Auto Fleet Insurance Questionnaire

Applicant's Name:

Address:

Mailing Address

Address (cont):

Mailing Address - continued

Contact:

Email

Telephone:

Website

Fax:

Applicant is:

Current Carrier:

Expiration Date:

Limits: ($)

Premium: ($)

Deductible: ($)

How did you hear about us?

Other

Vehicle Maintenance / Fleet Management

1. Is there a written vehicle maintenance policy in place, overseen by a fleet manager/coordinator? If yes, please provide a copy.

2. Do you implement vehicle GPS/Telematics tracking capability?

3. Do you keep maintenance and usage logs on each vehicle?

4. Are drivers allowed to take vehicles home at night?

4a. If yes, do you have a personal use policy? Please provide a copy.

Driver Screening

1. Do you obtain and review MVRs for all drivers at hire?

1a. How frequently are the MVRs reviewed?

2. Do you use specific criteria to determine acceptable vs. unacceptable driving records? If yes, provide a copy.

3. What is the minimum acceptable age of any driver?

4. Do all drivers have at least 5 years of driving experience as a fully licensed driver?

5. Drug / Alcohol Testing Policy - Please provide a copy.

Rows	Yes	No
a. Do you have a drug/alcohol testing policy in place for drivers?
b. Pre-employment?
c. Random?

Safety

1. Is there a written driver safety policy in place, overseen by a safety manager/coordinator? If yes, please provide a copy.

2. Does your safety program include a written cell phone/texting policy?

3. Do you hold regular and mandatory meetings to discuss safety topics with your drivers?

3a. If yes, how often?

4. Do you have a formal accident response policy and procedure? If yes, please provide a copy.