Forms

 All driving reviews should now be submitted via the new Driving Review System 
If you are unable to login to the system, contact your Org/Department HR Rep and ask them to add you as a user. Questions about this process may be sent to fleet-safety-program@uiowa.edu

Aircraft Information

This form is to be completed by University faculty/staff before using personally owned or leased aircraft while on University business.

Aircraft Release of Liability: Private Aircraft Travel

This form is to be completed by all individuals (pilots and passengers) before traveling in a personally owned or leased aircraft while on University business.

Federal Credit Reporting Act (FCRA): A Summary of Your Rights

Under the Fair Credit Reporting Act (FCRA) specific rights are outlined.

Student Vehicle Use Authorization

Student Vehicle use is limited to specific purposes and guidelines. Please carefully read the criteria on page one. If your situation meets all criteria complete this form and submit it along with the driving review request in the driving review system, or email the form to fleet-safety-program@uiowa.edu if a motor vehicle requisition was submitted but a separate driving review request was not submitted in the driving review system.

Driving Review System (Departments, Student Organizations, Sports Clubs, Pre-Employment)

In meeting the standard of the Fleet Safety Program, this form is used by departments, student organizations and sports clubs. Driver record reviews are performed for pre-employment purposes, employees who are requested to drive within the scope of their employment, and students affiliated with student organizations and sports clubs who plan to drive UI vehicles. A fee is assessed to the department, student organization or sports club as reimbursement for Risk Management's cost.

Fleet Safety — Adverse Action-Denial of Employment Non-Compliant Iowa Driving Record(MS Word doc format)

This sample letter should be used by departments when denying an applicant employment with The University of Iowa due to their Iowa driving record not complying with The University’s Fleet Safety Program.

Fleet Safety — Adverse Action–Denial of Employment Non-Compliant Out-of-State Driving Record (MS Word doc format)

This sample letter should be used by departments when denying an applicant employment with The University of Iowa due to their out-of-state driving record not complying with The University’s Fleet Safety Program.

Incident Information Form (fillable pdf)

All incidents affecting members of the general public, students or others while on campus which you believe could reasonably result in a liability claim against the University should be reported to the Risk Management, Insurance & Loss Prevention Department (not used for University Hospitals and Clinics, auto accidents or workers compensation).

Property Loss Report (fillable pdf)

Loss by theft or other unavoidable cause should be reported immediately to the Department of Public Safety (335.5022). Use this form to report a loss or damage to University of Iowa property. The University seeks reimbursement of loss from the State of Iowa pursuant to Iowa Code Chapter 29C.20 or through the Equipment Loss (FREC) Program. A departmental deductible will normally apply in the latter case. Complete and mail form to Risk Management.

Request for Equipment Allocation Form (FREC) (fillable pdf)

This form is used for losses covered under the Equipment Loss Program (FREC). Departments may seek reimbursement for equipment losses from theft or other unavoidable causes through the FREC Equipment Loss Fund, administered by Risk Management. A $500 departmental deductible will normally apply. Contact the Department of Risk Management, Insurance and Loss Prevention at (319) 335-0536 for information prior to submission of a FREC claim.

State Appeal Board Claim Form and Affidavit  Excel Version

Used to file a claim against the University of Iowa for damages. The University is self-insured and an agency of the State of Iowa. Claims are handled as provided in Iowa Code, Chapter 669, which authorizes claims of wrongful death, personal injury or property damage which are a result of the negligence of the State or its employees. Forms are completed in triplicate, signed, notarized and mailed to the State Appeal Board. Click here for form instructions.

Vehicle Accident Report Iowa Regents Institution

Within 24 hours of an accident, complete this form, answer all questions and return the form to Motor Pool, 603 S. Madison Street, Iowa City, IA 52242.

Accidents involving injury or death must be reported immediately to the nearest law enforcement agency and UI Department of Public Safety at 319.335.5022.

Vehicle Appeal Board Form  

On June 1, 1997, the University instituted a Fleet Safety Program, which is a set of guidelines designed to help ensure the safety of University employees. This program requires periodic screening of driving records to determine driving eligibility for University vehicles. Should you be denied the privilege of driving a University vehicle, you may choose to appeal the decision.

Appeal Process: If you feel there are special circumstances involved you may appeal your non-compliance to the Vehicle Appeal Board. Please forward the form to Risk Management, Insurance & Loss Prevention, 430 Plaza Centre One.

Volunteer Appointment & Authorization (guidelines included)

You are a volunteer if you provide services to, or on behalf of, the University and have no legal duty to do so, have no personal interest or gain from the activity, and receive no compensation or consideration (except expense reimbursement) for the services you provide.

Volunter - Special Event Log

This form is used for the same purpose as above, although is used when the activity involves a group of individuals all volunteering for the same purpose, such as Homecoming or Riverfest.