Home Run for Safety Award
Registration Form

When you have completed all 4 of the Home Run for Safety Award programs, you are eligible to receive the Home Run for Safety Award. After a company official completes the Management program and all of their drivers have completed the 4 Home Run programs, the company is eligible to receive a Home Run for Safety Award.

Please fill out the form below to request your Home Run for Safety Award

Congratulations on completing the Home Run for Safety Program! You will find that the safety training you have received provides valuable knowledge and techniques you may use to improve your safety record during your driving career. If you have questions please contact us: info@truckingsafety.org

Registration:

Name on award:
Address: we will send your award to this address
City:
State:
Zip: Telephone:
Email:
Company: if applicable (include driving schools)
   

Programs Completed

:

Defensive Driving for Professional Truck Drivers

Completion Date:

Professional Driver Coaching

Completion Date:

Fatigue Management

Completion Date:

Michigan Center for Decision Driving

Completion Date:

Company Awards require company official attending training:

Management training

Completion Date:

Comments:

Please print and fax or mail:

Michigan Center for Truck Safety
1131 Centennial Way, Suite 2
Lansing MI 48917

fax: 517-321-0864