4821 Bethlehem Road, Suite 101
Richmond, VA 23230
Phone: (804) 355-5371 ♦ Fax: (804) 358-1374
E-mail:
VTA Fleet Safety Contest
Annual Report Form
Entry Deadline is March 14. Complete using fleet safety data for calendar year 2016.
Reporting requirements for the VTA Fleet Safety Contest:
1.A separate report must be filed for each major division representing a type of service performed within the state.
2.Statistics and rates must be listed for state-wide not system-wide operations. Frequency rates shall be expressed in terms of the number of accidents per 1 million miles as determined by the following formula:
Frequency =Number of Accidents X 1,000,000
Total Mileage
Name of Company
Address
Safety Director
Contest Division - Check () one. A separate report must be filed for each Division entered. All Divisions must have a minimum of five participants before the Division will be judged in the contest. Contestants will be notified if their Division has less than five entries.
GENERAL COMMODITIES – TRUCKLOAD HEAVY HAULERS
GENERAL COMMODITIES - LTLPRIVATE CARRIERS
TANK TRUCKAUTO TRANSPORTERS
HOUSEHOLD GOODSBULK/DUMP TRUCK
MISCELLANEOUS (Specify)
Total Accidents / Total Mileage / 2016 Frequency Ratio / 2015 Frequency RatioCOMBINED
INTERCITY
LOCAL
The following certification must be signed by an officer of the company other than the Safety Director.
We hereby certify that the information submitted above is correct to the best of our knowledge and belief. We agree that a check of the record may be made prior to the announcement of any award to this organization.
______(Signature) (Title)
Virginia Trucking Association
4821 Bethlehem Road, Suite 101
Richmond, VA 23230
Phone: (804) 355-5371 ♦ Fax: (804) 358-1374
E-mail:
VTA FLEET SAFETY CONTEST RULES
For Calendar Year 2016
Section 1 - ELIGIBILITY
1.1All fleet members of the Virginia Trucking Association are eligible for entry in the contest for the Safety Awards.
Section 2 - REPORTING OF MILEAGE AND ACCIDENTS
2.1The contest shall be on a calendar year basis.
2.2Report requirements:
a.Reports shall be made for the total annual Virginia mileage of the entire fleet and all accidents that occurred in Virginia - both chargeable and non-chargeable - of all the fleet’s drivers.
b.Any accident involving injury, fatality, or property damage of any amount regardless of fault must be reported.
c.Types of accidents not reportable include: those involving fleet operated passenger cars and miscellaneous vehicles such as service trucks and wreckers; those in which the fleet vehicle was legally parked; debris thrown up by a vehicle’s tires; objects falling from over head; certain collisions with animals.
2.3All applicable information must be recorded on the report form attached. In the event a contestant's drivers have had no accidents during the year, the words "No Accident" must be inserted in the accident column of the report.
2.4Reporting deadline. All entries must be received in the VTA office no later than March 14, 2017.
2.5Reporting of accidents shall be in accordance with the standards set forth in Trucking Industry Guidelines for Recording Fleet Vehicle Accidents and Determining Preventability. Copies of the complete standard are available for purchase by calling 1-800-ATA-Line (Item#G6044.) A summary of major contest rules is available from the VTA office.
Section 3 - GRAND TROPHY REQUIREMENTS
3.1 Eligibility for Grand Trophy competition will be limited to those entrants meeting the following qualifications:
a.Entered motor carrier fleet safety contest and been judged a first place winner in a class of mileage competition.
b.Supplied information for the past twelve months of the reporting period regarding accident records of its Virginia-based drivers.
c.Completed Parts II and III of the Grand Trophy Contest Entry Form.