Extreme weather caused travel plan

• Conducted on

  Date

• Prepared by

• Location
  Address

• Describe reason requiring travel plan

• Depart

  Date

• Returned home safely

  Date

Pretrip inspection

• All other fluid levels

  Pass

  Fail

  N/A

• Fuel level 3/4 or greater

  Yes

  No

  N/A

• How would you rate the condition of the tires?

  Good

  Fair

  Poor

  N/A

• All lights operate

  Pass

  Fail

  N/A

• Is the vehicle free from visible signs of damage?

  Yes

  No

  N/A

• Vehicle up to date on required maintenance

  Yes

  No

  N/A

• Cell phone fully charged

  Yes

  No

  N/A

• Extreme cold weather

  Yes

  No

  N/A

• Spare blankets or cold weather gear (note type and quantity brought)

  Yes

  No

  N/A

• Extra water

  Yes

  No

  N/A

• Snacks

  Yes

  No

  N/A

• Extreme Heat

  Yes

  No

  N/A

• Extra Water

  Yes

  No

  N/A

• Snacks

  Yes

  No

  N/A

• Electrolytes solution

  Yes

  No

  N/A

Weather conditions, route, contact

• Current weather conditions

• Are conditions expected to change

  Yes

  No

  N/A

• Describe anticipated change and time frame

• Route

• Road conditions along route

• Home port contact aware of location and well being

  Yes

  No

  N/A

• Contact