.

 

268.02  VEHICLE ACCIDENT REPORTING

 

1.1              State employees are defended and indemnified in accordance with Nevada             Administrative Code (NAC), Chapter 41 in the event of an accident and claim for damages.

 

1.1.1    The Nevada Administrative Code allows defense and indemnification of state employees only.

 

1.1.2        Volunteers may or may not qualify for defense and indemnification depending on their individual situation.

 

1.1.3        Contracted individuals are not covered for defense and indemnification under NAC, Chapter 41. Contracted individuals should specifically advise their independent auto insurance agent and seek clarification as to claims for accident and damages.

 

1.2       All vehicle accidents must be reported promptly in detail to the Compliance Unit Supervisor and the Fleet Manager, as well as appropriate law enforcement officials.

 

1.2.1        If an accident results in substantial loss to the vehicle, a phone report should be made immediately to the Compliance Unit Supervisor.

 

1.3       The Compliance Unit Supervisor will be the liaison for any communications regarding the accident.

 

1.4       The Compliance Unit Supervisor will investigate all vehicle accidents and will notify the Attorney General’s Office and Risk Management if applicable.

 

1.5       Employees must complete a Vehicle Accident Report, Form RSK-001 within three days after the accident and submit the completed form to their supervisor unless the driver is incapacitated.

 

1.5.1    In the event the driver is incapacitated, a state employee passenger may be asked to complete the accident forms.

 

1.5.2    If no one else is available and the driver is incapacitated, the driver must complete the accident forms as soon after the accident as possible.

 

1.6       The Vehicle Accident Form RSK-001 must be forwarded to the Warden and/or designee at the institution/facility or Division Head for signature where the vehicle is assigned. The individual who signs the form will then forward it to the Compliance Unit Supervisor with a copy to the Fleet Manager.

 

1.6.1    All forms should be submitted promptly and not held pending receipt of police reports, photographs, estimates, etc. These items can be forwarded at a later date upon receipt.

 

1.7       The Warden, Division Head and/or designee will obtain repair estimates if possible forward them to the Fleet Manager.

 

1.7.1        The Vehicle Accident Report RSK-001 will be accompanied by three repair estimates when submitted to the Risk Management Office.

 

1.8       The Fleet Manager must authorize all vehicle repairs and will notify the assigned location when and where the repairs can be made.

 

1.8.1        The Fleet Manager will obtain a purchase order prior to contacting the assigned location to authorize the repairs.

 

1.9       Claims involving another party that are likely to result in a claim against the state must be reported to the Compliance Unit Supervisor who will contact the Tort Claims Adjuster in the Attorney General’s Office.

 

1.9.1    The employee may be requested to complete the Potential Liability Incident Report, Form TC-2 for these types of claims but only after being advised by the Attorney General’s Office through the Compliance Unit Supervisor. 

 

1.9.2    If an insurance company reimbursement check is received it must be   forwarded immediately to the Chief of Fiscal Services for processing to the Insurance Recovery Account.

 

268.03 STATE MOTOR POOL VEHICLES

 

1.1       If the Department directs travel and a Department vehicle is not available, the employee may use State Motor Pool vehicles rather than personal vehicles for state business.

 

1.2       The State Motor Pool is located in Carson City with branch offices in Las Vegas and Reno.  State Motor Pool vehicles are assumed to be available at all times unless a written           statement to the contrary is obtained from a State Motor Pool attendant.

 

1.3       Vehicles from State Motor Pool are obtained by completing a Daily Vehicle Approval Form, (MP-2).

 

1.4       The Form MP-2 must be previously approved and signed by the Assistant Director of Support Services and/or their designee in Carson City, or Assistant Director of Prison Industries in Las Vegas and/or their designee.

 

1.5       The employee will contact the State Motor Pool location to make reservations and provide their Budget Account number and Driver’s License number to the attendant when making the reservation.

 

1.6       Upon arrival, the employee will present the signed Form MP- 2 to the State Motor Pool attendant. The date, vehicle number, and starting mileage will be entered on the requisition which will be retained by the attendant while the vehicle is in use.

 

1.7      On return of   the vehicle, the ending mileage will be recorded and a copy of   the requisition will be given to the driver.  Drivers must verify the beginning and ending mileages on the requisition are correct. The copy of the requisition must be submitted to the Department Accounting Section within 5 days after the end of the trip.

1.8       The driver will notify State Motor Pool of any problems with the vehicle.  Accidents must be reported promptly in detail to State Motor Pool, as well as to the appropriate law enforcement officials.

 

1.9       If picking-up a vehicle in Las Vegas, the employee must telephone the State Motor Pool in Las Vegas and reserve a vehicle giving their name, flight number, and date and time of arrival in addition to their Budget Account number and Driver’s License number. State Motor Pool vans in Las Vegas are available at the airport. Courtesy van pickup location on lower level for transport to State Motor Pool facility.

 

1.10     If the employee reserves a State Motor Pool vehicle, but does not claim the vehicle upon

arrival, or fails to cancel a reservation, the employee may be held personally responsible for charges billed the Department at the daily rental cost, plus delivery and return of the vehicle to and from the local airport.

 

1.11     If a group of two or more employees is making the same trip with mutual destinations, only one vehicle will be approved up to the seating capacity of the vehicle per group. Larger vehicles are sometimes available to transport a larger group, but must be requested at the time of the reservation.

 

1.12          If the trip is outside of the State Motor Pool service area, the State Motor Pool attendant will furnish gas credit cards, field requisitions, and instructions for use to the driver.

 

1.13          State Motor Pool vehicles are not to be parked and left at the airport, therefore, all employees should plan sufficient check-in time to allow for returning the vehicle to State Motor Pool facility prior to departing on their flight. State Motor Pool will provide transportation to the airport.

 

1.14          All State Motor Pool vehicles are to be returned on the date indicated unless an extension of time has been obtained from Motor Pool. All servicing, including gas and oil, is to be obtained from the local State Motor Pool unless the car is outside the service area.

 

1.15     To avoid problems when using State Motor Pool vehicles, employees will adhere to the following basic rules:

 

1.15.1  In accordance with NRS 204.080, the private use of a State Motor Pool vehicle by any individual or group, whether an employee of the state or not, is unlawful. The employee who operates a State Motor Pool vehicle is responsible to the state for the use of the vehicle while assigned, used, or operated. A violation by an employee shall constitute a malfeasance of office.

 

1.15.1    State Motor Pool vehicles shall be used only for authorized official business.

 

1.15.2    State employees only are authorized to drive State Motor Pool vehicles.

 

1.15.3    Employees driving State Motor Pool vehicles must possess a valid Driver’s license as issued by a Department of Motor Vehicles, and must abide by all state laws.

 

1.15.5    Only persons traveling on state business may ride as a passenger in a State Motor Pool vehicle.

 

1.15.6    Smoking is prohibited in State Motor Pool vehicles.

 

1.15.7    The driver and all passengers must use seat belts in the manner prescribed by the manufacturer of the vehicle.

 

268.04 PERSONAL VEHICLES

 

1.1              Use of a private vehicle is not authorized unless a Department vehicle or Motor Pool vehicle is not available or;

 

1.1.1    If any employee is directed or approved to drive a personal vehicle for the States convenience or in an emergency, they will be entitled to expense reimbursement as provided in NAC or SAM.

 

1.1.2    Insurance on an employee owned vehicle is primary and would cover the state’s liability arising out of any accident involving an employee-owned vehicle used on state business.

 

1.1.3    It is the responsibility of all Department employees who park their vehicles on Department property to lock their vehicle.

 

1.1.4    When employees enter the secure perimeter of an institution or facility, the employee’s personal keys shall be turned over to an authorized person who will secure them in an area designated by the Warden.

 

1.1.5    If an employee is approved to utilize their own personal vehicle for their convenience they are entitled to reimbursement in accordance with the Department’s Administrative Regulation 265.

           

268.05 SEAT BELT REQUIREMENTS

 

1.1       All state employees are required to wear safety belts when traveling in any vehicle on state business.

 

1.1.1    This includes both state owned and personally owned vehicles.

 

1.1.2    The seat belt policy applies to both the driver and to all passengers.

 

1.2       The Fleet Manager and designated employee in charge of vehicles at their office or facility shall ensure that all state owned vehicles assigned to their locations have properly     working seat belts in all seating positions.

 

268.06 VEHICLE ACQUISITION AND DISPOSAL PROCEDURES

 

1.1              The Fleet Manager must approve all vehicle acquisitions and disposals prior to initiating action.

 

1.2              In all cases before acquisition except where special approval has been granted there must be a vehicle removed from inventory.

 

1.2.1    The budget for that vehicle is to be transferred to the vehicle being acquired.

 

1.2.2    Signatures from the Department Head, Business Manager, Budget Analysts and Fleet Manager will be required to obtain approval.

 

1.3       The Fleet Manager will maintain and prepare quarterly reports on all fleet vehicles and submit copies of these reports to the Chief of Fiscal Services and the Chief of Purchasing.

 

1.3.1    The Fleet Manager will assist the Chief of Purchasing in the reconciliation of fleet vehicles to the vehicle fixed asset report. 

 

1.4       Acquisition of Vehicles (NEW)

 

1.4.1    Budgetary approval is required prior to the purchase of any new vehicles and will be purchased in accordance with SAM.

 

1.4.2    A Stores Requisition accompanied with a Fixed Asset Location Form DOC–538 with signatures from the Department Head, Business Manager, Budget   Analysts and Fleet Manager will be required.

 

1.4.3    When  a  purchase  order  has  been  issued  it  will  then  be  forwarded  to   State

Purchasing for distribution to the vendors whom under contract in accordance with SAM.

 

1.5       The Fleet Manager will process the necessary registrations and notify the Attorney General’s Office and Chief of Purchasing of all vehicle purchases.

 

1.6       The Assistant Director of Support Services and/or their designee will oversee all vehicle purchases and maintain all vehicle titles.

 

1.7       Acquisition of Used Vehicles

 

1.7.1    Budgetary approval is required prior to the purchase of any used vehicles and will be acquired in accordance with SAM.

 

1.7.2    A Stores Requisition will be accompanied with Form DOC - 538 with signatures from the Department Head, Business Manager, Budget Analysts and Fleet Manager.

 

1.7.3    Warranties applying to used vehicles must be in writing and submitted to the Fleet Manager.

 

1.8       Acquisition of Surplus Vehicles

 

1.8.1    Vehicles may be acquired through State Purchasing at no charge. “ If applicable”

If there is a charge refer to Sec. 1.7

 

1.8.2    Form DOC-538 with signatures from the Department Head, Business Manager, Budget Analysts and Fleet Manager will be required prior to acquisition of surplus vehicle.

 

1.8.3    The Fleet Manager will notify the Attorney General’s Office and the Assistant Director of Support Services and/or their designee of the acquisition of surplus vehicles.

 

1.9       Disposal of Vehicles

 

1.9.1        Vehicles removed from the Department’s budget must be turned into State Purchasing and be disposed of in accordance with SAM.

 

1.9.2        Department Form 538 with the appropriate signatures will be required with every vehicle transaction.

 

1.9.3        The Fleet Manager will contact the Attorney General’s Office and Assistant Director of Support Services and/or designee to notify them of all vehicle deletions.

 

1.9.4        The Assistant Director of Support Services and/or their designee will sign-off on all vehicle titles.

 

1.9.5        Disposal Disposition Reports must be submitted to the Fleet Manager prior to disposal. The Disposal Disposition Report must contain the following information:

 

·        Reason for disposal;

 

·        State ID #  “EX 0000”;

 

·        Vehicle Identification Number  “VIN”;

 

·        Mileage;

 

·        Description of vehicle;

 

·        Condition “list of damage or repairs if needed”;

 

·        Budget Account Number;

 

·        Approving Authority Signature; and

 

·        State Purchasing Control Number.

 

268.07 VEHICLE MAINTENANCE

 

1.1       Each office or facility where the vehicle is assigned will:

 

·        Perform preventive maintenance on the vehicles and ensure billing to the appropriate budget account;

 

·        Maintain accurate records pertaining to each vehicle under the division’s budget code;

 

·        Complete the quarterly vehicle report and forward to the Fleet Manager.

 

·        Check to ensure that lube, oil, and oil filter along with the vital fluids are changed every 5000 miles or once a year whichever comes first;

 

·        Ensure that vehicles are not operated when repair is needed concerning driver or vehicle safety; and

 

·        Repairs including routine maintenance made to vehicles with a monetary value over $250.00 will be pre authorized by the Fleet Manager prior to the repair.

 

1.2       Repairs and services will be reported on the quarterly service report including nature of repair, vendor, date, mileage and cost. The report will contain accurate information and be submitted to the Fleet Manager no later than the due date specified.

             

1.3       Employees assigned to use Department vehicles must check the vehicle each time it is fueled for:

 

·        Proper engine oil level;

 

·        Visual inspection of tires for wear and proper inflation; and

 

·        Exterior inspection of the vehicle for body damage.

 

268.08 STATE PROPERTY DAMAGE

 

1.1              All losses/damages involving state property  (incidents involving vehicles) must be reported promptly to the Compliance Unit Supervisor of the Inspector General’s Office and the Fleet Manager.

 

1.2              The employee is to complete the Personal Injury and Property Loss/Damage Report Risk Management Form PROP-01 and forward it to their supervisor immediately.

 

1.3              The supervisor will sign the report; obtain the Warden, Manager, or Division Head’s signature and forward the completed form to the Compliance Unit Supervisor and the Fleet Manager within 24 hours. 

 

1.3.1        If he property loss is substantial, a phone report should be made to the Compliance Unit Supervisor immediately.

 

1.3.2        The report must not be held   for backup documents.  These   items may   be forwarded upon receipt.

 

1.4       The Compliance Unit Supervisor will be the liaison for any communications regarding the incident. The Compliance Unit Supervisor will investigate all state property incidents and will submit a report to the Fleet Manager and Attorney General’s Office, if applicable, with a copy to State Risk Management Division.

 

1.5       The Compliance Unit Supervisor will initiate and maintain files/records for each incident and process all documents pertinent to the claim.

 

1.6       The Compliance Unit Supervisor will coordinate all property replacements through the appropriate department staff and must be in accordance with State Purchasing procedures, rules and regulations.

 

1.7       If the incident has the potential to cause a liability claim against the state, the Office of the Attorney General’s Form TC-2 must be completed immediately and forwarded to the Compliance Unit Supervisor who will then forward the report to the TORT Claims Manager, Office of the Attorney General.

 

268.09   HOME STORAGE OF STATE VEHICLES

 

1.1       Home storage of state vehicles must be pre authorized by the Director and the authorized   form must forward the to the Assistant Director of Support Services

 

1.2       Eligibility for home storage must meet the requirements set forth in the State Administrative Manual # 1306.0

 

1.3       SAM requires the head of each cabinet level department, or their designee, to provide written approval of the permanent assignment of vehicles to an employee for home storage and a list of those approvals, with justification, must be submitted to the Director of the Department of Administration on or before January 1 of each year together with a report on the value, for federal income tax purposes, of commuting trips made by employees in state vehicles.

 

 

268.10 VEHICLE OPERATION BY INMATES

 

1.1       No inmate who is assigned to Medium or Close custody may operate a motor vehicle under any condition, with the exception of those inmates assigned to the fire department at Southern Desert Correctional Center (SDCC).

 

1.1.1    No inmate who is serving a sentence for driving under the influence or controlled substances may operate a motor vehicle under any circumstance, and regardless of custody level.

 

1.1.1        No inmate regardless of custody level is allowed to drive a motor vehicle within the perimeter of an institution, except as noted in 1.1 above.

 

1.1.3    No inmate will possess, store, or park a personal or commercial vehicle on Department property. 

 

2.1              Inmates assigned to Minimum or Community Trustee custody may operate a motor vehicle under the following conditions.

 

2.1 1    Minimum or Community Trustee custody inmates only may operate motor vehicles on state property.

 

2.1.2    Inmates will not be allowed to drive a motor vehicle on any public or private thoroughfare.

 

2.1.3        Inmates assigned to the Nevada Division of Forestry (NDF) may drive a vehicle of that agency in an emergency situation where the vehicle is at risk of destruction, or the NDF Supervisor is incapacitated.

 

2.1.4        Inmates assigned to Restitution and Transition centers may drive commercial vehicles during the course of their employment if the vehicle is used in the conduct of business only.  The inmate must have a valid driver’s license and the employer must provide appropriate insurance. 

 

2.1.4.1 No inmate at the Restitution or Transition centers who are incarcerated for an offense of driving under the influence of alcohol or a controlled substance may drive a vehicle for any reason whatsoever.

 

2.1.4.2 The Staff of the Restitution or Transition center must verify with the employer that insurance on the inmate is in place before the inmate is allowed to drive. 

 

2.1.4.3 Inmates assigned to Residential Confinement may drive motor vehicles if     approved by the Division of Parole and Probation, and if they have a valid Nevada Driver’s License and appropriate levels of insurance. 

 

3.1       Institutional Procedures will be developed at each institution and facility to control the use of State vehicles by inmates

 

REFERENCES

           

None

 

ATTACHMENTS

 

Vehicle Accident Report, Form # RSK – 001

Daily Vehicle Approval, Form, # MP – 2

Fixed Asset Location Form, Form # 538

Personal Injury and Loss Damage Report, Risk Management Form PROP – 01

Office of the Attorney General’s Form, TC – 2

Home Storage authorization Form.

 

 

_______________________________                                  __________________

Jackie Crawford, Director                                                        Date

           

CONFIDENTIAL                  ___                  XX

                                                Yes                  No

 

 

THIS PROCEDURE SUPERSEDES ALL PRIOR WRITTEN PROCEDURES ON THIS

SPECIFIC SUBJECT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Seal of Nevada

             

                       STATE OF NEVADA               

                                             VEHICLE ACCIDENT REPORT

INSTRUCTIONS: (If you need more space, attach a separate sheet of paper)

COMPLETE as much information as possible at the scene.  

REPORT all accidents involving third parties, whether or not there is damage or injury. 

COOPERATE with investigating officer(s) and the State’s adjuster(s). 

WITHIN 48 HOURS: 

Send original to AG’s Office Claims Manager, 100 N. Carson St., Carson City, NV 89710 

Send copy to Risk Management Claims Manager, 201 S. Roop St., Suite 201 Carson City NV 89701

Date of Accident ___________________Time ________

OUR INFORMATION:

Driver’s Name ____________________________________ Agency____________________________________

Office Address ________________________________________________ Bus. Phone_____________________

Driver’s Lic. No. _______________________________State____________ Expiration Date__________________

Contact Person ______________________________ Title __________________ Phone__________________

Is this a MOTOR POOL Vehicle? ¨ Yes ¨ No Vehicle ID No. (VIN)_____________________________________

Plate No. ________________ Year _________ Make ___________________ Model_______________________

Location of vehicle __________________________________________________________________________

Describe Damage to State Vehicle: o Windshield Damage only, No other party involved.

______________________________________________________________________________

THEIR INFORMATION: Self-Insurance card provided to driver/owner? o Yes o No

OWNER’S NAME _________________________________________ Daytime Phone_____________________

Address ______________________________________City/State/Zip_________________________________

Insurance Company _______________________ Policy No. _________________ City/State________________ 

Insurance Agent ____________________________________________ Phone No. ______________________

Plate No. _________________ State _______ Year _____ Make ____________ Model____________________

Driver’s name _________________________________________ Daytime phone________________________

Address ____________________________________________City/State/Zip__________________________

Driver’s Lic. No.________________________________ State _________ Expiration Date__________________

Describe damage to other vehicle and any injuries reported: _____________________________________________________________________________

EXPLAIN WHAT HAPPENED: _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Accident Reported to (NHP, Metro, Reno P.D., etc.) __________ Report #__________Citations Issued? o No o Yes If "Yes" explain__________________________________________________________________________________

WITNESSES:

Name

Address

Phone

 

 

 

 

 

 

PERSONS INJURED: (If injured person is a State Employee, complete a Worker’s Compensation Claim Form.)

Name

Address

Phone

 

 

 

 

 

 

Agency Information: ¨ Damage estimates attached ¨ Estimates will follow

State Driver’s Signature ____________________________________________ Date_________________

Reviewed by Safety Coordinator _____________________________________ Date _________________

Reviewed by Department Head ______________________________________ Date _________________

 

CT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEVADA STATE MOTOR POOL

                                                                                                                 License: __________________

                                               DAILY VEHICLE APPROVAL FORM

Conf. No: _________________

 

Agency to be charged________________________________________________________________________________

 

Division to be charged________________________________________________________________________________

 

Budget Account No._________________________________________________________________________________

 

Departure date/time______________________________Return date/time______________________________________

 

Type of Vehicle (4x4, van, sedan, etc)__________________Destination__________________________________________

 

Phone No._____________________________________Fax No._____________________________________________

 

Driver’s Name_____________________________________________________________________________________

                                                              Please print/type

 

Driver’s License No.________________________________________________________________________________

                                                              Please print/type                                   

 

Vehicle received by_________________________________________________________________________________

                                                     Signature of driver

 

 

NOTE:  By signature above, driver certifies that they have a valid operator’s license, as defined by the Nevada Department of Motor Vehicles; in their possession while operating a state vehicle and that they are cognizant of state law concerning misuse of state-owned vehicles

 

I hereby give approval for the above named employee to travel as shown above.

 

 

Approved by___________________________________________________________________________________________

                              ORIGINAL Signature of Approving Authority

 

 

SIGNED FORM MUST ACCOMPANY DRIVER

 

CONTRACT TERMS AND CONDITIONS:  The renting agency agrees to exercise all reasonable care and observe all traffic laws while using a state vehicle.  Except for Acts of God, mechanical failure or identifiable third party accident fault, the renting agency will return state vehicles in the same condition as received, less normal wear and tear, and will be financially responsible for all abuse or physical damage expense.  All non-reported accidents/incidents, including accidents/incidents reported after the reporting time requirements, will result in billing to the renting agency for total physical damage sustained by the state vehicle.

 

Each motor pool vehicle is issued or assigned with a spare tire, jack and jack handle.  The renting agency will be responsible for returning the vehicle with all items listed above.  If motor pool must replace missing items, the last renting agency will be billed for replacement items at motor pool cost.

 

 

 

 

 

 

  Credit card issued                            Snow chains issued                        

  Credit card returned                         Snow chains returned                     

 

Telephone:     Fax:

B.      Carson City                (775) 684-1880    Carson City          (775) 684-1888

Las Vegas          (702) 486-7050        Las Vegas       (702) 486-7042

Reno                  (775) 688-1325        Reno   (775) 688-1309

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of Nevada

Seal of Nevada

 

STATE OF NEVADA PROPERTY LOSS REPORT

 

INSTRUCTIONS: 

Use this form for: 

Reporting Thefts or Damage to State Property that exceeds $1,000 (Excluding Motor Vehicles). 

Reporting Boiler and Machinery Losses.

Notify Risk Management Tel: (775) 687-3189; Fax: (775) 687-3195) Immediately If Loss Will Exceed $10,000.

Send To: Risk Management Division, 201 S. Roop St., Suite 201 Carson City, NV 89701 

 

Date of Incident________________Time______________ Location Where Loss Occurred Including Street Address _______________________________________________________________________________

Department _______________________ Division_________________________ Budget Account_____________

Contact Person_____________________________ Title_______________________ Telephone No. ___________

Provide a Detailed Description of What Happened TAKE PICTURES (Attach related police or fire reports. Attach additional pages if necessary)

 

Provide a Detailed Description of How Property was Damaged or Lost (Attach additional pages if necessary):

 

Estimated Value of Loss $__________________________________

Form Completed By: ______________________________________ Date: _____________

 

Copy Sent To:

¨ Risk Management Date _________________________

¨ Supervisor of Affected Agency Date _______________

¨ Department Head of Affected Agency Date __________

Risk Management Form

PROP-01

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