                          SUBMITTED BY

                        KENNETH P. SOBEL
                      SAFETY ADMINISTRATOR
                       CITY OF LOS ANGELES
                         (213) 485-4691
                       FAX (213) 485-8765
_________________________________________________________________


                                                      SAFETY BELT USE ENCOURAGEMENT USE OUTLINE

        1.      Design report form (complete)

        2.      Ask safety coordinators' cooperation in monitoring use
          of safety belts in their departments.

        3.      Disseminate forms to coordinators and establish a date
          as a deadline for returning forms.

        4.      Work through the Safety Administrator to obtain
          cooperation of field personnel in monitoring (using
          established form) use of seat belts at Parker Center,
          City Hall, City Hall East, and Piper Tech.

        5.      Upon receipt of forms, formulate report to appropriate
          managers.

                                              SEAT BELT SURVEY OBSERVATION FORM*


OBSERVER ___________________________________  DATE ____________________

LOCATION ______________________________________________________________

START TIME: ________ AM - PM ____   END TIME: _______  AM - PM ________


VEHICLE  DEPARTMENT  DRIVER  PASSENGER  REAR PASSENGERS  COMMENTS
NUMBER              Ĵ
                     YESNO  YES  NO    YES     NO    

                                                     

                                                     

                                                     

                                                     

                                                     

                                                     

                                                     

                                                     

                                                     

                                                     

                                                     

                                                     


SEND COMPLETED FORM TO:  OCCUPATIONAL SAFETY OFFICE, M/S 517.

* SEE REVERSE FOR INSTRUCTIONS

LOCATION:  Print the names and/or numbers to identify the facili-
ty, lot and the lot entrance or location where you are standing.

START AND END TIME:  Specify the hour and minutes, and circle AM
or PM for the start and end of the work shift.

LIST CITY VEHICLE NUMBER, EMPLOYEE'S DEPARTMENT, AND WHETHER THE
DRIVER OR PASSENGERS ARE WEARING SEAT BELTS WITH APPROPRIATE CHECK
IN YES OR NO COLUMN.  A COMMENTS SECTION IS PROVIDED IN CASE A SEAT
BELT IS NOT PROVIDED OR IS UNUSABLE.
