"Safety Restraint Overtime Enforcement Stat Sheet Template"

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Safety   R estraint   O vertime   E nforcement   S tat   S heet
Please   r etain   t his   f orm   f or   f our   ( 4)   f iscal   y ears.  
The   U HSO   m ay   r eview   t hese   r ecords   f or   a uditing  
purposes.
Officer   N ame
Badge   #
Employee   #
Agency
Time   s tart
Time   e nd
Event
Activity   D ate
Miles   t raveled   ( estimate)
 
 
Total   H ours   C laimed
 
Hourly   W age   S traight   T ime
Safety   R estraint   S tatistics
 
 
 
 
 
#   V ehicles   S topped
#   C ontacts   p er   H our
 
 
#   S eat   B elt   C itations
#   S eat   B elt   W arnings
#   C hild   R estraint   C itations
#   C hild   R estraint   W arnings
 
Age   f or   c hild   r estraint   c itations:  
#
0-­‐2  
 
#
2-­‐4
 
#
5-­‐8
Other   R elated   S tats
#   C ar   S eat   I nspections
(if   C PS   c ertified)
#Warrants
Amount   $
Officer   A ssists
Public   A ssists
Impounds
Violation
Citation
Warning
DUI
Violation
Citation
Warning
Open   C ontainer
Speeding
Youth   A lcohol
Texting
Drug-­‐Misdemeanor
Reckless
Drug-­‐Felony
Careless
Ignition   I nterlock   V iolation
Failure   t o   Y ield
Alcohol   R estricted   D river
Following   T oo   C lose
Seat   B elt
Improper   T urn
Child   R estraint
Stop   S ign   o r   L ight
Driving   o n   S uspension
Improper   L ane   T ravel
Registration   V iolation
Other   M oving
Other   D L   V iolation
Other   M isdemeanor
No   I nsurance
Other   F elony
Other   N on-­‐Moving
I   c ertify   t he   a bove   i nformation   i s   c orrect.  
Officer   S ignature
Date
Approved   b y:
Supervisor   o r   T eam   L eader   S ignature
Date
Safety   R estraint   O vertime   E nforcement   S tat   S heet
Please   r etain   t his   f orm   f or   f our   ( 4)   f iscal   y ears.  
The   U HSO   m ay   r eview   t hese   r ecords   f or   a uditing  
purposes.
Officer   N ame
Badge   #
Employee   #
Agency
Time   s tart
Time   e nd
Event
Activity   D ate
Miles   t raveled   ( estimate)
 
 
Total   H ours   C laimed
 
Hourly   W age   S traight   T ime
Safety   R estraint   S tatistics
 
 
 
 
 
#   V ehicles   S topped
#   C ontacts   p er   H our
 
 
#   S eat   B elt   C itations
#   S eat   B elt   W arnings
#   C hild   R estraint   C itations
#   C hild   R estraint   W arnings
 
Age   f or   c hild   r estraint   c itations:  
#
0-­‐2  
 
#
2-­‐4
 
#
5-­‐8
Other   R elated   S tats
#   C ar   S eat   I nspections
(if   C PS   c ertified)
#Warrants
Amount   $
Officer   A ssists
Public   A ssists
Impounds
Violation
Citation
Warning
DUI
Violation
Citation
Warning
Open   C ontainer
Speeding
Youth   A lcohol
Texting
Drug-­‐Misdemeanor
Reckless
Drug-­‐Felony
Careless
Ignition   I nterlock   V iolation
Failure   t o   Y ield
Alcohol   R estricted   D river
Following   T oo   C lose
Seat   B elt
Improper   T urn
Child   R estraint
Stop   S ign   o r   L ight
Driving   o n   S uspension
Improper   L ane   T ravel
Registration   V iolation
Other   M oving
Other   D L   V iolation
Other   M isdemeanor
No   I nsurance
Other   F elony
Other   N on-­‐Moving
I   c ertify   t he   a bove   i nformation   i s   c orrect.  
Officer   S ignature
Date
Approved   b y:
Supervisor   o r   T eam   L eader   S ignature
Date