Online Driver Safety Training Request

Online Driver Safety Training Request

Instructions

Use this form to request enrollment in an online driver safety course.

Before submitting this form, please read below prior to moving forward:

There must be an active WorkSafe Profile for the driver. Visit www.worksafe.ucla.edu to confirm and use your UCLA Logon ID and password. If unable to logon to the WorkSafe LMS, click on the Create/Activate button and follow the WorkSafe instructions to create a profile then return to this form after the profile is created/confirmed.
In order to ensure the driver is sent the training assignments and other communications, it is very important to make sure whatever email is in the drivers WorkSafe profile is the same email entered in the field below.
ALL FIELDS ARE REQUIRED. IF A FIELD IS LEFT BLANK, THE TRAINING REQUEST WILL BE DELETED.

I have confirmed that I have an active WorkSafe LMS profile and will use the same email in my WorkSafe profile when submitting this request*

Course Selection*

Please select at least one of the following courses.

UCLA Basic Driver Safety Training

UCLA Online Motorized Cart Driver Training

UCLA Towing Small Trailers

University ID*

Enter the 9 digit University ID Number. Type N/A for Non-UCLA Affiliate

First Name*

Enter the first name of the person who will attend training

Last Name*

Enter the last name of the person who will attend training

Email*

Enter the email address of the person who will attend training

THIS EMAIL MUST MATCH THE EMAIL IN THE WORKSAFE PROFILE

Driver Category

Select

DMV Pull Notice Program*

Is the driver already enrolled in the DMV Pull Notice program?

Yes

Department/Group – Request will be denied if blank*

Dept/Group Sup/Leader First Name - REQUIRED*

Dept./Group Sup/Leader Last Name - REQUIRED*

Dept./Group Sup/Leader E-Mail - REQUIRED*

Comments

Send me a copy of my responses