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MAP Client Services Registration

Contact Name:

Company:

Email:

Phone Number:

Title:

Address:

City:

State:

Zipcode:

Please check the service(s) you are requesting for activation:
Safety Essentials Online (safety management resource library)
HR Essentials Online (HR and employment practices content and resources; exclusively for Employment Practices Liability policyholders)
Law Enforcement Liability Resources (self-assessment tool, updated policies & procedures templates; exclusively for Law Enforcement Liability policyholders)
Workers Comp Kit® (post-loss practices assessment, sample forms, modules and benchmark reporting)
Safety Training Source (online training with over 600 titles, including videos on demand)
Safe Patient Handling Evaluation Resource
Office Ergonomics Solution (computer workstation self-assessment tool)
Select the Commercial Auto Resources Network service(s) for which you want to be contacted for discounted and/or funded access::
LifeSaver Mobile – (Blocks cell phone access while driving and enforces distracted driving policy.)
Azuga Fleet (Safety-driven telematics to enhance accountability and risk management)
Rosco Vision Systems (Camera monitoring system for inside vehicle and outside traffic behaviors)

Fleet Size:

Select the School Risk Management service(s) for which you want to be contacted for discounted and/or funded access:
Adult Sexual Misconduct (ASM), Bullying & Violence Risk Control Programs
EmployeeSafe Program Suite (staff safety and risk management)
Incident Management (STOPIt Solutions)
Proactive Behavioral Crises Intervention
Student Accident Management
Student Crises Intervention

Briefly describe the safety and risk management issue you would like to address:

The following are courses to help address the risks of employee driving. Each course simulates and educates on controlling driving hazard scenarios.
S:ERVE (Safety: Emergency Responder Vehicle Education) Police, Fire, EMS drivers, Code 3 Intersection Negotiation – 3 hour online course

If you are registering for S:ERVE, please complete this section:

Minimum Passing Score:

Notify Instructor: Select this box to automatically receive notification when a student completes a course.

Do you plan to train within your organization for any of the following*:

Ambulance
Police
Fire

*Training is not guaranteed for all employees.

Distracted Driving Online Course (All drivers, managing distractions including phones – 30 min. online course)
Defensive Driving + Distracted Driving (All drivers, 5 most common causes of crashes – 3 hour online course)
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