VEHICLE USAGE FORM
DRIVER
Vehicle #
DESTINATION
PURPOSE
Pick Up Date
ORGANIZATION
Return Date
IMPORTANT -- NOTE TO DRIVER
In signing out this vehicle, you and your department are responsible for the following:
1 Bringing the vehicle back with a full tank of gas. Must have a receipt! 2 Keeping the vehicle clean. Inside of vehicle must be clean of all trash after trip. 3 Reporting any noticeable damange or vehicle concerns before and after trip. 4 All motor vehicle violations incurred.
An additional cost for vehicle use or losing privilege will occur if these conditions are not met.
DRIVER SIGNATURE
Van signed out by:
SECTION BELOW TO BE COMPLETED BY DRIVER
**** BEFORE TRIP ****
Noticeable damage / concerns:
Gas level
E
F Beginning Odometer Reading
**** AFTER TRIP ****
Noticeable damage / concerns:
Gas level
E
F Returning Odometer Reading
Driver initial upon return:
SECTION BELOW TO BE COMPLETED BY SECURITY / STUDENT LIFE
Inspected by:
Inspector's concerns:
RETURN KEYS AND COMPLETED FORM TO CAMPUS SECURITY OFFICE
REVISED 9/2016
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