GRO-454-FRM-Journey Management Plan

• Primary Driver:

• Reason for Travel:

• Vehicle Type:

• Registration Number:

• Prepared by

Proposed Travel Itinerary:

• Distance of Travel:

• Departing From:

• Select date

  Date

• Arrive At:

• Select date

  Date

Emergency Contact During Travel Period (List for Driver and All Passengers)

• Employee Name:

• Contact Name:

• Relationship:

• Phone Number:

• Employee Name:

• Contact Name:

• Relationship:

• Phone Number:

• Employee Name:

• Contact Name:

• Relationship:

• Phone Number:

• Employee Name:

• Contact Name:

• Relationship:

• Phone Number:

• Employee Name:

• Contact Name:

• Relationship:

• Phone Number:

• Employee Name:

• Contact Name:

• Relationship:

• Phone Number:

Journey Risk Assessment and Controls

• Expected Road Conditions

  Good

  Fair

  Bad

  Unknown

• Expected Climate

  Very Hot

  Hot

  Mild

  Cold

• Expected Road Surface

  Bitumen

  Gravel

  Off Road

• Expected Weather Conditions

  Fine

  Overcast

  Wet

• List Other Hazards:

• Driving On Your Own?

  Yes

  No

• How many people sharing the driving?

• Hours awake before commencing the journey?

Controls: Do you acknowledge the following controls?

• No driver to drive more than 2 hours before having a minimum 15 minute break

  Yes

  No

• Sufficient rest has been taken prior to the drive for lone drivers

  Yes

  No

  N/A

• If you are driving more than 2 hours at the end of the roster cycle, are you planning on taking a 4 hour rest break prior to commencing driving?

  Yes

  No

• List all other proposed controls:

Vehicle Safety Checklist: Is the vehicle equipped with the following items in good operating condition?

• Headlights

  Yes

  No

• Horn

  Yes

  No

• Wiper Blades

  Yes

  No

• Tyres (including spare)

  Yes

  No

• Indicators

  Yes

  No

• Registration is current

  Yes

  No

• Seatbelts

  Yes

  No

• Brakes

  Yes

  No

• Mirrors

  Yes

  No

• Oil and Coolant levels

  Yes

  No

• Windscreen

  Yes

  No

• Fuelled up

  Yes

  No

• What other safety equipment is present:

Approval

• Driver:

  Sign

• Manager:

  Sign