Information
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Instructions: Employees driving on company business and greater than 120 miles (200km) are required to complete this form and have the appropriate level of approval before making the trip.
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Journey Management
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FIRST NAME/LAST NAME
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District
- Appalachia
- Grande Prairie
- Leduc
- Midland
- North Dakota
- Rio Vista
Journey Management
INFORMATION
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Vehicle Unit #
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Employee Position
- Assets
- Director
- District Admin
- District Manager
- Engineering
- Executive
- Field Supervisor
- Field Technician
- Finance
- HR and Benefit
- HSE
- Integrated Services
- Informational Technology
- Ops Coordinator
- Regional Manager
- Repair Facility
- Sales and Marketing
- Service Quality
- Shop Foreman
- Shop Tech
- Training Center
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Starting Location
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Ending Location
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Departure Date and Time
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Arrival Date and Estimated Arrival Time
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Road Trip Directions
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Estimated Trip Mileage or Kilometers
SAFETY CHECK ITEMS
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I will use my seatbelt at all times and ensure all passengers will do the same.
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While driving, I will be hands-free from any hand-held electronic device such as a cell phone, GPS, etc.
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If I have had less than 8 hours of quality rest in the last 24 hours I will notify my supervisor.
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If I get drowsey I will pullover and STOP driving so that I can nap/get adequate rest.
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As a driver, I am "Fit for Duty" which means that I am free of alcohol, medications that cause drowsiness, fatigue, etc.
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I have check that I have a spare tire available and it is fully pressurized.
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I have checked that all loads in my vehicle, including the bed of the truck, are secure.
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I have checked that all potential projectiles in vehice, including the bed of the truck, are secured.
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I will not tailgate by keeping a minimum following distance of 4 seconds. I will also increase the 4 seconds of following distance when additional hazards exist such as weather.
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I have ensured that my headlights/daytime running lights are working and will be used at all times while driving.
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I have removed all in vehicle distractions.
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I will obey all posted speed limits.
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I will stop and take rest/break every 2-3 hours.
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I will park in such a manner so that my first move will be forward when I leave.
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I am aware that my company vehicle has a tracking device that monitors driving behavior such as speed, harsh braking/acceleration/turns, etc. I will also notify my supervisor if there is any known problem with my vehicle's tracking device.
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If conditions or plans change, I will stop and reassess my trip.
DRIVING HAZARD ASSESSMENT
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Journey Distance
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Journey Drive Time
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Any additional Drive Time?
- 1 = 60 additional min
- 2 = 120 additonal min
- 3 = 180 additional min
- 4 = 240 additional min
- 5 = 300 additional min
- 6 = 360 additional min
- 7 = 420 additional min
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Journey Drive Hours (Time of Day)
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Passengers
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Road Conditions
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Emergency Communications
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Emergency Equipment Available
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Driver Hours Awake by End of Trip
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Duration of Driver's Last Sleep
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Weather Conditions
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Animal Activity
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Journey Risk Assessment Score (total your score from your "Driving Hazard Assessment" selections
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Journey Risk Assessment Score Risk Level (select risk based on score)
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SUPERVISOR APPROVAL: By checking this box I am stating that I have created an "Action Item" by checking the paper clip to the right of this area, filling out the information, as well as assigning this to my supervisor for approval.
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SUPERVISOR APPROVAL: By checking this box I am stating that I have created an "Action Item", filling out the information, as well as assigning this to my supervisor for approval.
