Chuch Safety Checklist

 

Appendix A – Safety Check - list

 

 

ECOD ChurchBus Safety Check-list

Equipment

Location

Check

Comment

Fire Extinguisher

Front Floor boardt

 

 

Safety Triangles/Flares

Right front passenger

floor

 

 

First Aid Kit

Front Floor board

 

 

Flash Light

 

 

 

Fluid Levels

N/A

 

 

Belts

N/A

 

 

Tires

N/A

 

 

Lights

N/A

 

 

Interior Clean

N/A

 

 

Gas Tank Full

N/A

 

 

Date:                                                          Driver:

Church Administrator:                                                      Phone #:

 

 

 

 

 

ECODChurchBus Safety Check-list

Equipment

Location

Check

Comment

Fire Extinguisher

Front Floor boardt

 

 

Safety Triangles/Flares

Right front passenger

floor

 

 

First Aid Kit

Front Floor boardt

 

 

Flash Light

 

 

 

Fluid Levels

N/A

 

 

Belts

N/A

 

 

Tires

N/A

 

 

Lights

N/A

 

 

Interior Clean

N/A

 

 

Gas Tank Full

N/A

 

 

Date:                                                          Driver:

Church Administrator:                                                        Phone #

 

 

 

 

 

Appendix B – Bus Driver Application Form

 

 

ECOD Bus Driver Application Form

 

 

Name(Last)                 First          Middle Initial

 

 

 

Birth Date

 

               /                 /

Address

 

 

Home Phone Number                                        (         )

Drivers License Number

 

 

Cell  Phone Number                                                         (         )

 

Church Ministries / Auxiliaries

 

YES    NO

[   ]       [   ]    Are you a member of ECOD?

[   ]       [   ]    Do you have a Commercial Drivers License for “P” (passenger)?  

[   ]       [   ]    Do you have five or more years of driving experience?

[   ]       [   ]    Have you been convicted of reckless driving in the last 5 years?

 

[   ]       [   ]    Do you have more than 2 moving violations in the in the last 5 years?

 

DECLARATION (Please read carefully)

 

I declare that all answers on this application are true.  If approved I will comply with all bus policies for Evangelistic Church Of Deliverance Church Bus operations.

 

 

 

Applicants Signature

Date

 

 

 

 

 

 

Appendix C – Bus Trip Log

 

 

ECOD Bus Trip Log

Date

# Passengers

Driver

Trip Purpose

Mileage Start

Mileage

End

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D-Liability Release Form

 

Evangelistic ChurchOf Deliverance

 Liability Release Form

 

Child / Youth Name

Parent / Guardian Name

 

 

Address

 

Home Phone #

 

(        )

Parent / Guardian’s Cell #

 

(        )

 

  1. As a parent / Guardian of above minor child / youth, I hereby release, forever discharge and agree to hold harmless Evangelistic Church Of Deliverance, staff and volunteers thereof, from any and all liability, claims, or demands for personal injury, property damage and expenses, actions or right of action which in any way related to riding the church bus and attending the church event.
  2. In case of emergency, I understand that every effort will be made to contact parents or guardians.  However, if parents or guardians cannot be reached, I hereby give ECO permission to act on my behalf in seeking and administering medical treatment in the event that such treatment is deemed necessary or advisable for the child / youth’s health, safety and welfare. I release ECOD from liability in acting on my behalf in this regard and rendering such medical treatment.
  3. This Liability Release Form will remain in effect until the named / youth reaches adulthood at 18.

 

 

 

Parent / Guardian’s Signature

Date