10-12 Passenger Van Safety Acknowledgment

This form shall be completed by students who may, for any reason, need to drive a University-owned vehicle or, a vehicle leased or rented for the purpose of transporting 10-12 passengers. COMPLETE THIS FORM EVEN IF ONLY FOR POSSIBLE FUTURE AUTHORIZATION. You will then be assured of your authorization should the need arise for you to drive.

ALL FIELDS ARE REQUIRED - INCOMPLETE OR ILLEGIBLE FORMS WILL BE REJECTED.

Carefully read this form and provide the following information:

Possible Risk associated with operating a 10-12 Passenger Van:
12-passenger vans have an increased risk of rollover.
The risk of rollover increases dramatically as the number of passengers is increased from less than five to more than ten. Vans should be loaded by filling the front seats first.
The weight of the van, particularly when fully occupied, causes the center of gravity to shift to the rear and upward increasing the likelihood of rollover.
The shift in the center of gravity will also increase the potential for loss of control in panic maneuvers.
The weight of a fully occupied van requires additional stopping distance.
The width of the van allows for less lane room.
The length of the van increases distances needed for making turns, changing lanes, and backing

I have read and understand the possible risk involved while operating a 10-12 passenger van.

(Initial below)

I am aware the handling characteristics of a 10-12 passenger van may change dramatically, especially when fully loaded. I understand that extra caution is required when operating this vehicle.

(Initial below)

I understand that seatbelt use is mandatory for the driver and passengers at all times.

(Initial below)

Operator's First Name

Operator's Last Name

Department

Operator's Signature

Sign above