VEHICLE DAILY VEHICLE INSPECTION. 1. No SNEMT assigned vehicle will be allowed to carry passengers unless the driver has determined that the vehicle is in good working order. Each driver will perform a pre-shift inspection of the vehicle at the beginning of the shift and a post-shift inspection at the end of the shift. A sample of the Vehicle Daily Vehicle Inspection Form is included in Section XI.G XI. SAMPLE FORMS A. SNEMT APPLICATION FORM B. SNEMT CLIENT RELEASE FORM/SNEMT PROGRAM WAIVER FORM C. USER FEE WAIVER FORM X. XXXXX INSTRUCTIONS AND CLIENT GUIDELINES E. CLIENT COMPLAINT FORM F. INCIDENT REPORT FORM G. VEHICLE DAILY INSPECTION FORM H. VEHICLE INSPECTION FORM I. INVOICE TEMPLATE J. MONTHLY PERFORMANCE REPORT K. SAMPLE DEMOGRAPHIC REPORT A. SAMPLE CLIENT APPLICATION {CONTRACTOR LETTERHEAD} SAMPLE Application for Senior Non-Emergency Medical Transportation Program PLEASE PRINT CLEARLY. ALL FIELDS MUST BE FILLED OUT COMPLETELY. YOU MUST SIGN AND DATE APPLICATION PRIOR TO SUBMITTING FORMS BACK TO {CONTRACTOR NAME} FOR PROCESSING. INCOMPLETE APPLICATIONS WILL BE RETURNED TO SENDER. Last Name: First Name: Date: Date of Birth: Age: Male: Female: Address: Apartment/Unit #: City: Zip Code: Home Phone: ( ) Cell: ( )
VEHICLE DAILY VEHICLE INSPECTION. 1. No SNEMT assigned vehicle will be allowed to carry passengers unless the driver has determined that the vehicle is in good working order. Each driver will perform a pre-shift inspection of the vehicle at the beginning of the shift and a post-shift inspection at the end of the shift. A sample of the Vehicle Daily Vehicle Inspection Form is included in Section XI.G XI. SAMPLE FORMS A. SNEMT APPLICATION FORM B. SNEMT CLIENT RELEASE FORM/SNEMT PROGRAM WAIVER FORM C. USER FEE WAIVER FORM X. XXXXX INSTRUCTIONS AND CLIENT GUIDELINES E. CLIENT COMPLAINT FORM F. INCIDENT REPORT FORM G. VEHICLE DAILY INSPECTION FORM H. VEHICLE INSPECTION FORM I. INVOICE TEMPLATE J. MONTHLY PERFORMANCE REPORT K. SAMPLE DEMOGRAPHIC REPORT DocuSign Envelope ID: E698D8F8-A9B3-46FA-8AD3-BAC2DD2BC10F
VEHICLE DAILY VEHICLE INSPECTION. 1. No SNEMT assigned vehicle will be allowed to carry passengers unless the driver has determined that the vehicle is in good working order. Each driver will perform a pre-shift inspection of the vehicle at the beginning of the shift and a post-shift inspection at the end of the shift. A sample of the Vehicle Daily Vehicle Inspection Form is included in Section XII.G I. XI. PUBLIC HEALTH EMERGENCY
VEHICLE DAILY VEHICLE INSPECTION. 1. No SNEMT assigned vehicle will be allowed to carry passengers unless the driver has determined that the vehicle is in good working order. Each driver will perform a pre-shift inspection of the vehicle at the beginning of the shift and a post-shift inspection at the end of the shift. A sample of the Vehicle Daily Vehicle Inspection Form is included in Section XI.G XI. SAMPLE FORMS A. SNEMT APPLICATION FORM B. SNEMT CLIENT RELEASE FORM/SNEMT PROGRAM WAIVER FORM C. USER FEE WAIVER FORM X. XXXXX INSTRUCTIONS AND CLIENT GUIDELINES
