Risk Management & Internal Control

Explanation of State Vehicle Report Forms

Authorization to Use Privately Owned Vehicles on State Business (Form 261) - This certification verifies the employee’s private vehicle has the minimum amount of liability insurance coverage, is in safe working condition, is adequate for the work in accordance with SAM section 0753.  The form warns the employee that personal insurance is primary in the event of a vehicle accident.  The up-to-date form shall be sent to accounts payable on an annual basis and a copy retained in the departmental office.

Accident Information Card (Form 269) - When a vehicle is involved in an accident, he/she must record all pertinent information on the Accident Information Card (Form 269).  These should be in the glove compartment of each state-owned vehicle and are also distributed to employees using privately-owned vehicles upon request.  When another vehicle is involved in an accident, the appropriate portion of the Std Form 269 is completed, detached and given to the other driver.

Vehicle Accident Report (Form 270) - All motor vehicle accidents involving a vehicle being used on state business must be reported on a Vehicle Accident Report Form 270 within 48 hours to the State Office of Risk and Insurance Management.  If the accident results in bodily injury or significant property damage, the accident must first be reported by fax at 916/3226006 or telephone to the Office of Risk and Insurance Management.

State Driver Accident Review (Form 274)  - The supervisor of each driver involved in an accident must investigate the accident promptly and thoroughly.   They must initiate verbal or written corrective action, record the action and forward copies to EH&S.  The purpose is to determine whether the accident was avoidable and to aid in the prevention of future accidents.  This report must be submitted to ORIM with a copy of the State Vehicle Accident report form.

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