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Auto Forms

Auto Forms

Motor Vehicle Use Program

DID YOU KNOW?

While conducting university business, Collision and Liability insurance coverage are included in the car rental rate via the State Contract. Make sure to place a copy of the State of Georgia Government Vehicle Liability Insurance Identification Card in the vehicle.

Auto Accident Report Form

Auto Accident Report Form

All accidents must be reported within 24 hours to the Department of Safety & Risk Management. Please include photographs with completed forms.

  • General Information

  • GSU Vehicle/Driver Information

  • Date Format: MM slash DD slash YYYY

  • Other Vehicle Information

  • Police Report

  • Injury Information

  • Witness Information

  • Incident Description

Driver Acknowledgement Form

Driver Acknowledgement Form

  • Before operating a vehicle for the State of Georgia business, employees, as designated by the Motor Vehicles Use Policy, must use this form to certify that they are qualified to safely operate the vehicle.
  • Date Format: MM slash DD slash YYYY

Driver Notification Form

Driver Notification Form

Employees are to use this form to notify their supervisor of activities that may affect their eligiblity to operate a motor vehicle for state business.

  • Employee Information

  • Reported Activity (Select all that apply)

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • * Only if conviction would result in more than 10 points accumulated on the driving record.
  • Date Format: MM slash DD slash YYYY

Supervisor's Accident Follow-up Checklist Form

Supervisor's Accident Follow-up Checklist Form

Supervisors are to complete this checklist and forward it to the Risk Management Services Division (RMS) within 2 work days of being advised of an on-the-job accident that occurred while driving on state business.

  • Driver Information

  • Date Format: MM slash DD slash YYYY

  • Checklist

  • Supervisor Information

  • Date Format: MM slash DD slash YYYY

Weekly Motor Vehicle Checklist

Weekly Motor Vehicle Checklist

Submit Checklist to The Fleet Coordinator on the 5th Day of Each week.
  • Do not operate any vehicle if an unsafe condition exists.

  • Windshield Wipers and Washer Fluid

  • Date Format: MM slash DD slash YYYY

  • Directional Signal

  • Date Format: MM slash DD slash YYYY

  • Lights

  • Date Format: MM slash DD slash YYYY

  • Horn and Mirrors

  • Date Format: MM slash DD slash YYYY

  • Inspect Vehicle Decals

  • Date Format: MM slash DD slash YYYY

  • Ensure License Plate is Attached

  • Date Format: MM slash DD slash YYYY

  • Check for 4000-mile Maintenance

  • Date Format: MM slash DD slash YYYY

  • Tire Inflation and Safe Tread Depth

  • Date Format: MM slash DD slash YYYY

  • Power Steering Fluid

  • Date Format: MM slash DD slash YYYY

  • Antifreeze/Coolant

  • Date Format: MM slash DD slash YYYY

  • Motor Oil Level

  • Date Format: MM slash DD slash YYYY

  • Break Fluid & Break Operation

  • Date Format: MM slash DD slash YYYY

  • Exterior and Interior Condition Acceptable

  • Date Format: MM slash DD slash YYYY

  • Transmission Fluid & Hydraulics (if apply)

  • Date Format: MM slash DD slash YYYY
  • Any item not passing inspection shall immediately be brought to the attention of the Department Head/Manager/Supervisor.

Contact

Insurance and Risk Management inquiries can be sent to
[email protected]

Occupational Health and Safety inquiries can be sent to
[email protected]

Workers' Compensation inquiries can be sent to
[email protected]

Office Hours

Monday-Friday,
8:30 a.m.-5:15 p.m.

Fax:  404-413-9550
Email: [email protected]

Office Location

Citizens Trust Building
75 Piedmont Avenue
Suite 506
Atlanta GA 30302

Emergency Numbers

Emergencies: 911
Campus Police: 404-413-3333

Mailing Address

Georgia State University
Department of Insurance & Risk Management
P.O. Box 3961
Atlanta GA 30302-3961

 

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