DO NOT GIVE THESE 2 PHONE NUMBERS TO THE PUBLIC!!!!

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1 DO NOT GIVE THESE 2 PHONE NUMBERS TO THE PUBLIC!!!! FOR POSTAL USE ONLY All MOTOR VEHICLE ACCIDENTS, NON-POSTAL PERSON ACCIDENTS (ON POSTAL PROPERTY OR OFF-PREMISES IF INVOLVING A USPS EMPLOYEE WHO IS ACTING WITHIN THE SCOPE OF EMPLOYMENT, OR USPS EQUIPMENT), and PROPERTY DAMAGE ACCIDENTS must be investigated at the scene, regardless of damage, injury or no injury, or fault. All such accidents must be reported on the same day of occurrence. All offices should notify Safety and the applicable management office. In addition, THE DALLAS PERFORMANCE CLUSTER S ACCIDENT INVESTIGATIONS & TORT CLAIMS COORDINATOR (AI/CC) must be notified on the ACCIDENT REPORT HOTLINE. This is a dedicated accident reporting line, to be used 24-hours a day, 7 days a week, including holidays. Voice Mail will take your messages when AI/CC is out of the office. ACCIDENT REPORT HOTLINE (972) TOLL FREE: (OPTION 1 & 1) You are the on-scene Ad Hoc Accident Investigator and are responsible for the complete investigation and timely submission of all applicable reports, photographs, information, etc. as well as ensuring the accident is reported to the appropriate offices in a timely manner. ******************************************************************************************** FOR FATALITY AND MAJOR ACCIDENTS: Any accident that involves a fatality, possible fatality pending, major trauma injuries such as loss of limb, loss of eye, serious injuries to children and/or elderly persons, etc. must be reported to the AI/CC IMMEDIATELY!!! If not at the HOTLINE NUMBER ABOVE, leave a Voice Mail message there and then call: MAJOR EMERGENCY PHONE NUMBER PLEASE DO NOT GIVE THIS PHONE NUMBER OUT TO THE PUBLIC!! IF YOU GET VOICE MAIL, INCLUDE YOUR NAME, FACILITY, PHONE NUMBER (WITH AREA CODE!!) & BRIEF DESCRIPTION OF THE EMERGENCY. I WILL RETURN YOUR CALL A.S.A.P. INSTRUCTIONS - PAGE 1 OF 6

2 ACCIDENT INVESTIGATION CHECK LIST MATERIALS IN THIS PACKAGE ARE FOR U.S. POSTAL SERVICE USE ONLY!! Contact Dallas Performance Cluster s Accident Investigations / Tort Claims Coordinator (AI/TCC) at (972) TOLL FREE: (OPTION 1 & 1) The following checklist has been prepared in order to assist those Postal Employees charged with accident investigation. Additional information is available in the Handbook PO -702, which provides policy and procedures for investigating and handling accidents, both vehicle and nonvehicle, that could result in tort claims and for processing such claims. Please be advised that Forms -1700, SF -91, SF -94, etc., may be subject to release to litigants. Describe the FACTS ONLY and Do Not State Your Opinion. Technical assistance is available from the AI/CC. You, the Ad-Hoc Accident Investigator, will remain responsible for all activities relating to the investigation of motor vehicle accidents, non-postal persons in USPS-related accidents and property damage accidents. ACCIDENT KIT -- Make sure that you have the necessary items to conduct an investigation at the scene of the accident. Prepare the accident kit in advance. Your kit should include as a minimum: This ACCIDENT INVESTIGATION WORKBOOK, as provided by your AI/TCC. Clip Board Measuring tape or measuring wheel, Disposable 35MM Camera or 35MM camera with film or Digital Camera. Photographs from Polaroid or instant cameras are NOT acceptable. You may wish to supplement your accident kit with additional forms as required by the Safety Office, or Human Resources, and with additional items as listed in Exhibit 222, Handbook PO-- 702, Accident Investigations-Tort Claims. Remember to replenish your accident kit immediately after each use with the appropriate items. REPORT -- Phone the AI/TCC at the Dallas Performance Cluster Accident Report HOT LINE (972) (FOR POSTAL USE ONLY - DO NOT GIVE THIS PHONE NUMBER TO THE PUBLIC) within 24 hours of accident. ALL postal vehicle accidents, ALL vehicle accidents involving private vehicles and the Postal Service, the public or their property, ALL non-postal persons in USPS-related accidents, and ALL accidents involving private property damaged by the Postal Service or property owned by the U. S. Postal Service, must be investigated at the scene and reported. ALL ACCIDENTS INVOLVING SERIOUS INJURY, CHILDREN, OR DEATH must be reported immediately to the AI/TCC (See INSTRUCTIONS - Page 1 for information). PS FORM Accident Investigation Worksheet -- The Vehicle or Non-Vehicle accident investigation narrative included in this package and completed at the accident scene is the basic work tool for completing PS Form Remember to describe facts only; DO NOT include conclusions or opinions in Item #27 (PS -1700), "Accident Description" Section. DO NOT complete Items #43 and #44 (conclusion and recommendation sections); INSTRUCTIONS - PAGE 2 OF 6

3 LEAVE ITEMS #43 & #44 BLANK. SF Motor Vehicle Accident Report HIGHLIGHTS FOR COMPLETION OF THE SF-91: OPERATOR COMPLETES ITEMS 1-71b. (MUST SIGN 71b.) SUPERVISOR/INVESTIGATOR COMPLETES ITEMS AND SIGNS. ITEM 88 IS COMPLETED BY THE DALLAS PERFORMANCE CLUSTER AI/TCC. SF Statement Of Witness -- You may wish to prepare ahead of time, a selfaddressed, postage paid envelope with an SF-94 and a standard letter requesting a statement from a witness in the event that completion of the form can not be accomplished at the accident scene. Any signed document from a witness is acceptable. FIELD SKETCH -- Freehand illustration prepared at accident scene with measurements of what you observe, (See Instructions on Pages 7 & 9). DO NOT MAKE ANY CHANGES TO A FIELD SKETCH ONCE YOU HAVE LEFT THE SCENE OF THE ACCIDENT! GRAPHIC DIAGRAM -- Additional illustration drawn from the field sketch and available information that depicts objects either temporary or permanent, relative to the accident. COPY OF POLICE REPORT - Obtain Service Number from police officer at the scene and provide a copy of the police report with this workbook or as soon as available. COPY OF POSTAL OPERATOR S COMPLETE PERSONAL LIABILITY INSURANCE POLICY with coverage/declaration page(s), booklet, as well as all attachments (if employee was using personal vehicle, i.e., RURAL CARRIER, DRIVEOUT, etc.). The wallet card is not sufficient! COPY OF PROPERTY LEASE AGREEMENT -- If the postal property is leased. Determine if the accident occurred on PUBLIC PROPERTY OR POSTAL PROPERTY. PHOTOGRAPHS -- 35MM COLOR PRINTS ONLY! Photographs from Polaroid or instant cameras are NOT acceptable. The Postmaster or Manager of each installation is required to have on hand, a disposable 35MM Camera or an inexpensive 35MM Camera with color print film. The size of your unit and the frequency of accidents will dictate the appropriate camera purchase. Watch for expiration dates on the cameras. If a DIGITAL Camera is used, you must the electronic files to the AI/TCC along with hard prints. Photograph the overall accident scene, all sides of the private vehicle(s), and all sides of the postal vehicle. Include close-ups of damaged area so that the full extent of property damage as a result of this accident can be determined, as well as prior-existing damages on all vehicles, including the postal vehicle. (See Instructions on PHOTO INFORMATION COVER SHEET and complete that page.) SEND EITHER THE ENTIRE DISPOSABLE CAMERA OR 1 COMPLETE SET OF 4 x 6 PRINTS (and the negatives) TO THE AI/TCC. (You may be asked to affix the photographs to the photographic information sheets, along with the description of each photo- INSTRUCTIONS - PAGE 3 OF 6

4 graph.) You must complete the PHOTO INFORMATION COVER SHEET that is in this workbook. (You must send ALL the NEGATIVES with the accident package.) ACCIDENT INVESTIGATIVE NARRATIVE (WORKSHEETS AT SCENE) -- Separate Worksheets areas are provided for either Motor Vehicle Accidents or Non-Postal Injury/Property Damage Accidents. Complete only the applicable narrative section. This narrative is completed at the accident scene. Use the narrative as a "PLAN" or "GUIDE" in conducting your investigation. The worksheets will facilitate your investigation and help to ensure that you provide all the necessary information and guide you in the proper completion of the required forms. Most of the information required to complete PS Form 1700 is extracted from the narrative. Make observations and record facts or statements relative to the accident. DO NOT INCLUDE YOUR OPINION. Remember, all accident investigations are conducted in anticipation of litigation. ************************** FROM THE U.S. POSTAL SERVICE LAW DEPARTMENT EMPLOYEE INTERVIEWS & STATEMENTS Employees of the U.S. Postal Service are not available for interviews and are not to discuss accidents with anyone outside of the Postal Service (except for Law Enforcement Officials and, in the case of an employee operating a personal vehicle, their own liability insurance carrier, or their own attorney) in anticipation of litigation. All such requests should be directed to the AI/TCC. *************************************** Call the DALLAS PERFORMANCE CLUSTER S AI/TCC within 24 hours to report accident. You will be assigned an Accident Case Number. SEND ACCIDENT PACKAGE WITHIN 2 DAYS TO: ACCIDENT INVESTIGATIONS & TORT CLAIMS COORDINATOR U.S. POSTAL SERVICE 951 W BETHEL RD COPPELL TX ACCIDENT REPORT HOT LINE (USPS USE ONLY) IS (972) TOLL FREE: (OPTION 1 & 1) You may contact the AI/TCC for additional assistance at (972) or FAX (972) INSTRUCTIONS - PAGE 4 OF 6

5 INTERVIEWING POSTAL PERSONNEL, PRIVATE PARTY, AND WITNESS ACCIDENT INVESTIGATION Interviewing individuals involved with postal-related accidents is important for several reasons. Their statements add to the total information obtained from all sources, it can verify or disprove statements, and it can make the picture clearer to the investigator or adjudicator. Remember to use the "Accident Investigation Narrative" as your guide while interviewing witnesses and asking questions. When obtaining information from individuals involved in the accident, or from witnesses, there are some basic principles or guidelines that should be followed: INTRODUCE OR IDENTIFY YOURSELF Do not assume that the witness, police officer or private party knows who you are. Identify yourself as an employee of the U. S. Postal Service assigned to investigate this accident. BE OBJECTIVE Do not form opinions; stay with the facts. BE POSITIVE Ask direct questions and be straightforward. BE SPECIFIC Let persons know exactly what you are asking. Be sure they understand you and be sure you understand them. DON'T SUGGEST ANSWERS Let the persons you are interviewing talk and express themselves in their own words, but keep them in bounds. AVOID CONFLICTS In vehicle accidents separate the postal driver from the private party and interview each person privately. Use good human relation skills and stay in command of the situation. BE ADAPTABLE Be able to deviate from planned procedure when needed. VERIFY STATEMENTS If you suspect any wrong information, verify or disprove. Be very careful as you check the identity of the drivers and ownership of the vehicle. BE DIPLOMATIC AND UNDERSTANDING Your approach to postal personnel, private parties, and witnesses will to a large extent determine how successful you are in the interviewing process. REMAIN CALM AND BUSINESSLIKE Remember your primary mission in accident investigation is to record the facts and in doing so ensure that the interests of both the U. S. Postal Service and the public are protected. INSTRUCTIONS - PAGE 5 OF 6

6 All USPS-related accidents involving Motor Vehicles Non-Postal Persons Property Damage (USPS-owned or Private) Must be investigated at the scene, regardless of damage or lack of damage, injury or no apparent injury, fault or no fault. All above accidents must be reported to the DALLAS PERFORMANCE CLUSTER S AI/TCC at the ACCIDENT HOT LINE (972) TOLL FREE: (OPTION 1 & 1) by CLOSE OF BUSINESS ON DAY OF OCCURRENCE This Original Workbook, all Original Notes & Materials, Photos, Negatives, MUST BE MAILED within 2 days to: ACCIDENT INVESTIGATIONS & TORT CLAIMS COORDINATOR U.S. POSTAL SERVICE 951 W. BETHEL ROAD COPPELL TX Accidents involving death, dismemberment, or children must be reported immediately to the AI/TCC. (See INSTRUCTIONS - Page 1 OF 6) INSTRUCTIONS - PAGE 6 OF 6

7 COMPLETE THE NEXT SECTION (WORKSHEET PAGES 1-5) FOR ALL MOTOR VEHICLE ACCIDENTS A MOTOR VEHICLE ACCIDENT IS ONE WHERE A POSTAL EMPLOYEE IS ACTUALLY OPERATING A MOTOR VEHICLE AT THE TIME OF THE ACCIDENT & ALL RUNAWAY/ROLLAWAY VEHICLE ACCIDENTS NOTE: YOU MUST INVESTIGATE ALL ACCIDENTS AT THE SCENE REGARDLESS OF DAMAGE OR LACK OF DAMAGE AND REGARDLESS OF INJURY OR NO APPARENT INJURY! SECTION DIVIDER

8 VEHICLE ACCIDENT INVESTIGATIVE NARRATIVE CASE # Postal Facility Phone ( ) ZIP + 4 Street Address of Post Office: City Date USPS Notified Time Notified Date of Accident Time of Accident Location of Accident Visibility: Weather: Road Type: No. Lanes: (Obstructions) Posted Speed Limit: MPH Road Width Ft Traffic Control: PRIVATE DRIVER Private Driver Day ( ) Night ( ) (If Pedestrian, List Name Here) PHONE PHONE Driver s License #: Exp. Date: Restrictions: Date of Birth: Age: Address: State: City ZIP + 4 Injury to Private Party (Describe): Statements made by the private driver concerning injuries received in the accident: First Aid By: Taken To: By: Private Vehicle (Year and Make): License Plate, State & # Color: Odometer: Vehicle/Property Owner: (Parents If Private Party Is Minor) Address: City State: ZIP + 4 Phone Day( ) Night ( ) Insurance Company: Name of Agent: Policy #: Phone ( ), ( ) Address: City: State: ZIP + 4: MOTOR VEHICLE ACCIDENTS - ON SCENE WORKSHEET - PAGE 1 OF 5

9 Damage to the Private Vehicle (Describe): Estimated Cost $ Removed From Scene By: (Private Driver, Owner, Wrecker, etc.,) Additional Property Damage: Cost $ Description of accident per the private driver, pedestrian, or property owner statements - facts - your observations - physical evidence - no opinions! Where was the private driver coming from when the accident occurred?: Where was the private driver going to when accident occurred?: Tire Position Marked On Roadway By Postal Employee Or Investigator? Yes ( ) No ( ) (If No, Explain): (Required). Skid Marks: Dist. Danger Noticed (Ft): Skid after Impact (yes) (no) Dist. (Private Vehicle) (Ft) Dist. Traveled After Impact Direction Of Travel (N., SW., Etc., And Name Of Road, Hwy, Interstate, Or Address If Parked): "REMEMBER TO IDENTIFY WITNESSES AND PASSENGERS AT THE ACCIDENT SCENE NOTE: COMPLETE ADDITIONAL NARRATIVE PAGES AS APPROPRIATE FOR MORE THAN ONE PASSENGER, MORE THAN ONE WITNESS, OR MORE THAN ONE PRIVATE VEHICLE) WITNESS: Witness Name: Phone: Day( ) Night ( ) Address: City: State : ZIP + 4: Witness description of accident. DO NOT include investigator s opinions or conclusions. Have you PROVIDED THE SF 94, Statement Witness, in this book to the Witness? YES / NO MOTOR VEHICLE ACCIDENTS - ON SCENE WORKSHEET - PAGE 2 OF 5

10 PASSENGER(S) IN PRIVATE VEHICLE (USE SEPARATE PAPER IF MORE THAN 1): Passenger Name: Phone Day ( ) Night ( ) Date Of Birth: Age: Address: State : Injury To Passenger? ZIP + 4: City: (Describe): Statements made by the passenger concerning injury: Description of accident by passenger in private vehicle (do not include your opinions or conclusions): ************************************************************************************************************************ POLICE REPORT: YES( ) NO ( ) IF YES YOU MUST PROVIDE A COPY TO THE AI/CC. If YES what is the report s SERVICE NUMBER: Police Officer: Badge #: Precinct/Zone/Agency: CITATIONS - POSTAL DRIVER: Citation Issued To Postal Driver No ( ) Yes ( ) Contributing Factors Listed For Postal Driver: Postal Drivers Estimated Speed Of Postal Vehicle MPH (If Yes, Describe): CITATIONS - PRIVATE DRIVER: Citation Issued To Private Driver No ( ) Yes ( ) Contributing Factors Listed For Private Driver: Private drivers Estimated Speed Of THEIR Vehicle MPH (If Yes, Describe): ************************************************************************************************************************* "The field sketch with measurements recorded at the accident scene and separate graphic diagram are required in your accident package. THEY ARE NOT OPTIONAL - THEY ARE A REQUIREMENT!" "Remember to take 35MM color print photographs at the accident scene and complete the Photo Information Cover Sheet in this book; Polaroid or instant photographs are not acceptable." MOTOR VEHICLE ACCIDENTS - ON SCENE WORKSHEET - PAGE 3 OF 5

11 POSTAL-OPERATED VEHICLE: Postal Driver (Full Name): Age: Position Title: Social Security Number: - - Was Postal Employee Acting Within The Scope Of Employment Accident? Yes ( ) No ( ) (If No, Explain And Submit Supporting Documentation): Injuries To Postal Employee? (If Yes, Describe): First Aid By: Taken To: By: POSTAL VEHICLE #: Year/Make): Capacity Ton): Odometer: RHD LHD IF OPERATING A POV, LICENSE PLATE# Driving Experience With This Type Of Vehicle: USPS Driving Experience: Fixed Object Accident? Yes ( ) No ( ) (If Yes, Describe Object): Weather: Was/Was Not A Contributing Factor. The Road Was (Surface Type): ( Wet / Dry ) Describe Postal-Operated Vehicle Damage: Cost Is Estimated At $ Reported Defects Prior To The Accident? Yes ( ) No ( ) (If Yes, Describe): Postal-Operated Vehicle Was Removed From The Scene By (Postal Driver, Wrecker, Etc.,): Tire Position Marked On Roadway By Postal Employee Or Investigator? Yes ( ) No ( ) (If No, Explain): (Required) Postal drivers Estimated Speed Of THEIR Vehicle MPH Skid Marks: Ft. Dist. Danger Noticed: FT. Dist. Traveled After Impact: FT Direction Of Travel: (North, Southwest, Etc., And Name Of Road, Hwy, Interstate, Etc.,) Description of accident per the postal driver. DO NOT include investigator s opinion regarding negligence of employee. Describe the facts only. POSTAL DRIVER IS REQUIRED TO FILL OUT FORM SF 91, MOTOR VEHICLE ACCIDENT REP0RT, AT THE SCENE AND MARK THE POSITION OF EACH VEHICLE'S WHEELS AS LONG AS THIS DOES NOT PRESENT A SAFETY HAZARD. MOTOR VEHICLE ACCIDENTS - ON SCENE WORKSHEET - PAGE 4 OF 5

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13 USPS PASSENGER IN POSTAL VEHICLE (MUST PROVIDE A SIGNED STATEMENT OF ACCIDENT): USPS Passenger: Position Title: Soc Sec #: Date Of Birth: Age: Phone Day ( ) Night ( ) Postal Unit: St. Address: City: ZIP + 4: Statements made by the USPS passenger concerning accident: ****************************************************************************** IF POSTAL EMPLOYEE WAS OPERATING A PRIVATELY-OWNED VEHICLE THEY MUST FURNISH A COPY OF THE DECLARATION PAGE(S) AS WELL AS THEIR ENTIRE LIABILITY INSURANCE POLICY, INCLUDING ALL ATTACHMENTS for forwarding to this office INVESTIGATOR MUST COMPLETE THE FOLLOWING INFORMATION: Insurance Company: Name of Agent: Policy #: Phone ( ), Address: State: ( ) ZIP + 4: City: INVESTIGATOR COMPLETE AND SIGN THIS SECTION!! INVESTIGATOR (PRINT NAME): TITLE: SIGNATURE: DATE: PHONE ( ) END OF VEHICLE ACCIDENT INVESTIGATION NARRATIVE MOTOR VEHICLE ACCIDENTS - ON SCENE WORKSHEET - PAGE 5 OF 5

14 COMPLETE THE NEXT SECTION (WORKSHEET PAGES 1-4) FOR ALL NON-POSTAL PERSON USPS-RELATED ACCIDENTS (CUSTOMERS, HIGHWAY CONTRACTORS, MAILERS, UTILITY WORKERS, ETC) NOTE: UNDER NO CIRCUMSTANCES SHOULD YOU ATTEMPT TO TRANSPORT AN INJURED PERSON IN A POSTAL VEHICLE, YOUR PERSONAL VEHICLE, OR IN THE INJURED PERSON S VEHICLE. IF NECESSARY, CONTACT 911 / LOCAL EMERGENCY SERVICE. & PROPERTY DAMAGE ACCIDENTS LEGALLY PARKED POSTAL VEHICLES, COLLECTION BOXES, CBU S, BUILDINGS, MAILBOXES, PRIVATE PROPERTY, ETC. NOTE: YOU MUST INVESTIGATE ALL ACCIDENTS AT THE SCENE REGARDLESS OF DAMAGE OR LACK OF DAMAGE AND REGARDLESS OF INJURY OR NO APPARENT INJURY! SECTION DIVIDER

15 NON-POSTAL PERSON ACCIDENT OR PROPERTY DAMAGE ACCIDENT INVESTIGATIVE NARRATIVE CASE # Postal Facility: Phone #: ( ) Location of Postal Facility (street address): City: State: Zip + 4: Location of the Accident: Date Notified: Accident Occurred On (Date): Time Notified: AM / PM At (time) AM / PM Injured Party: Male Female (last name) (first name) (mi) Address Of Injured Party: City: State: Zip + 4: Telephone #: Day-Time ( ) Night-Time ( ) Date Of Birth: Age: Description of The Accident Per The Injured-Party or Per Owner of Damaged Property Statements - Facts - Your Observations - Physical Evidence - No Opinions! Any statements or allegations that the private party makes concerning what may have caused the accident should be thoroughly considered. Describe Vehicle or Property Damaged: POSTAL VEHICLE NUMBER, IF A POSTAL VEHICLE IS DAMAGED: (IF EMPLOYEE S POV, SHOW THE LICENSE PLATE NUMBER): Exact Location of the Accident On Postal Premises, or In the Field: Fully determine exactly where the accident occurred. NON-POSTAL PERSON ACCIDENT / PROPERTY DAMAGE ACCIDENT - ON-SCENE WORKSHEET - PAGE 1 OF 4

16 PRIVATE DRIVER WHO DAMAGES POSTAL PROPERTY (if applicable) Private Driver Day ( ) Night ( ) State License #: Exp. Date: Restrictions: Date of Birth: Age: Address: City State: ZIP + 4 Injury To Private Party (Describe): Statements made by the private party concerning the accident: First Aid By: Taken To: By: Private Vehicle (Year and Make): License Plate, State & # Color: Odometer: VEHICLE OR PRIVATE PROPERTY OWNER NAME: (Parents If Private Party Is Minor) Address: City State: ZIP + 4 Phone Day( ) Night ( ) POLICE REPORT: YES( ) NO ( ) SERVICE NUMBER: Police Officer: Badge #: Precinct/Zone/Agency: INSURANCE COMPANY: Policy #: Phone ( ) Name of Agent: Address: City: State: ZIP + 4: Damage To The Private Vehicle (Describe): Estimated Cost $ Removed From Scene By: (Private Driver, Owner, Wrecker) NON-POSTAL PERSON ACCIDENT / PROPERTY DAMAGE ACCIDENT - ON-SCENE WORKSHEET - PAGE 2 OF 4

17 Description Of Injuries: Statements made by the private party concerning injury. Include your observations, not your opinions. "Remember to identify witnesses at the accident scene" Additional Non-Postal Person Information: Occupation: Employed By: Address Of Employment: City: State: Zip + 4: Phone ( ) Name Of Spouse: Address: City: State: Zip + 4: Phone ( ) Medical Assistance Offered (911) Yes/No Medical Facility: Medical Assistance Authorization By, USPS Supervisor: Address Of Medical Facility: City: State: TX Zip + 4: Glasses/Contacts Yes/No Phone ( ) Date Of Last Eye Examination: Did injured party have glasses/contacts on at the time of the incident (yes/no) Name Of Insurance Company: Policy Number: Address Of Insurance Company: City: State: Zip + 4: Phone ( ) Description Of Footwear At The Time Of The Fall: Shoe Sole Material: Low Heel: High Heel: Have they had a previous accident on government or privately owned property? Yes ( ) No ( ). Has the injured party experienced any other personal injuries as a result of any other slips, trips, falls, or accidents on private property not owned by them or on any other federal, state, or local government owned facility and/or properties, or as a result of any employee of the U. S. Postal Service or United States of America, whose act or omission may have given rise to claims by reason of the above subject matter? If yes when and where: Describe: High blood pressure: Low Blood Pressure: Diabetes: Was the person carrying anything at the time of the incident? (yes / no) What? How many times do they visit this facility each week, month, etc.? How long have they been a visitor to this facility? Approximately how many persons visit this facility daily(include box customers)? How long has this facility been at this location? Have there been prior accidents of this nature at the same area of the facility? (If Yes explain & when) What was the purpose of their visit?: Weather conditions at the time of their visit?: Was moisture or debris present at the time of their visit? (yes/ no, per injured party) If so, how much and where? (describe): NON-POSTAL PERSON ACCIDENT / PROPERTY DAMAGE ACCIDENT - ON-SCENE WORKSHEET - PAGE 3 OF 4

18 Witness: Witness address: City: State: Zip + 4: Phone ( ) Statement of witness: Have you PROVIDED THE SF 94, Statement Of Witness, in this book to The Witness? (YES / NO) Postal Premises: Postal premises owned ( ) leased ( ) if leased, attach a COPY OF THE LEASE. Building owner if leased: Bldg. owner address: City: State: Zip + 4: Phone ( ) Owner contacted concerning this incident (yes / no) when? (Time/Date) Custodial and Maintenance: Custodian Name: Phone ( ) Type Floor Finish Applied: GSA #, Brand Name, (Attach Copy Of Label And Or Material Data Sheets): Date Last Applied: Time Last Applied: AM / PM A signed statement should be included from all personnel having responsibility for and knowledge of maintenance conditions and who maintain schedules concerning care of the accident area. This should be included as a matter of routine even if custodial maintenance is not alleged by the claimant as having caused the claimant's injury. IF APPLICABLE: Were floor mats in place and in good condition? Were Hazard Warning Signs placed in public area? Was increased custodial monitoring of the area in force? (Specify Schedule) Observation Of Accident Area (Per USPS Investigator): "The field sketch with measurements recorded at the accident scene and separate graphic diagram are required in your accident package. They are not optional!" "Remember to take 35mm color print photographs at the accident scene and complete the Photo Information Cover Sheet; Polaroid or instant photographs are not acceptable." ************************************************************************************************************************ INVESTIGATOR COMPLETE AND SIGN THIS SECTION!! INVESTIGATOR (PRINT NAME): TITLE: SIGNATURE: DATE: PHONE ) END OF NON-POSTAL PERSON OR PROPERTY ACCIDENT INVESTIGATION NARRATIVE NON-POSTAL PERSON ACCIDENT / PROPERTY DAMAGE ACCIDENT - ON-SCENE WORKSHEET - PAGE 4 OF 4

19 YOU MUST COMPLETE THIS PAGE PHOTO INFORMATION COVER SHEET DALLAS DISTRICT CASE #: YOUR OFFICE: ZIP: PHONE ( ) NAME OF PHOTOGRAPHER: USPS TITLE: DATE PHOTOGRAPHS TAKEN: TIME PHOTOGRAPHS TAKEN: *********************************************************************************************************************** FYI: PHOTO TIPS Photographs -- 35MM COLOR PRINTS ONLY. Polaroid or instant cameras are not acceptable. Prepare your camera and film ahead of time. Make sure that you are familiar with that type of camera. Replenish film or place a new disposable 35MM camera in your accident kit immediately after each use. Digital Cameras may be used but YOU MUST THE AI/CC THE JPEG FILES. In those instances involving vehicle accidents, photograph the accident scene, all sides of the private vehicle and all sides of the postal vehicle, including postal vehicle numbers and the POV license plate numbers. Include close-ups of damaged areas so that the full extent and location of property damage can be determined. Photograph the entire intersection, section of road, parking lot, etc., from different directions and varied distances. Photograph debris on the roadway that may indicate the point of impact. Photograph any skid marks associated with the accident as these can later be used, along with measurements taken at the accident scene, to calculate the approximate minimum speed of the vehicle. If private vehicle is struck from rear, ask to see and photograph the inside of trunk or cargo area. If private vehicle is struck in front, ask to see and photograph the inside of the engine compartment. For Non-Postal Person Accidents, photograph the area where the accident happened, such as in a lobby, in the parking lot, stairwell, sidewalk, etc., from different directions and at different distances. Photograph the floor mat or "Wet Floor" signs if applicable, and any debris or wet areas on the floor. Photograph the outside of buildings or any USPS equipment involved. Send either 1 complete set of 4 x 6 prints and the negatives or the entire disposable camera or undeveloped roll of film to the AI/CC. If specifically requested by the AI/CC, affix two photographs to each photographic information sheet, along with the description of each photograph and/or comments. If mounting is required, send the negatives and 4 x 6 prints with the accident package to the AI/CC. The quality of the photographs taken at the accident scene, along with your investigation, will, to a large extent, affect the outcome of claims and/or litigation against the U. S. Postal Service. Our ability to collect for damages in the event that the private party is at fault will also be affected by photographs taken by you. Remember that the adjudicator of any future claim or tort action will not be familiar with the accident area and he or she will have to rely quite heavily on your photographs. TAKE GOOD PHOTOGRAPHS FROM DIFFERENT ANGLES PHOTOGRAPH ALL SIDES OF ALL VEHICLES INVOLVED AND THE SCENE PHOTO INFORMATION COVER SHEET - PAGE 1 OF 1

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21 ACCIDENT INVESTIGATION WORKSHEET (PS FORM 1700) THIS FORM MUST BE COMPLETED WITH DIAGRAM ON-SCENE INVESTIGATOR MUST SIGN ITEM 45 FOR EVERY ACCIDENT

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23 UNIT #3 POSTAL VEHICLE IS UNIT #1 PRIVATE VEHICLE(S) ARE UNIT(S) #2, 3, 4, etc. USE THIS ADDITIONAL PAGE IF THERE IS MORE THAN 1 PRIVATE VEHICLE INVOLVED PS Form 1700, December 1991 (Page 1a of 4)

24 UNIT #4 POSTAL VEHICLE IS UNIT #1 PRIVATE VEHICLE(S) ARE UNIT(S) #2, 3, 4, etc. USE THIS ADDITIONAL PAGE IF THERE IS MORE THAN 1 PRIVATE VEHICLE INVOLVED PS Form 1700, December 1991 (Page 1b of 4)

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27 FIELD SKETCH - DIAGRAM UNITED STATES POSTAL SERVICE SCALE: NOT TO SCALE PLACE ARROW IN CIRCLE TO INDICATE NORTH CASE NUMBER: #1 POSTAL VEHICLE #2 PRIVATE VEHICLE INDICATE WIDTH OF ROADWAYS, TRAFFIC FLOW WITH ARROWS, PATH OF VEHICLES WITH DASHED LINES, POINT OF IMPACT, PLACE WHERE VEHICLES STOPPED AFTER IMPACT, PARKED VEHICLES, TRAFFIC CONTROLS, ETC. POSTAL OPERATOR: COMMENTS: POSTAL OPERATED VEHICLE # POSTAL FACILITY: LOCATION OF ACCIDENT: DATE / TIME OF ACCIDENT / DRAWN BY: PS Form 1700, December 1991 (Page 4 of 4)

28 MOTOR VEHICLE ACCIDENT REPORT (SF-91) USPS VEHICLE OPERATOR COMPLETES ITEMS 1 THRU 71 BE SURE THEY SIGN ITEM 71b!! ******************************** SUPERVISOR COMPLETES ITEMS 72 THRU 87 FOR EVERY MOTOR VEHICLE ACCIDENT

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34 LAW ENFORCEMENT OFFICIALS FINANCIAL RESPONSIBILITY LAWS WHEN COMPLETING A STATE ACCIDENT REPORT, THE TEXAS DPS RECOGNIZES SELF-INSURED / U.S. GOVERNMENT WHEN ENTERED IN THE APPROPRIATE INSURANCE INFORMATION AREA OF THE FORM. There is no policy number for an Agency of the United States of America. The United States Postal Service is an independent establishment of the executive branch of the Government of the United States, 39 U.S.C The Postal Service does not purchase commercial insurance, but rather, like insurance companies, it is authorized to pay proper claims against it, and is subject to suit for damages. Liability claims against the Postal Service are governed by the Federal Tort Claims Act, 39 U.S.C. 409(c), whose provisions are set forth at 28 U.S.C. 1346(b), 2401(b), The United States Postal Service is NOT insured with any automobile insurance carrier, does NOT carry uninsured motorist coverage and is NOT a self-insured entity. To the extent that the United States Postal Service may be found liable for damages under the provisions of the Federal Tort Claims Act, payment of any judgment is made from its general fund. TEXAS MOTOR VEHICLE SAFETY RESPONSIBILITY ACT TRANSPORTATION CODE - CHAPTER 601 (See: TRC (a),(b) & (d) Applicability of chapter to government vehicles) In cases of accidents, the U.S. Postal Service is governed by THE FEDERAL TORT CLAIMS ACT (U.S.C. - TITLE 28) ************************************************************************************************************************ Reference Texas Traffic Laws,, Transportation Code, TRC , noting that vehicles which are the property of and used exclusively in the service of the United States Government, such as United States Postal Service-owned vehicles, do not require the payment of Registration Fees. The State of Texas recognizes United States Postal Service Regulations pertaining to the operation of a Postal -owned vehicle without Registration Plates, as follows: The State of Texas recognizes the painted registration number in lieu of metal license plates, provided the vehicle on which such numbers are displayed can be readily identified as U.S. Government-operated. The United States Postal Service is free to adopt its own regulations concerning the use of "P-Tags" (Federal License Plates). Per United States Postal Service Maintenance Bulletin, V20-73, dated January 19, 1973, P Tags were eliminated from requirements on Postal Service Vehicles that are numbered and display emblems of the United States Postal Service, but they are used on Administrative Vehicles. ADDITIONAL INFORMATION MAY BE OBTAINED BY CONTACTING: AI/TCC 951 W. BETHEL ROAD COPPELL, TX

35 ACCIDENT INVESTIGATIONS DALLAS CUSTOMER SERVICE & SALES ATTENTION: USPS ON-SCENE ACCIDENT INVESTIGATOR *YOU MAY REMOVE THIS BACK COVER AND PROVIDE IT TO ANY PRIVATE PARTY INVOLVED IN A U.S. POSTAL SERVICE-RELATED ACCIDENT PRIOR TO ISSUANCE TO A PRIVATE PARTY COMPLETE THE FOLLOWING INFORMATION, AS APPLICABLE: NAME OF POSTAL EMPLOYEE: DRIVER S LICENSE #: NAME OF POSTAL FACILITY: POSTAL VEHICLE #: DATE OF ACCIDENT ************************************************************************************************ To Whom It May Concern: ACCIDENT INFORMATION In cases such as this, The United States Postal Service may be governed by the FEDERAL TORT CLAIMS ACT, (SECTIONS , TITLE 28, U.S.C.). This is a Federal Claim Program, not an Insurance Program, and does not provide any features normally expected from an insurance program. To receive further information or assistance in this case, please call or write: AI/TCC U.S. Postal Service 951 W. Bethel Road Coppell, TX (972) (*) PROVIDING THIS DOCUMENT DOES NOT CONSTITUTE AN ADMISSION OF LIABILITY ON THE PART OF THE UNITED STATES POSTAL SERVICE IN THIS CASE.

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