new employee data sheet - The Plummer Painting Company

new employee data sheet - The Plummer Painting Company

NEW EMPLOYEE DATA SHEET
(Please Print)
Name:
_______________________________________
Address:
_______________________________________
City, State, Zip:
_______________________________________
Phone #:
___________________________
Type: _______________
(Home/Cell)
Email:
_______________________________________
Social Security #:
___________________
Marital Status:
Married _______
Date of Birth: _______________
Single _______
EMERGENCY CONTACTS:
Name
Date of Hire:
Relationship
Phone #
_________________________________
(Office use only)
Position applying for: _________________________ Years of Experience: ________
Starting Salary:
_________________________________
(Office use only)
Class # 4:
Temporary, Full Time Project Workers
I understand that I am on probation as an employee for the first ninety (90) days
of my employment.
________ (Initial)
__________________________
Employee Signature
__________________________
Supervisor Signature
Note: CLASS 4 EMPLOYEES ARE NOT ELIGIBLE FOR BENEFITS.
**A DRUG TEST IS MANDATORY BEFORE HIRE IS APPROVED**
GENERAL
Have you ever applied to or been employed by our Company before?
Yes _________________ No ____________ If yes, give dates: ____________________
Are you employed now? _______
If so, may we contract your present employer? _______
Person to Contact: __________________________
Phone #
If we can not inquire of your present employer, please explain why:
______________________
______________________
EMPLOYMENT HISTORY: (List below your last four employers, beginning with your current or most
recent employer.)
DATE
Month &
Year
From &
To
Name and Address of Employer
Are you a veteran of the U.S. Military Service?
If yes, what Branch?
Position
Salary
Reason for Leaving
Yes _________ No ______
______________________
Have you been convicted of a crime, other than a minor traffic violation, within the last five years?
Yes _________ No ______
If yes, describe:
_________________________________________________________________________________
(a conviction record will not necessarily be a bar to your employment. Factors such as the age and
type of offense, the seriousness and nature of the violation, and your rehabilitation will be taken
into account.)
1
3
4
3
3
6
3
5
4
Is (will) medical insurance be available to employee? Y/N
(UCT-6) Number:
2
7
1
T
H
6
4
3
8
7
E
P
L
U
6
0
J
A
C
W
I
N
T
E
R
4
0
7
5
8
5
Contact Name: L
A
U
0
R
*
M
E
R
P
A
I
S
O
N
A
V
E
P
A
R
K
2
1
0
K
A
M
*optional information
1
R
E
0
Y
5
N
4
E
T
0
I
N
F
L
7
5
G
8
C
O
3
2
7
8
9
5
0
2
2
0
S
*
Rev (01/06)
Payroll Administrator
Reyes, Laura
660 Jackson Ave
The Plummer Painting Company
Winter Park
FL
32789
TO: _______________________
Acknowledgment of Written Safety Plan & Substance Abuse Program
---------------------------------------------------------------------------------------------------------------------------------------------1. I am familiar with Safety Guidelines for my trade.
2. I have received, read and understand the The Plummer Painting Company Safety Policy on Drug,
Alcohol and Prohibited items. I understand that unannounced searches, blood and/or urine drug
screening tests will be used to assure compliance with this Policy.
3. I have been advised and understand that failure to comply with Safety Regulations of Federal, State
and Local Government and the The Plummer Painting Company Safety Policy on Drug, Alcohol and
Prohibited Items could result in dismissal from this Project. Any willful or deliberate violation of Safety
Regulations or Company Policies will be automatic dismissal from this Project.
I understand all of the requirements asked of me and I was given an opportunity to ask any questions.
I understand that The Plummer Painting Company intent in establishing rigid Safety Regulations and a Safety
Policy on Drug, Alcohol and other Prohibited items is necessary to ensure a safe, healthy and productive
work environment for employees and others on company property to protect company property and assets, to
assure efficient operations, and is in no way meant to be used in a discriminatory capacity. I further indicated
by my signature below that I fully understand all that is expected of me with regard to safety and agree to
abide by all The Plummer Painting Company policies and all other applicable safety rules while on this
project.
I have read and understand the guidelines for lifting and carrying items to reduce injuries.
A machine copy of this authorization and release shall have the same force and effect as the original.
I have received, read and understand the Workers Comp “Our Commitment to Your Well-Being” & “Managed
Care Arrangement Grievance Form.”
When injury is caused by the willful refusal of the employee to use safety equipment or obey safety rules, the
workers’ compensation benefits can be reduced by 25%. (Florida Statute 440.09.(4).
_____________________________
Signature
_________________________
Witness
_____________________________
Print Name
_________________________
Date
Para: _____________________________
Certificación de Conocimiento del Plan de Seguridad en el Trabajo y el Programa de Abuso de Sustancias
redactado por Nuestra Compañía.
----------------------------------------------------------------------------------------------------------------------------------------------1. Estoy familiarizado con las normas de Seguridad aplicables a mi oficio u occupación.
2. He recibido, leído y comprendido las regulaciones sobre drogas, alcohol y artículos prohibidos
establecidos por The Plummer Painting Company.
3. He sido debidamente istruido y comprendo que si violara los reglamentos de seguridad en el trabajo
establecidos por el Gobierno Federal, Estatal y Local, y los reglamentos de The Plummer Painting
Company con relación al uso (abuso) de drogas, alcohol y sustancias, puede dar como resultado el
ser despedido automaticamente de este proyecto (o cualqueir otro proyecto asignado).
Entiendo todo lo requerido de mi persona y me fue dada una oportunidad para preguntar y aclarar dudas e
interrogantes al respecto.
Entiendo la necesidad de The Plummer Painting Company de establecer regulaciones estrictas de seguridad
y normas rigidas contra drogas, alcohol y otras substancias / artículos prohibidos, para de esta manera
proveer un ambiente seguro, saludable y productivo para los empleados y otros que transiten por nuestors
predios; para protejer las propiedadesy bienes; asegurar la operación eficiente de todo proceso; tambien
estas regulaciones en manera alguna serán usadas en forma discriminatoria. Mi firma al pie de esta página
es indicativo de que entiendo y comprendo completamente lo que es requerido de mi con relación a
seguridad de trabajo y estoy de acuerdo en cumplir / regirme por las reglamentaciones de The Plummer
Painting Company y toda otra regla de seguridad aplicable mientras sea parte de este proyecto ( o cualquier
otro asignado).
He leido y entiendo los procedimientos para levantar y transportar artículos de manera que se reduzca la
posibilidad de alguana lesión.
Una fotocopia de esta certificación /autorización y permiso tendrá la misma validez y efecto como la hoja
original.
En caso de una lesion ser el resultado de la negativa del empleado de usar el equipo de seguridad requerido
o de obedecer las reglas de seguridad, los beneficios del Seguro de Compensación para Trabajadores
podrán ser reducidos en un 25% [Estatuto de la Florida 440.090(4)].
______________________________
Firma
_____________________________
Testigo
______________________________
Nombre en letra de molde
_____________________________
Fecha
MANAGED CARE ARRANGEMENT ACKNOWLEDGEMENT
In order to control the rising cost of workplace injuries as well as ensuring that
employees receive appropriate care, a managed care arrangement has been
instituted. In the event of an injury, certain steps must be followed to ensure that
you receive appropriate benefits and care. The steps are as follows:
NON-EMERGENCY INJURIES
1.
Report the injury to your immediate supervisor.
2.
Receive directions to the nearest Managed Care provider.
3.
Receive the network identification form. (This form needs to be
presented to the treating physician and initiates the managed care
process. Instructions to the medical facility include that drug/alcohol
testing be done.)
EMERGENCY INJURIES
1.
Report the injury to your immediate supervisor.
2.
Your employer will facilitate transportation to the closest emergency
facility.
GRIEVANCE PROCEDURES
You have the right to change your primary care physician one time by filing a
written grievance form (see your employer for this form).
I have been notified of the procedures to follow under my employer’s managed
care arrangement should I be injured on the job and understand that my benefits
can be affected (pursuant to State statues) if these procedures are not complied
with.
______________________________
Employee Signature
__________________________
Date
CERTIFICACION DE CONOCIMIENTO SOBRE EL CONVENIO Y
PROCEDIMIENTOS DE CUIDADO MEDICO
Con el propósito de controlar el alto costo del tratamiento de lesiones en el
trabajo y a la misma vez asegurar que todo empleado reciba atención médica
adecuada, se ha creado este programa de cuidado médico. En el caso de
ocurrir alguna lesión, ciertos pasos deben seguirse para asegurar que la persona
afectada reciba los beneficios correspondientes y el cuidado apropiado. A
continuación presentamos dichos pasos a seguir:
LESIONES MENORES (NO DE EMERGENCIA)
1. Reporte su lesión a su supervisor inmediato.
2. Obtenga direcciones para llegar a la oficina del proveedor de servicios
medicos mas cercano.
3. Obtenga la forma que lo identifica como miembro del conglomerado
afiliado al programa de salud. (Esta forma debe ser presentada al
médico asignado y se inicia asi su proceso de cuidado de salud. En
las instrucciones para el proveedor de servicios se incluye que una
prueba de drogas/alcohol se realice).
LESIONES MAYORES (EMERGENCIAS)
1. Reporte su lesión a su supervisor inmediato.
2. Su patrono proveerá transportación al centro de servicios médicos de
emergencia más cercano.
PROCEDIMENTO PARA CAMBIO DE SERVICIO DE MEDICO PRIMARIO
Usted tiene el derecho de cambiar su proveedor de servicios primarios una sola
vez. Esto se hace llenando el formulario de solicitud de cambio y sometiendolo
para su consideración. (Su patrono le ayudará a obtener dicho formulario).
Certifico que he sido notificado de los procedimentos a seguir dentro del plan de
servicios de salud de mi patrono de ocurrirme una lesión de trabajo. Entiendo
que mis beneficios (Según lo establecido por los estatutes estatales) pueden ser
afectados si dichos procedimentos no son seguidos según descritos.
____________________________________
Firma del empleado
_____________________
Fecha
Special Disability Trust Fund Questionnaire
(Duplication of form is permissible)
Statement of Purpose:
The purpose of this questionnaire is to provide the employer with knowledge about the employee—specifically about any preexisting condition or disability
which may entitle the employer to reimbursement from Florida’s Special Disability Trust Fund (Florida Statute 440.49). The information provided shall not be
used to discriminate against a qualified individual with a disability because of the disability of such individual in regard to job application procedures; the hiring,
advancement, or discharge of employees; employee compensation; job training; and other terms, conditions, and privileges of employment.
The Plummer Painting Company
Name of Employer ______________________________________________________________________________________
Name of Employee ______________________________________________________________________________________
Employee’s Social Security No. _________________________ Height ____________________ Weight __________________
1.
Do you now have or have you had any of the following?
Yes
No
Yes
Epilepsy (convulsions, seizures)
No
Chronic osteomyelitis (infection in bone)
Diabetes (medication?  Yes  No)
Surgical or spontaneous fusion of a major weightbearing joint (frozen joint)
Cardiac (heart) disease
Hyperinsulinism
Meniscectomy (inflammation of cartilage of
certain joints – e.g., knee)
Muscular dystrophy
Amputation of foot, leg, arm or hand
Thrombolphlebitis
Total loss of sight of one or both eyes,
Or partial loss of corrected vision of
More than 75% bilaterally
Herniated intervertebral disk
Polio (poliomyelitis)
Total deafness
Cerebral palsy
One or more back or neck injuries or a disease
process of the back or neck, substantiated by a
doctor’s opinion and resulting in disability over a
total of 120 or more days
Multiple sclerosis
Surgical removal of an intervertebral dick, or spinal
fusion
Parkinson’s disease
Patellectomy (surgically removed kneecap)
Ruptured cruciate ligament (knee ligament)
Hemophilia
Obesity (30% overweight)
Other _________________________________
______________________________________
______________________________________
2.
Have you previously received worker’s compensation for an on-the-job injury? Yes  No If yes, please write why, when and where.
3.
Have you ever received a disability rating or had one assigned to you by an insurance company or state/federal agency?  Yes  No
If yes, state percentage: ______ %.
4.
Have you ever injured or sprained your back?  Yes  No If yes, did you have surgery?  Yes  No If yes, please give details.
5.
Have you ever injured or sprained your neck?  Yes  No If yes, did you have surgery?  Yes  No If yes, please give details.
6.
Have you ever injured or sprained a knee?  Yes  No If yes, did you have surgery?  Yes  No If yes, please give details.
7.
Have you ever had any other type of surgery not mentioned above?  Yes  No If yes, please give details.
8.
Do you have arthritis?  Yes  No If yes, what part of the body are affected? Are you on medication for arthritis?  Yes  No
Employee’s signature _____________________________________________________
Date _______________________________
Employer’s signature ______________________________________________________
Date _______________________________
Position __________________________________________________________________________________________________________
Fondo Especial de Recursos para Incapacitados
(Es permitible la duplicación de esta forma)
Declaración de Proposito:
El motivo de este questionario es para proveer conocimiento al patrono de su empleado; especificamente conocimiento de alguna condición pre-existente o
inpedimento físico por el cual pueda recibir reembolsos del Fondo Especial de Recursos para Inpedidos de la Florida (Estatuto 440.49 Estado de la Florida).
Esta información provista no sera usada para discriminar contra individuos cualificados, con algún impedimento por motivo de dicha limitación al presentar
una aplicación de trabajo y someterse a sus procedimientos, a entenderse: Aceptación para empleo, promociones o terminación de empleo, compensación,
entrenamiento y otros términos, condiciones y privilegios relacionados a dicho empleo para el cual el aplicante es aceptado.
The Plummer Painting Company
Nombre del Patrono _____________________________________________________________________________________
Nombre del Empleado ___________________________________________________________________________________
Seguro Social (Empleado): _________________________ Estatura: ____________________ Peso: __________________
1.
Tiene usted en el presente o a padecido alguna vez o varias de las siguentes?
Si
No
Si
Epilepsia (Convulsiones)
No
Ostiomielitis Crónica (Infección de los huesos)
Diabetes (Tomas medicamentos?  Si  No)
Fusión por cirujía o espontanea de una coyentura
mayor que soporta peso (Coyentura fundida)
Enfermedades Cardiacas (Corazón)
Hiperinsulinismo
Menissectomía (Inflamación del cartilage en ciertas
coyunturas: ej. Rodilla)
Distrofia Muscular
Amputación (Pie, Pierna, Brazo, Mano)
Tromboflevitis
Perdida total de la vista en uno o ambos ojos,
o parcial corregida po más de 75% bilateral.
Polio (poliomielitis)
Disco vertebral herniado
Remoción qururjica de un disco vertebral o fusion
de la espina dorsal.
Sordo
Paralisi Cerebral
Una o más lesiones de la espalda o el cuello o
Escleriosis Multiple
alguna enfermedad determinante de ellos que
Enfermedad de Parkinson
resultó en la perdida de trabajo por 120 días o más.
Patelectomia (Remoción quirurjica de la Rótula)
Sobre peso (30% sobre lo normal o más)
Ruptura del ligamento de la rodilla
Otras:_________________________________
Hemofilia
______________________________________
______________________________________
2.
Ha recebido algulna vez pagos del Seguro de Compensación para Trabajadores debido a una lesión en el trabajo?  Si  No
Si contesta que Si, indique: Porque, cuando y donde.
3.
Ha recibido alguna vez alguna asignación de porcentaje (%) de incapacidad, o alguna compañía de seguros, agencia Estatal/Federal le ha
asignado uno?  Si  No Si contesta que Si, indique el porcentaje: ______ %.
4.
Se a lesionado o torcido su espalda alguna vez?  Si  No Si contesta que Si, fue intervenido quirurjicamente?  Si (De detalles)  No
5.
Se a lesionado o torcido su cuello alguna vez?  Si  No Si contesta que Si, fue intervenido quirurjicamente?  Si (De detalles)  No
6.
Se ha lesionado o torcido la rodilla alguna vez?  Si  No Si contesta que Si, fue intervenido quirurjicamente?  Si (De detalles)  No
7.
Ha tenido cualquier otro tipo de cirugía no mencionada anteriormente?  Si (De Detalles)  No
8.
Padece de artritis?  Si  No Si contesta que Si, qué partes del cuerpo estan afectadas ? Está tomando medicamentos para la artritis?
 Si  No
Employee’s signature _____________________________________________________
Date _______________________________
Employer’s signature ______________________________________________________
Date _______________________________
Position __________________________________________________________________________________________________________
To:
All Employees
From:
Operations
Date:
5/19/2015
MEMORANDUM
The normal commuting area for Plummer’s business is up to and including one (1) hour from the Company’s office/
employee’s home where applicable. Thus, a commute of one (1) hour or less, each way, from the employee’s home to
the jobsite and from the jobsite to the employee’s home is not compensable. Any travel time exceeding one hour is
compensable above the first hour of travel time each way. It is the employee’s responsibility to for keeping track of
his/her travel time that exceeds one (1) hour each way and recording it on his/her timecard each week.
_________________________________________
Signature of Employee
________________________________
Date
COMPENSATION FOR TRAVEL TIME
The normal commuting area for the Company’s business is up to and including one (1)
hour from the Company’s office or employee’s home where applicable. Thus, a commute of one
(1) hour or less, each way, from the employee’s home to the jobsite and from the jobsite to the
employee’s home is not compensable. Any travel time exceeding one hour is compensable above the first
hour of travel time each way. It is the employee’s responsibility to report all travel time exceeding one
hour each way on the employee’s timecard.
However, if the employee is directed to report to the Company’s office for any reason, then the
employee’s shift starts at the time that the employee is directed to arrive at the office.
MEMORANDUM
You as an employee are required to supply the following equipment/tools as part of your job requirements:
PAINTERS
WATERPROOFERS/CAULKERS
Hard Hat
Work Boots or Shoes
5-way tool
Caulk Gun (Paint)
Screw drivers (Phillips & Flat head)
Paint Brushes (Latex & Oil)
Rolling paint pole 2ft-4ft
Putty Knives 3” & 6”
Pot Hook
Cut Pot
Wire Brush
Tool Bag
Whites (plain white paints & T-shirts)
Respirator (for spray painters only)
Gloves if needed
Hard Hat
Work Boots or Shoes
5-way tool
Caulk Gun (Tube, Sausage, Bulk)
Screw drivers (Phillips & Flat head)
Caulk Gun Accessories (rings, plungers,
hooks)
Margin Trowel(s)
Set of Spatulas and/or Tuck Pointers
Solvent Bucket & Brush
Wire Brush
Utility Knife
1” Razor Scraper
Gloves if needed
Please contact Project Manager/Foreman if you do not have these items and he will be able to order them for
you at cost. They will then be deducted out of your next paycheck.
________________________________________
Signature of Employee
________________________
Date
MEMORANDUM
Tu como emploeado estas requerido a suplir los suguientes equipos/herramientas como parte de los
requerimientos de tu trabajo:
PINTORES
WATERPROOFERS/CAULKERS
Casco de Protección
Botas o Zapatos de Trabajo
Herramienta 5-en-1
Pistola de Caulking (Pintura)
Destornilladores (Estrella & Plano)
Brochas de Pintura (Latex & Aceite)
Palo de estensión para rolear 2ft-4ft
Espatulas para enmasillar 3” & 6”
Colgador para “bucket”
“Bucket” de un gallon
Brocha de alambre
Bolsa para Herramientas
Pantalones y Playeras/Camisetas Blancas
Respirador (para esprayadores solamente)
Guantes si es necesario
Casco de Protección
Botas o Zapatos de Trabajo
Herramienta 5-en-1
Pistola de Caulking(Tubo, Salchicha, Gruesa)
Destornilladores (Estrella & Plano)
Accesorios Pistola de Caulking (aros, colgadores)
Llana(s) - “Margin Trowel(s)”
Set de Espatulas y/o Punteros “Tuck Pointers”
“Bucket” y Brocha
Brocha de alambre
Navaja de utilidad
1” Razor Scraper
Guantes si es necesario
Por favor comunicarse con su supervisor si usted no tiene estos artículos y el los ordenará el costo. Los
artículos seran deducidos de su próximo cheque de pago.
________________________________________
Firma del Empleado
_______________________
Fecha
December 1, 2014
TO ALL PLUMMER EMPLOYEES:
RE: YOUR PAYCHECK
YOUR SIGNATURE BELOW ACKNOWLEDGES THAT YOU HAVE BEEN TOLD THE
FOLLOWING:
NO EMPLOYEE WILL BE PAID FOR ANY HOURS OVER 12 HOURS WORKED
ON ANY ONE DAY.
NO EMPLOYEE WILL BE PAID FOR ANY HOURS THAT YOU HAVE NOT
SIGNED FOR ON THE DAILY REPORT.
THERE ARE NO EXCEPTIONS. THIS IS PLUMMER’S POLICY AND IT WILL
BE ENFORCED.
Steve Krout,
CEO
_____________________________________________________________________
Employees Signature
Date Signed
1 de diciembre de 2014
PARA TODOS LOS EMPLEADOS DE PLUMMER:
ASUNTO: SU CHEQUE DE PAGO
SU FIRMA A CONTINUACION RECONOCE QUE LE HAN DICHO LO SIGUIENTE:
NINGUN EMPLEADO SERA PAGADO CUALQUIER HORA POR ENCIMA DE 12 HORAS
TRABAJADAS EN CUALQUIER DIA.
NINGUN EMPLEADO SERA PAGADO POR CUALQUIER HORA QUE NO HAYA FIRMADO
EN EL REPORTE DIARIO.
NO HAY EXCEPCIONES. ESTA ES LA POLITICA DE PLUMMER Y SERA APLICADA.
Steve Krout
CEO
___________________________________________________________________________
Firma del Empleado
Fecha
September 4, 2015
RE: Work Shirts Requirement
Upon being hired with The Plummer Painting Company, you will be required to purchase five
(5) Plummer Painting work shirts at the price of $4.00 per short sleeve shirt and $6.00 per long
sleeve shirt. The cost will be payroll deducted from your first paycheck.
Employees must keep their shirts in a presentable condition or they are required to replace them
at their own cost.
Please sign below to acknowledge this requirement.
Employee Signature
Employee Name Printed
Date
4 de septiembre de 2015
Asunto: Requerimiento de las Camisas (franelas/playeras) de Trabajo
Al ser contratado con The Plummer Painting Company, será requerido comprar cinco (5) camisas
(franelas/playeras) de trabajo de Plummer Painting a un costo de $4.00 por camisa de manga corta y
$6.00 por camisa de manga larga. Este costo de las camisas será deducido de su primer cheque de
pago.
Los empleados deben mantener sus camisas en condiciones presentables o están obligados a
reemplazarlas a su propio costo.
Por favor firmar abajo para dar conocimiento a este requisito.
__________________________________
Firma del empleado
__________________________________
Nombre del empleado
Fecha
PLUMMER PAINTING & WATERPROOFING POLICY UPDATE
Cell Phone and Hand Held Devices
Employee inattention is a factor in a majority of accidents. We are not only
concerned about your welfare as a Plummer Painting & Waterproofing employee, but
also the welfare of others who could be put in harm’s way by inattentive work
methods.
As an employee, your first responsibility is to pay attention to the work you are
doing and proceed in a safe manner. When working on Plummer Painting &
Waterproofing time, or driving while conducting business on behalf of the company in
any other manner, the following applies:
Procedures:
Definition - Mobile Hand Held Units: Hand held devices may include cell
phones, pagers, palm pilots, faxes and other communication devices.
WHEN ON PLUMMER JOBSITE OR DRIVING ON PLUMMER BUSINESS:










Cell phones are to be used during breaks and lunchtime only.
There are to be no personal calls when working.
Allow voicemail to handle your calls and return them when safe
if driving and on your break or lunchtime when on the jobsite.
If you need to place or receive a call when driving, pull off the road to
a safe location and stop the vehicle before using your phone.
Ask a passenger to make or take the call
Inform regular callers of the best time to reach you based upon your
driving schedule.
The only exception to this policy is for calls placed to 9-1-1.
If placing or accepting an emergency call when driving, keep the call
short and use hands-free options, if available.
When receiving an emergency call, ask the caller to hold briefly until
you can safely pull your vehicle off the road.
Absolutely no texting, email or any other social media while operating
a personal vehicle on Plummer business or a company vehicle in any
instance. This also applies to when you are on a jobsite working
CELL PHONES ARE ONLY TO BE USED DURING BREAKS AND LUNCHTIME
EXCEPT IN AN EMERGENCY.
FOR THE 1ST VIOLATION YOU WILL RECEIVE A WRITTEN WARNING.
FOR THE 2ND VIOLATION YOU WILL BE TERMINATED.
I have read and understand the Cell Phone & Handheld Device Policy of Plummer
Painting & Waterproofing.
Employee Signature : ___________________________________ Date:__________
Printed Name: __________________________________
P:\@FILES\FORMS MASTER\POLICIES\Cell Phone and Hand Held Devices-Field.doc
PLUMMER PAINTING & WATERPROOFING POLICY UPDATE
Celulares y Dispositivos Portátiles
En la mayoría de los accidentes, la falta de atención por parte de los empleados es un factor
determinante. Al ser usted un empleado de Plummer Painting & Waterproofing, no sólo nos
preocupamos por su bienestar sino que también lo hacemos por el bienestar de aquellos que
pudieran estar en peligro por la falta de atención al utilizar los métodos de trabajo.
Como empleado, su primera responsabilidad es prestar atención al trabajo que desempeña y
proceder de una manera segura. Cuando se trabaja en Plummer Painting & Waterproofing o
cuando conduce para realizar alguna negociación en nombre de la empresa, debe aplicar lo
descrito a continuación:
Procedimientos:
Definición - Unidades móviles portátiles: los dispositivos portátiles incluyen teléfonos celulares
o móviles, localizadores, palms, faxes y otros dispositivos de comunicación.
CUANDO SE ENCUENTRE EN EL SITIO DE TRABAJO DE PLUMMER O CONDUCIENDO
PARA REALIZAR ALGÚN NEGOCIO A NOMBRE DE LA EMPRESA:
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Debe utilizar los teléfonos celulares o móviles únicamente durante los
descansos y a la hora del almuerzo.
Durante la ejecución del trabajo no se deben recibir llamadas personales.
Utilice el correo de voz para controlar sus llamadas, si va en el vehículo y
desea devolver la llamada, hágalo cuando sea seguro. Así mismo, cuando se
encuentre en el lugar de trabajo, hágalo durante el descanso o a la hora del
almuerzo.
Si necesita realizar o recibir una llamada mientras conduce, salga de la
carretera a un lugar seguro y detenga el vehículo antes de utilizar su teléfono.
Pídale a un pasajero que realice o conteste la llamada por usted.
Infórmele a aquellas personas que lo llaman con regularidad, acerca de la
mejor hora para comunicarse con usted según su horario de manejo.
La única excepción a esta política es para las llamadas realizadas al 9-1-1.
Si realiza o acepta una llamada de emergencia mientras conduce, procure que
sea corta y utilice la opción de manos libres, si está disponible.
Cuando reciba una llamada de emergencia, pídale a la persona que llama que
espere brevemente hasta que pueda sacar su vehículo de la carretera.
Bajo ninguna circunstancia puede enviar mensajes de texto, correo electrónico
o de cualquier otro medio social mientras conduce un vehículo personal para
negocios de Plummer o un vehículo de la empresa. Esto también aplica cuando
se encuentre trabajando en una obra.
LOS TELÉFONOS CELULARES O MÓVILES SERÁN UTILIZADOS SOLO DURANTE LOS
DESCANSOS Y A LA HORA DEL ALMUERZO, EXCEPTO EN CASOS DE EMERGENCIA.
AL INCURRIR EN UNA 1era VIOLACIÓN RECIBIRÁ UN AVISO POR
ESCRITO.
AL INCURRIR EN UNA 2da VIOLACIÓN SE DARÁ POR TERMINADA SU
RELACIÓN CON LA EMPRESA.
He leído y entiendo la Política de Celulares y Dispositivos Portátiles de Plummer Painting &
Waterproofing.
Firma del Empleado: _____________________________________ Fecha: __________
Nombre del Empleado: ___________________________________
P:\@FILES\FORMS MASTER\POLICIES\Cell Phone and Hand Held Devices-Field.doc
Plummer Painting & Waterproofing
Fleet Safety Policy
Notice to Employees
Traffic-related motor vehicle accidents are the leading cause of work-related fatalities. The
environment in which these accidents occur involves numerous complex factors, of which
the majority are uncontrollable. The purpose of Plummer Painting & Waterproofing’s Fleet
Safety program is to provide the means to reduce such factors to eliminate unnecessary
injuries and fatal circumstances. We value our employees not only as employees but also
as human beings crucial to the success of their family, the local community, and Plummer
Painting & Waterproofing.
All employees are expected and required to actively participate in this program for their
own health and well-being. Plummer Painting & Waterproofing encourages its employees
to take a proactive approach in identifying potential hazards by promptly reporting them to
their supervisor.
*** Use of seatbelts and other safety devices is mandatory. ***
Accident Procedures
All accidents or moving violations must be reported immediately to the company no
later than within 24 hours. The reporting requirement applies if the accident or
moving violation took place in either a business or a personal vehicle.
If an employee sustains physical damage to a company vehicle as a result of their
negligence, the employee is responsible for reimbursing the company for the
comprehensive and collision coverage deductible, not to exceed $500.00, payable
within 90 days.
MVRs will be requested periodically at a minimum of at least twice per year. Management
reserves the right to use its discretion in determining an unsatisfactory MVR.
Accident Investigation Procedures:
Plummer Painting & Waterproofing realizes some accidents are unpreventable.
Drivers should seek medical attention immediately, if necessary. Supervisors and
drivers are required to be trained in post-accident procedures to secure the details
of the accident and document the damage. Providing detailed facts of the accident
will help our insurance carrier deter fraudulent third party insurance schemes.
All vehicles will be supplied with accident claims kit, a pen, and a disposable
camera.
Drivers are required to document all details of the accident: traffic flow, speed
limits, stop lights/signs, weather conditions, citations issued, etc. Pictures should
be taken to document the extent of damage to all vehicles involved.
Once this information is secured, the driver is to report all accidents immediately to
the dispatcher and/or supervisor. If the vehicle is inoperable, arrangements need
to be made for towing and delivery of cargo. Hazmat operations, containment, and
clean up will be coordinated by dispatcher, supervisor and/or driver.
Driver Eligibility
All type “A” violations (as defined below) will result in termination of driving privileges for
employees and will disqualify any potential driver employees.
Any drivers (employees or applicants) showing anyone of the following will be restricted
from driving company vehicles:
• One (1) or more type “A” Violations in the past 3 years.
• Three (3) or more accidents (regardless) of fault in the last 3 years.
• Three (3) or more “B” violations in the past 3 years.
• Any combination of accidents and type “B” violations which equal four (4) or more
in the last 3 years.
Type “A” Violations:
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Driving while intoxicated
Driving while under the influence of drugs
Negligent homicide arising out of the use of a motor vehicle (gross negligence)
Operating during a period of suspension or revocation
Using a motor vehicle for the commission of a felony
Aggravated assault with a motor vehicle
Operating a motor vehicle without the owners’ authority (grand theft)
Permitting an unlicensed person to drive
Reckless driving
Speed contest (racing)
Hit and run (bodily injury or property damage)
Type “B” Violations:
All moving violations not listed as type “A” violations
Plummer Painting & Waterproofing conducts mandatory random drug and alcohol testing.
Driving under the influence of alcohol or other illegal substances is grounds for
termination.
Absolutely no transportation of Plummer employees in Company vehicles without prior
approval from Management.
We encourage all employees to report any and all maintenance and malfunction issues
immediately to their supervisor. Plummer Painting & Waterproofing realizes a proper
working vehicle is the first step to ensuring everyone’s safety.
Cell Phone and Hand Held Devices
Driver inattention is a factor in a majority of motor vehicle accidents. We are not only
concerned about your welfare as a Plummer Painting & Waterproofing employee, but also
the welfare of others who could be put in harm’s way by inattentive driving.
As a driver, your first responsibility is to pay attention to the road. When driving on
Plummer Painting & Waterproofing business, or driving while conducting business on
behalf of the company in any other manner, the following applies:
Procedures:
Definition - Mobile Hand Held Units: Hand held devices may include cell phones,
pagers, palm pilots, faxes and other communication devices.
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Allow voicemail to handle your calls and return them when safe.
If you need to place or receive a call, pull off the road to a safe location and
stop the vehicle before using your phone.
Ask a passenger to make or take the call
Inform regular callers of the best time to reach you based upon your driving
schedule.
The only exception to this policy is for calls placed to 9-1-1.
If placing or accepting an emergency call, keep the call short and use
hands-free options, if available.
When receiving an emergency call, ask the caller to hold briefly until you can
safely pull your vehicle off the road.
Absolutely no texting, email or any other social media while operating a
personal vehicle on Plummer business or a company vehicle in any instance.
Obey the Law:
Plummer Painting & Waterproofing is not responsible for any moving traffic
violations, parking tickets or any other city ordinances or state/federal laws
regarding your driving habits and operation/care of your personal motor vehicle
or any company vehicle you may be driving.
Any tickets issued are the employee’s responsibility, even if the ticket is issued
while conducting business for our company.
Preventative Maintenance:
To retain the safety and integrity of the vehicle, Plummer Painting &
Waterproofing will provide the necessary resources to ensure all vehicles are
operating at their best. All routine motor vehicle maintenance will be done
according to the manufacturer’s specifications. Critical components that must
always be maintained and promptly repaired are: brakes, tires, suspension,
steering, lights, mirrors, windows, and windshield wipers.
Employees are required to conduct pre-trip vehicle inspections. Any
unsatisfactory result requires a Fleet Hazard Identification form to be completed
and forwarded to their immediate supervisor. Thereafter, the identification
form will be forwarded to the maintenance department to confirm the
equipment malfunction, complete repairs, and sign off on the completed
identification form.
Company Vehicles for Personal Use:
Personal use of company vehicles is prohibited without prior permission from
management. If permission is granted, the employee assigned to the vehicle
will be the only driver allowed to operate the vehicle. Spouses are not
permitted to drive Plummer vehicles unless approved by the owner. Use of the
company vehicle is limited to travel to and from work and work related events.
The vehicle is not to be used for personal and/or entertainment purposes.
Employees are expected to use their discretion.
Once again, our goal is to provide a safe working environment for all employees
by protecting employees and Company property.
Other Safe Driving Precautions:
Use better judgment when road conditions are poor. Limit or avoid driving when rain,
snow, or other severe weather conditions threaten your safety.
Make an effort to avoid distractions such as eating, applying makeup, paying too
much attention to your radio/CD player, or other distracting behavior.
Do not drive if your ability to drive safety is impaired by the influence of medications.
Laptop computers should never be used at any time while driving.
If using a vehicle not your own (rental or otherwise), be sure to properly adjust the
mirrors and familiarize yourself with the vehicle’s controls before operating.
Be concerned for your coworkers’ safety. Ask them to call you back at a safer time if
they call you while driving.
Use of Personal Vehicles While Doing Business for Plummer:
Your Personal Auto Liability insurance is the primary payer. Plummer Painting and
Waterproofing, Inc.’s insurance is in excess of your coverage.
You should carry at least $100,000/$300,000 per occurrence liability coverage.
Evidence of insurance coverage is to be provided to Plummer Painting and
Waterproofing’s each year, by either a copy of your policy’s Declaration page or a
Certificate of Insurance.
You must show proof that you have declared the use of the auto for business to your
insurer.
There should be an endorsement or letter that your agent can give you that shows
that you “occasionally” use your personal vehicle for Plummer business. If your
insurance company is not notified and your personal vehicle is damaged, your auto
insurer “May” deny the claim.
You must carry your own Collision and Comprehensive coverage.
Plummer’s insurance does not cover damage to your personal vehicle.
Report business mileage for expense reimbursement.
All vehicles will be supplied with an accident claims kit, a pen, and a disposable camera.
Drivers are required to document all details of the accident: traffic flow, speed limits, stop
lights/signs, weather conditions, citations issued, etc. Pictures should be taken to
document the extent of damage to all vehicles involved. REPORT ALL ACCIDENTS
IMMEDIATELY TO YOUR SUPERVISOR.
Personal use of company vehicles is prohibited without prior permission from
management.
I have read and understand the Plummer Painting & Waterproofing Fleet Safety Policy, and
its requirements and expectations of me as an employee.
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Employee’s Signature
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Date