Utility Task Vehicle (UTV) Authorization Form

The Berg Group UTV Authorization Form permits one driver (site foreman) to safely operate and oversee care/maintenance of the UTV on site. The operator must either be the site general foreman or a competent employee approved by the foreman, superintendent and safety manager. This authorization applies only to the one individual actually signing the form, no one else. The operator agrees to ensure safety and proper function of the UTV; fluid levels, passenger safety, tire pressure/quality, etc. The operator also agrees to adhere to all manufacturer requirements as outlined in the manufacturer operator’s manual, which can be found on the machine. The Berg Group maintains a zero-tolerance policy regarding any horseplay, tomfoolery or similar antics while operating or riding within a company UTV. Such conduct is not aligned with Berg’s culture and is grounds for immediate dismissal. It is prohibited to operate a company UTV while under the influence of drugs, alcohol, medications or any other substances that may affect your driving capabilities. If at any point you are unfamiliar or uncomfortable with the UTV, stop immediately and do not operate the machine. If the UTV is a rental, be sure to communicate with the rental representative regarding any advance maintenance, concerns or mechanical failures with the UTV, or if the UTV is missing any required decals, operator’s manual, etc.

The operator shall adhere to the following:

Have and maintain a valid United States driver’s license * Motor Vehicle Records required before operating UTV
Be at least 16 years of age or older
Complete the ROHVA online e-course and forward a copy of the completion certificate to safety manager
1. This e-course is free but does require that you make an account (username and password)
2. Go to https://cbt.rohva.org/login/index.php and follow the steps to make an account
3. Enroll in “ROV E-Course”, the course will take about 45 minutes to complete
4. Once completed, send a copy of the certificate to safety manager
Complete/Pass the Berg Group Hands-On UTV Exam (see page 2)
Complete Berg Group UTV Pre-Operation Inspection daily prior to operating and keep on the machine
Ensure operator’s manual is located on the UTV prior to operating
Follow all site-specific requirements as determined by the general contractor
Follow all city, state and federal regulations & ordinances

Any questions or concerns should be directed to the Regional Safety Manager prior to signing this form.

Employee's Name*

First NameLast Name

Employee's Signature*

Safety Manager Name*

First NameLast Name

Safety Manager Signature*

Date*

Date

Rows	Pass	Fail
Basic understanding of UTV operation functions/controls (brakes, accelerator, headlamps, seat belts, turn signals, etc.)
Verifies safety decals, operators manual in vehicle, thorough preoperation inspection and function test. Operator securely fastens seatbelt and cargo.
Safely accelerates in all directions, demonstrating proper operation. Reverses in all directions showing correct technique and line of site.
Operation consistently kept at safe speeds. Operated according to operators manual, never attempting stunts, fast-turns, jumps, etc. Both hands on steering wheel at all times.
Ensure operator understands how to safely operate UTV in applicable circumstances; i.e., uphill, downhill, sidehill, windy conditions, mud, rain, cold, etc.
Safely enters/exits vehicle, only keeping the key in the ignition when operating. Safely parks UTV with emergency brake engaged.