Transport Form with Personal Vehicle Safety Checklist (WY) Logo
  • Transport Form with Personal Vehicle Safety Checklist (WY)

  • By signing below and selecting the Non-Transport option I am verifying and agreeing to the following:

    • I have reliable transportation to and from work.
    • I have a valid driver's License
    • I will not transport any participants, at any time, for any reason.
    • I will call 911 if an emergency should occur and transportation is necessary.
    • I understand that if I violate this agreement.
      • I will be violating State Regulations.
      • This will be grounds for termination of my employment.
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  • By signing below, I certify under penalty of law that:

    1. I have inspected the above elements and the vehicle is safe and in good repair.
    2. I will only transport participants in this vehicle if the safety equipment meets the needs of the participant(s) I transport (e.g., wheelchair-locking devices for persons using wheelchairs)
    3. I will maintain current liability insurance as required whenever I transport participants in this vehicle.

     

     

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  • Should be Empty: