Drivers Representation Form

  1. Watch the video in this link: Driver's Video
  2. Save a copy of your "Certificate of Completion" from your personal Email, from State of Utah Risk Management to your computer.
  3. Proceed to fill out the USU Driver Representation form by clicking the Large Blue button below.

** Please note:

You cannot drive or rent a University Vehicle without filling out this form.

Departments: Please make sure your drivers complete this form and return it to Fleet Operations along with the Certificate of Completion from the online test. If your department decides to also keep a copy of this form, then you need to black out the license number (since it is secure information).

I hereby certify that:

  • I have watched the Utah State University approved State of Utah Defensive Driving video and have taken and passed the corresponding online State of Utah Defensive Driving written test.
  •  I have given a copy of the Certificate of Completion to my department to keep on file and I understand that myself and my department are responsible to have me take the driving test every two years as required by the Vehicle Use Policy #514 section 1.5-1.7.
  • I am 18 years old or older and have a valid driver's license(s) to drive in the State of Utah.
  • I have read USU's Vehicle Use Policy #514 and agree to its terms and conditions.
  • I have not received a citation within the past twelve (12) months for any of the following
  • Driving under the influence of alcohol or drugs
  • Reckless Driving
  • I understand that if I am cited at fault in an accident, I should not drive a USU vehicle until I complete the driver safety course.

NOTE: The University's automobile liability insurance imposes a $10,000 deductible on any accident involving a University vehicle is which the driver has received a citation within 12 months prior to the accident, UNLESS the driver has completed an approved Driver Safety Program subsequent to receiving such citation.

  • I will inform my Department Head/Supervisor of any changes in my driving status.
  • I will wear a seat belt at all times during the trip and will require all passengers to do the same.
  • My personal automobile, if used, is legally registered, inspected and in safe operating condition.
  • I understand that the University has no insurance to cover damages to my personal automobile and that my personal automobile liability insurance is primary in the event of a claim.
  • I understand that if I provide false information on this form, I may be personally liable for loss. 

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Enter Your Personal Phone Number
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Enter your A number or F number
*Gender
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Department you are driving for.
Select your Dept ID
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Enter your email
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Enter your Drivers License number
Enter the date you took the test
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*Need USU Fueling PIN?
Please check if you need to be issued a Personal USU Fueling PIN to fuel USU vehicles with the state issued gas cards that are assigned to department vehicles. (Motor Pool Vehicles Do Not Require a Personal PIN) If you already have a PIN, please Select 'No'.
   
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