District Property Notice of Loss

District Property Notice of Loss

Other specify:*

Form Date Field*

Describe what happened, what caused the accident:*

Did a Law Enforcement Officer investigate?*

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Who was the violation issued to & what was it for?*

Police Report Number*

Date and Time Police Notified*

Investigating Officer*

School/Building*

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Specific Location in Building*

Work Order Number*

Kind of Loss*

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I acknowledge to have read the disclaimer below.*

Employees may participate in the insurance plan by providing a monthly contribution of $1.

Any participating employee who has personal property stolen or vandalized during working hours on school district property, through no fault of the participating employee, may apply for reimbursement. The reimbursement will be made for the repair or replacement of the property up to a maximum of $500 or the participating employee’s insurance deductible, whichever is less, provided the participating employee files a police report on the damaged or stolen item within 24 hours of occurrence.

Specify*

Reported by*

Phone*

Position*

Date item(s) First Discovered Missing*

Time (please denote am or pm)*

This item was assigned to*

Give the name of a specific person, department, and date assigned.

Enter missing items and replacement cost*

Give a detailed account of what happened*

Date Supervisor was notified*

Supervisor's name*

You acknowledge*

You acknowledge by entering your initials below that you personally completed and submitted the information to Westminster Public Schools and that all information is true and correct to the best of your knowledge. I also acknowledge that my supervisor has reviewed and approved my claim of District Property Loss.

Attachment(s)*

If you are uploading more than 10 documents please email them to finance@wps.org.

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Year, Make and Model*

Driver's Name:*

Was a traffic violation summons issued? *

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Location of Accident (Street, City and County)*

Date of Accident*

Approximate Damage $:

Year, Make and Model*

WPS Driver's Complete Address:*

WPS Driver's Phone Number:*

Other Person's Complete Address:*

Other Person's Phone Number: *

Other Vehicle Approximate Damage $:*

Initial*

Westminster Public Schools

At – Fault Vehicle Accident Procedure

This procedure applies to all employee drivers of Westminster Public Schools owned vehicles. It is intended to provide fair and equitably applied consequences to drivers involved in an accident in which the driver is considered “at fault,” while driving a School District owned vehicle.

1.0 When a Vehicle Accident Occurs

1.1 Driver reports accident immediately to Transportation office and immediate supervisor.

1.2 Supervisor, or designee, must respond to accident scene to investigate accident.

1.3 Supervisor must, within one working day of the accident, write an accident summary, detailing results of their investigation.

1.4 Driver must immediately file all necessary accident reports with the Auxiliary Services office, including, but not limited to, the District vehicle accident report, State accident report, and the CDE accident report.

1.5 The supervisor will determine whether the driver is “at fault,” and whether the accident should be remanded to the committee for review, or whether there are circumstances that lessen or eliminate the employees responsibility.

1.6 If the supervisor determines circumstances that lessen or eliminate the employees responsibility for the accident exist, the supervisor will discuss those circumstances with the Director of Operations & Maintenance.

1.7 If the Director or the driver does not concur with the supervisor’s assessment of circumstances, the accident will be submitted to the committee for review.

1.8 When it is determined that circumstances that lessen or eliminate the employee’s responsibility, the Director will inform the committee chairperson.

2.0 Accident Review Committee

2.1 The committee will include three (3) Transportation Department employees, and one employee representative each from the Maintenance, Grounds, & Warehouse Departments.

2.2 Each employee group will elect its representative(s) and one alternate. If no employee(s) from an employee group wants to serve on the committee, one will be appointed to do so by that group’s administrator. The alternate will serve only if a group’s representative is on vacation, or another extended absence, that will prevent the committee from meeting in a timely fashion.

2.3 The committee will elect a chairperson to lead meetings and to be the communicator for the committee.

2.4 The Transportation Manager will attend each accident review meeting to act as an administrative liaison, and to provide needed information to the committee regarding law and standard practices.

2.5 Committee members are requested to make at least a one-(1) year commitment to serving on the committee.

2.6 If a committee member chooses to resign from the committee during their term, the appropriate department’s administrator will seek a replacement.

2.7 If no replacement can be found, the committee will decide whether to continue without a representative, or whether to appoint the administrator of that department to serve the remainder of the term.

2.8 If the employee make-up of the committee does not meet the standards described in 2.1, the previous year’s committee will determine new standards, and revise this procedure to reflect the changes.

3.0 Committee Review Process

3.1 When an accident is remanded to the committee for review, the committee will review all written reports and interview the driver. This review will include the driver’s assessment of whether or not they were at fault for the accident. The committee may elect to discuss the accident summary with the supervisor who wrote it, for clarification, if they feel it necessary.

3.2 The committee will determine, based upon their investigation, whether the driver is at fault, and the consequences to be recommended to the supervisor.

3.3 The committee will review the accident as soon as possible, usually within three working days.

3.4 The committee chairperson will inform the employee’s supervisor of their recommendation for action immediately after the review is completed.

3.5 Determination of the disciplinary action to be taken is the responsibility of the employee’s Supervisor. The Supervisor will give strong consideration to the committee’s recommended action.

3.6 Committee members will not discuss their review or recommendation with other employees. Committee members are advised to direct employees who may inquire to the Director of Operations & Maintenance.

3.7 Recommendations from the committee for employees found to be “at fault” for a particular accident should closely follow the following guidelines:

3.7.1 1st Accident

• Written reprimand from employee’s supervisor, signed by both, and placed in employee’s personnel file.

3.7.2 2nd Accident within one (1) year

• Written reprimand from supervisor, up to three (3) days suspension without pay, and/or up to four (4) hours driver training in-service.

3.7.3 2nd Accident within two (2) years

• Written reprimand from supervisor, signed by both, and included in employee’s personnel file; up to 2 days suspension without pay, and/or up to four (4) hours driver training in-service.

3.7.4 3rd Accident within two (2) years

• Written reprimand from supervisor, signed by both, and placed in the employee’s personnel file; 3 to 5 days suspension without pay, and mandatory eight (8) hours driver training in-service.

3.7.5 4th accident within two (2) years

• Employee will no longer be permitted to drive a district owned vehicle, which may result in termination of the employee’s employment relationship with this school district.

3.7 Each accident will be reviewed on a case by case basis. The committee may recommend any action in excess of the guidelines, up to and including termination for any accident, depending on the severity and the circumstances of the accident.

Other Driver's Name

Vehicle Number

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