Operating instructions

Dole – Drivers Reference Manual
Page 71
EQUIPMENT ACCIDENT/STOLEN REPORT No.
Fre sh Fruit Company
To: Monica Sánchez - DFFI, San Jose, Costa Rica Date:______________________
cc: Karina Rodríguez - DFFI, San Jose, Costa Rica
Robert McKenry - Wilmington, DE, USA ( US and Europe accidents only) From:______________________
Local USA M&R Manager & Supervisors
Instructions: Complete items 1-14 as soon as possible & fax or email to above personnel.
When this form is complete (items 1-17) resend to above personnel.
EQUIPMENT INFORMATION
1. Date of Loss: 2. Location of Accident: City
State or
Country
3. Container Number: Prefix No.
4. Chassis Number: Prefix No.
5. Generator Set Number: Prefix No.
6. Detailed Description of Accident:
7. Cause of Accident:
Discharged from Vessel
8. Responsible of Equipment when accidented
Commercial
Cargo
Banana /
Diversified
Other
CARRIER INFORMATION
9. Name of Carrier: Company
Address
Contact Phone
10. Carrier Driver: Name
11. Carrier Insurance Company Name:
Contact Claim #
12. Address and Phone Number: Address
Phone
13. Disposition of cargo:
14. Present Location of Equipment: Company
Address
City
State or
Country
COST ESTIMATE
15. Estimated Cost of Repair: Container Status R T*
Chassis Status R T*
Generator Status R T*
Owner*
Owner*
Owner*
Banana /
Diversified
* Note: If totaled, the unit must be returned by the trucker / responsible party to the terminal within 15 days from the day this report is
submitted. . If unit is not returned to a Dole Terminal or where requested, the Depreciated Value will be charged to the Responsible Party
(Carrier, Trucker) stated on this report.
Note: In OWNER indicate if equipment is OWNED of LEASED
Mark with an X the activity / bussiness unit that held the unit when accidented
Indicate the equipment status. R for Repairable - T for Totaled
Indique la condicion del equipo. R para Reparable - T por Perdida Total
$0.00
$0.00
$0.00
Revised Feb 2010