Get Safety Performance History Records Request

This guide provides clear and supportive instructions for completing the Safety Performance History Records Request form online. By following these steps, users can ensure they accurately request their safety performance history from previous employers.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling in your name clearly at the top of the form. Ensure all information is legible to avoid any delays.
3. Enter your Social Security Number and Date of Birth in the designated fields. This information helps verify your identity.
4. Provide details about your previous employer, including their contact name, telephone number, email address, street address, city, state, and zip code. This section is crucial for directing your request.
5. State the dates of your employment by providing the start and end dates, as well as your job title during your employment.
6. Authorize the release of your employment safety information by signing and dating the form at the bottom of the first page.
7. Proceed to the second page to detail your accident history. Fill in your name and report any accidents, including the date, location, and any injuries or fatalities, if applicable.
8. Complete the drug and alcohol history section by confirming if you were a DOT regulated driver. Answer all questions truthfully regarding any testing results and incidents.
9. After thoroughly reviewing your entries, save your changes to the form. If needed, you can download, print, or share the completed request.

Complete your Safety Performance History Records Request online today for a hassle-free experience.