Administrators Menu TowMAX Loss Control Survey Report Step 1 of 4 25% Untitled RISK OR INSURED:(Required) HOME OFFICE ADDRESS: Effective: MM slash DD slash YYYY LOCATION SURVEYED:Telephonic visitCONSULTANT:Marty HollernJustin CruseConsultants Email(Required) PRODUCER:Chester Point Programs, LLCDATE REQUESTED: MM slash DD slash YYYY PRODUCING OFFICE:MIUNDERWRITER:Collin LesterDATE OF SURVERY: MM slash DD slash YYYY TYPE OF SURVEY:TelephonicSite VisitTYPE OF OPERATION: DOT# COVERAGE: (FOR INTERNAL USE ONLY)CONFERRED WITH DESCRIPTION OF OPERATIONS DESCRIPTION OF OPERATIONS1. The insured conducts AAA and other auto club towing operation Yes No Notes:2. Insured performs Mechanical Repair Services for Commercial Vehicles Yes No Notes:3. Insured performs Mechanical Repair Services for Non-Commercial Vehicles Yes No Notes:4. Insured performs snow removal operations Yes No Notes:5. Insured Mechanics have certifications from an accredited school or an authorizing agency Yes No Notes:6. Operations travel over 100 air radius miles (CDL) requiring E-Logs Yes No Notes:7. Operations travel over 150 air radius miles (non-CDL) requiring E-Logs Yes No Notes:8. Deck transport Yes No Notes:9. Insured performs "crane" operations with Rotator Yes No Notes:10. Insured performs auto body repairs Yes No Notes:11. Towing and Recovery Operations12. does the insured have Towing and Recovery contracts with?(Required) Local Police Department State Police Department Apartment Complex Port Authorities Shopping Centers Schools (private and public) Others Select AllUntitled 13. Location(s) that insured does Towing and Recovery Airports Commercial Property Construction Sites Ditches Docks / Port Authorities Private Property Rural Roads Train Station Water Other Select AllNotes:If other is selected please provide a description in notes section.14. Specialty Towing, Recovery, Hauling Services Boats Buses (school, commercial, private) Cranes Motorcycle / ATV Motorhomes No Vehicle Tows (sea containers, customer items, toolboxes, etc.) Planes Trains Other Select AllNotes:If other is selected please provide a description in notes section.15a. Salvage Yard or Storage Lot Salvage Yard Storage Lot 15b. Onsite or Offsite Onsite Offsite Offsite Address If offsite is selected please provide the address.16. Bulk Fuel Delivery Yes No Notes:17a. Hazardous Materials Recovery Employees received required OSHA training for Hazardous spill clean up Employee Hazmat Training is current 17b. Maximum Quantity will Recover Notes:Owner(s) - Management Responsibility & Accountability1. How many years in the towing business? 2. How many years at location? 3. Does the insured have any additional locations? Yes No Notes: If yes is selected please provide the additional locations address.4. Does the insured operate any other business requiring a USDOT number? Yes No Notes: If yes is selected please provide additional business information. 5. Is the insured a member of any towing association? Yes No Notes: If yes is selected please provide name of association.6a. Is the insured a registered member of WreckMaster? Yes No 6b. Is the insured a registered member of TRAA? Yes No 7. Does the company have a publised safety policy signed that is reviewed and signed annually? Yes No 8. Does the insured have a qualified person assigned to oversee USDOT compliance? Yes No NotesIf yes selected please provide name in notes section.9. Does the insured (managers, owners, etc.) attend classes and/or seminars for FMCSA compliance? Yes No 10. Is the top management support of safety activities clear in evidence? 11. Does the insured MSC150 - reflects towing operations and registered with the FMSCA as a class 9 Non-Bulk HAZMAT insured? Yes No 12. Does the insured have MC Authority for Towing operations that cross state lines as per USDOT? Yes No 13. Insured has current UCR, IRS2290, NY HUT, etc. fillings Yes No 14. Insured has all required permits and registrations to perform towing operations? Yes No 15. Does insured have all required (current) consumer protection singage posted as required by state and local ordinances? Yes No 16. Does the insured monitor SAFER score? Yes No 17. Does the insured have a qualified person to submit company information in the FMCSA Data? Yes No 18. In the last five years has the insured received a fine from the FMCSA? Yes No If yes, why?19. In the last five years has the insured submitted a Corrective Action Plan to the FMCSA? Yes No If yes, obtain a copy20. In the last five years has the insured SAFER Rating been changed? Yes No If yes, why?21. In the last five years has the insured recived an audit or recived a letter from the FMCSA regarding their SAFER Score? Yes No If yes, why and outcome?22. Does the insured provide employees with OSHA required PPE? Yes No If yes, please list what is provided.23. Does the insured provide employees with uniforms? Yes No 24. Does the insured have a dress code for all employees? Yes No USE OF SUBCONTRATORS1. USE OF SUBCONTRATORS Yes No Types Used ACCIDENT INVESTIGATION 7 RECORDKEEPING1. Is there an accident investigation procedure and timely notification of insurance carrier? (Written accident investigation call-in form) Yes No 2. Does each vehicle have a current accident investigation packet? Yes No 3. Are accidents investigated within 24-hours? Yes No 4. Is a follow-up made to ensure that causes of accidents are correctly identified, and that correction action is taken? (Documented counseling, retraining, the discipline of driver?) Yes No 5. Are accident repeaters identified and required to attend remedial safety training? Yes No 6. Do upper management members receive and review all accident reports? Yes No 7. Are cameras with instruction in use, provided in each vehicle for accident documentation purposes? Or do employees use cell phones?8. Does insured conduct loss trend analysis study at least annually? Yes No Notes9. Is a DOT accident register maintained? Yes No Notes10. Are separate files kept on all accidents? Yes No 11. Is DOT required drug testing done after an accident? Yes No NotesDrive Controls1. Are driver selection standards written and adhere to? Yes No 2. If driver selection standards are not followed on new or retrained drivers is the reason for hire documented?3. Is the minimum driver’s age requirement 23 years of age and above? Yes No 4. Are drivers required to have at least one year of verifiable experience? Yes No If answer is yes to question 4 please list and provide details.5. Is pre-hire drug test obtained before dispatched? Yes No 6. Is the student-training program in writing – including evaluations forms? Yes No 7. Does the company adhere to all parts of the student-training program? Yes No 8. IS the training provided for the driver trainers annually? (Documented) Yes No Driver Performance Monitoring Systems (speed, acceleration, braking & steering) installed in vehicles? Yes No In answered yes please provide more details10. Are all new drivers subject to a documented road test? Yes No 11. Is a fresh long-form physical exam required? Yes No 12. If a prior medical exam from a previous employer is accepted is the long form required and is it verified? Yes No 13. Is a pre-hire MVR obtained on all (FT, PT, Seasonal, On Call, Emergency, etc.) and new hires? Yes No FLEET SAFETY-EQUIPMENT AND STORAGE GENERAL INFORMATION1.Does the insured have a written disciplinary action plan? Yes No 2. Does the individual in charge of safety have authority to hire drivers? Yes No 3. Does the individual in charge of safety have authority to terminate drivers? Yes No 4. Does the insured use the SAFER profile to identify drivers with multiple out-of-service violations? Yes No 5. Does the insured have a written policy concerning passengers? Yes No 6. Does the insured have a policy for monitoring speed? Yes No 8. How many vehicles does the insured have?8a. Number of Vehicles Owned8b. Number of leased Vehicles9. How many trailers and types does the insured have?9a. Number of Trailers Owned9b. Number of Leased Trailers10. Does the insured operate heavy equipment (skid steer, forklifts, loaders, etc.)? Yes No 11. Does the insured have plows, snow blowers, any snow removal equipment? Yes No 12. Is insured’s equipment stored in building? Yes No 13. Is equipment stored/parked on public street? Yes No 14. Are company vehicles stored at an “off” site locations? Yes No 15. All registered vehicles with a GVWR over 10,000 have required USDOT, state, and local markings? Yes No QUALIFICATION OF DRIVERS1. Do the insured conduct interviews with drivers to verify information submitted on their applications? Yes No 2. Does the insured have a system in place that will ensure ALL driver’s (FT, PT, Seasonal, On Call, Emergency, etc.)? Medical Certificates remain current CDL/DL Remains Valid Annual Record of violations remain current Annual review of driving record (MVR) is run 3. Does the insured review the results of the health history and physical examinations? Yes No 4. Does the insured have a checklist outlining the documents to be included in the qualification file? Yes No 5. Can the insured produce the driver-qualification files on drivers selected at random? Yes No 6. Are all documents required in the driver-qualification files readily available? Application for employ – Meets USDOT requirements Original Motor Vehicle Record (MVR) Previous Employment check (last three years) Current FMCSA Physical Examination Certificate (valid for 2 years) Valid Commercial Driver’s License Record and Certificate of Road Test or copy of current CDL If employed for a year – Annual Review of Moving Violations (signed) and Certificate of Violations. • Annual MVR Pre-employment drug test – Safety Sensitive work has not been conducted until results are reviewed and all Negative Diluted Samples are sent for re-test. Receipt of drug and alcohol information. Pre-Employment Screening Program (PSP) being requested and reviewed Drug and alcohol history maintained per USDOT Regulations HOURS OF SERVICE Starting December 16, 2019 All carriers and drivers subject to the rule must use ELDs NOTE: Exceptions to the ELD Rule. Driver who use paper logs no more than 8 days during any 30-day period. Driveaway-towaway drivers (transporting a vehicle for sale, lease, or repair), provided the vehicle drive is part of the shipment or the vehicle being transported is a motor home or recreational vehicle trailer. Drivers of vehicles manufactured before model year 2000.Is the insured exempt from hours-of -service regulations (operate a tow truck less than 150 air miles from their work location and not exceeding the 14-hour shift limit) Yes No DRIVER/EMPLOYEE TRAINING1. Does Required Drug and Alcohol Training meeting USDOT regulations Yes No If answered yes please provide details2. Does the insured provide hazardous materials training for new drivers? Yes No If answered yes please provide details3. Do new drivers hauling Hazmat undergo a criminal record check? Yes No If answered yes please provide details4. Have all drivers been issued a copy of the Emergency Response Guidebook? Yes No If answered yes please provide details5. Is Hazmat refresher training provided every three years? Yes No If answered yes please provide details6. Is there a system to track Hazmat refresher training? Yes No If answered yes please provide details7. Does the insured have a written DOT Hazmat Security Plan? Yes No If answered yes please provide details8. Have drivers completed or enrolled in Wreckmaster Training? Yes No 9. Have drivers attended Traffic Incident Management Training (TIMS)? Yes No 10. Do drivers/employees have current training on heavy equipment operations per OSHA regulations? Yes No 11. Have drivers been trained in proper load securement and inspections per USDOT and OSHA regulations Yes No 12. Have drivers received Bloodborne Pathogen Training per OSHA regulations Yes No 13. Have drivers received training on the hazards of towing “electrical vehicles” Yes No 14. Have drivers received training on “hot loads” (vehicles that catch on fire” when towing Yes No INSPECTION, REPAIR AND MAINTENANCE1. Does the insured have a written procedure explaining their systematic, periodic vehicle maintenance program? Yes No 2. Does the insured obtain monthly copies of maintenance records for leased equipment? Yes No No Equipment Leased 3. Does the insured complying with the annual vehicle inspection procedures? Yes No 4. Can the insured produce the prior three months’ vehicle inspection reports on a vehicle selected at random? Yes No 5. Are drivers assigned specific equipment? Yes No 6. Can the insured produce a complete maintenance file on a vehicle selected at random? Yes No 7. Are company mechanics certified in brake inspection and repairs? (Documented) Yes No If answered yes please provide details8. Are mechanics certified to conduct annual vehicle inspections? (Documented) Yes No 9. Are Mechanics Tire Certified (OSHA and TIA) (Documented) Yes No 10. Do drivers receive special recognition or rewards for successfully passing a DOT roadside inspection? Yes No 11. Are new vehicles subject to an initial DOT annual safety inspection at the insured’s shop or approved garage? Yes No 12. Are drivers conducting documents Pre and Post Inspections? Yes No 13. Does the insured “off-site” for repairs? Yes No SECURITY-STORAGE OF VEHICLES (CUSTOMER)1. Building security – monitored 24 hours? Yes No 2. Video stored in cloud Yes No 3. Security System – monitored 24 hours? Yes No 4. Is there security for vehicle storage yard? Yes No 5. Worksite Security? Yes No 6. Is there bullet proof glass for front desk area? Yes No 7. Is there a panic button for front desk area? Yes No 8. Is storage area light? Yes No 9. Is there controlled gate access? Yes No 10. Does the vehicle storage yard have a fence? Yes No 11. Yard lights? Yes No 12. Security guards (armed)? Yes No 13. UntitledDoes the insured have security dogs (trained)? Yes No 14. Are yard locations routinely patrolled by security or police? Yes No 15. Policy for security cash over $1,500? Yes No If answered yes please provide details16. Does insured have a policy for cash deposit? Yes No If answered yes please provide details17. Are all keys security and accounted for? Yes No DRUGS AND ALCOHOL1. Does the insured have a USDOT written substance abuse policy? First Choice Second Choice Third Choice If answered yes please provide details2. Does the insured have a non-USDOT written abuse policy? First Choice Second Choice Third Choice 3. Is the substance abuse policy reviewed annually and updated as necessary to reflect current laws and regulations at the federal, state, local and case law level? First Choice Second Choice Third Choice 4. Is post-accident drug/alcohol testing conducted as prescribed by the FMCSA regulations? (Verified by comparing time of accident to drug and alcohol test collection time.) First Choice Second Choice Third Choice If answered yes please provide details5. Do drivers receive and sign for the drug policy? First Choice Second Choice Third Choice 6. Does the company provide a resource of employees to seek help for substance abuse? First Choice Second Choice Third Choice 7. Are supervisors trained in drug and alcohol-use detection (reasonable suspicion)? First Choice Second Choice Third Choice 8. Has the Designated Employee Representative (DER) received required training? First Choice Second Choice Third Choice PREMISESOwned or Leased Owned Leased Years at LocationWho owns property Other tenants occupy Yes No Neighborhood is Estimated age of building(s)Number of stories Square footage Type of construction Condition of structure Number of buildings at facility Size of buildings What type of utilities (city) Age of roof Type of roof Is roof inspected regularly Yes No Is there electric back up power to building Yes No Electrical size How old is the electrical system Is there a sprinkler system Yes No Smoke detectors Yes No Are fire extinguishers throughout the building(s) Yes No Types of flooring Types of walls Types of ceilings UntitledAre photos of the facility taken and storage off site Yes Yes No What type of heating system Who inspects and maintains heating system Are properties in flood plain Yes No Are there any confined spaces on properties Yes No Is there a fueling station on properties Yes No Is fueling station guarded and contained Yes No Is there a fire extinguisher at fueling station Yes No RISK QUALITYGeneral Liability Satisfactory Satisfactory with vital recommendations Unsatisfactory (reported to underwriter) NotesAuto Satisfactory Satisfactory with vital suggestions Unsatisfactory (discuss with underwriter) CommentsThe major exposures in this line include the following:These risks are being controlled by:LOSS INFORMATIONMANAGEMENT ASSESSMENTRECOMMENDATIONSCOMMENTS Δ