Risk Management Golf Cart Driver Agreement Version 13.0

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Driver Status:

OU Employee

Volunteer

State Issued:

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I agree with the statements above.

Text Input 655

Driver's License Number:

Date of Birth:

Form routing to:

Person routing form:

Department

Requester

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First Name:

Last Name:

Unit Name:

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Risk Management

Golf Cart Driver Agreement Form

Department Head Email:

Department Head Name:

Department Phone:

Name of Department:

Email:

Supervisor

Phone

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Name

Unit Name

Phone

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Office Location:

Phone:

Form Complete

Routing Instructions

I hereby swear that:

I am not currently prevented from driving to, from or in the course of employment due to a suspension, restriction, or revocation by the State/Country that has issued the license or permit. I will immediately notify my Supervisor if I am prevented from driving to, from or in the course of employment due to a suspension, restriction, or revocation for any reason by the State/Country that has issued the license or permit.

I understand that the Office of Risk Management may conduct a periodic review of my driving record and may, at its sole discretion suspend my University driving privileges if they discover repeated or excessive driving infractions on the driving record, or other relevant information, where revocation, suspension or restriction has not taken place. I have read the Oakland University Golf Cart Safety Guidelines and will adhere to all of the stated requirements.

Requester: Click on Submit. The form will be routed to the Supervisor identified on the form. If a new supervisor field has been provided then the form will route to that email address for processing. A notification on Approval or Disapproval will be sent to the Requester by riskmgmt@oakland.edu.

Supervisor: Please review and approve. The form can be forwarded back to the Requester for correction if needed. Add riskmgmt@oakland.edu in the 'Form routing to' field for the final decision.

Read Only

Edit

Unit Name

Please provide the Department owner/renter of golf cart.

Use the fields under Edit to update - if Supervisor information is incorrect.

Saved

To complete processing - please be sure to click on the "Ok" in the pop up message once a button is clicked.