Appendix A
Alliance for Uniform Hazmat Transportation Procedures
Desk Audit Questionnaire
Company
Address
City, State, zip
Dear Hazardous Materials Motor Carrier:
The (Alliance State) is conducting a desk audit of your Hazardous Materials Uniform Registration and Permit application.
As part of this desk audit, we ask that you forward legible copies of the requested documents and data to (State agency address) within fifteen (15) days following receipt of this letter.
Requested Documents or Data
1. Documents supporting the total number of power units owned, leased, or operated by your company.
2. A copy of the International Registration Plan (IRP), International Fuel Tax Agreement (IFTA) filed by your company for the last billing period. If you do not maintain mileage records for either IRP or IFTA, provide an explanation of the methodology used to calculate the percentages indicated in question 12b of the application.
3. Provide copies of worksheets or documentation that supports your percentage of hazmat activity, as indicated in question 12c of the application.
4. A legible copy of your Form MCS-82 or MCS-90, as appropriate, and the cover page of any insurance policies identified in the Form MCS 82 or 90.
5. Has the applicant been assessed or paid any fines with penalties over $1,000, relating to hazmat transportation the past two years? Yes or No
If yes, please provide date of fines/penalties/judgment levied, date of the action, nature of the violation, cause or reason for the action, and remedial action taken to mitigate the situation, if any.
6. Has the applicant been involved in an accident while transporting hazardous materials in the past year? Yes or No
If yes, attach a copy of applicants accident register.
7. Has the applicant been involved in an incident, in the past two years, involving the transportation of hazardous materials that was required to be reported under 49 CFR 171.15(a)(1)? Yes or No
If yes, please provide the following information; date, location, cause of the incident, details of the remediation process, and the agency that supervised the remediation.
8. Vehicle Inspection Report and Tank Certification, if applicable. Please provide your companies statement attesting that all vehicles, per 49 CFR 396.17, and tanks, owned and/or operated has been inspected in the last 12 months. Statement should be on company letterhead and signed by a principle of the company.
9. How often are applicant's vehicles serviced, and who services the vehicles?
10. Where are driver logbooks maintained and, how are they evaluated to insure conformance with hours of service?
11. Provide a copy of your Emergency Response Plan, in compliance with OSHA 29CFR 1910.120(q) regulations and, a letter attesting that all applicable employees have been fully trained to deal with hazardous materials, as outlined in 49 CFR 172 subpart H and 177.816. Letter should be on company letterhead and signed by a principle of the company.
12. Provide a statement attesting that the person certifying Part IV of the application is authorized, by the applicant, to certify this application. Statement should be on company letterhead and signed by a principle of the company.
Your prompt cooperation in this desk audit is greatly appreciated. If you have any questions, please do not hesitate to contact this office at (contact number).
Sincerely,
(Name of agency employee)
(Title)
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