Title Page
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Carrier
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Main Office Address
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Home Terminal Address
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Driver's Name
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Employee No.
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Date
Driver Data
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Place Where You Reported
Off Duty
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Use time standard of home terminal.
Off Duty
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Start Time
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End Time
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Where Change of Duty Occured
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Off Duty Total Hours
Sleeper Berth
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Use time standard of home terminal.
Sleeper Berth
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Start Time
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End Time
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Where Change of Duty Occured
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Sleeper Berth Total Hours
Driving
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Use time standard of home terminal.
Driving
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Start Time
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End Time
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Where Change of Duty Occured
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Driving Total Hours
On Duty (not driving)
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Use time standard of home terminal.
On Duty (not driving)
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Start Time
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End Time
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Where Change of Duty Occured
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On Duty (not driving) Total Hours
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Place Where Released From Work
Truck Data
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Truck ID / Number
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Truck License Plate
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Total Miles Driving Today
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Total Mileage Today
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Receipts (Fuel Stops, etc.)
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Tickets (Toll, Scale, Speeding, etc.)
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Inspections (Pre-trip, Roadside, Post-trip, etc.)
Shipping Documents
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Shipper
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Commodity
Sign Off
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Additional Notes
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Driver's Name and Signature
