Personnel & Vehicle Details

  • Primary Driver:

  • Reason for Travel:

  • Vehicle Type:

  • Registration Number:

  • Document No.

  • Prepared by

Travel Itinerary & Contact Details

Proposed Travel Itinerary:

  • Distance of Travel:

  • Departing From:

  • Time of departure:

  • Route:

  • Destination:

  • Expected arrival time:

Other Drivers and All Passengers (if any)

  • Passenger 1 Name:

  • Phone:

  • Passenger 2 Name:

  • Phone:

  • Passenger 3 Name:

  • Phone:

  • Passenger 4 Name:

  • Phone:

Check in Details. Must check in at start and end of journey.

  • Name of check in person

  • Number of check in person

  • Method of check in

  • Frequency of check in (2 hours maximum)

Journey Management Plan

Journey Risk Assessment and Controls

  • Road conditions expected:

  • Weather expected:

  • List Other Hazards:

  • Driving On Your Own?

  • How many people sharing the driving?

  • Hours awake before commencing the journey?

Controls: Do you acknowledge the following controls?

  • Have I completed a Light Vehicle prestart? Mandatory *

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

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

  • List all other proposed controls:

  • Fuelled up

  • Sign off:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.