• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Date

  • Driver 1 (Name)

  • Driver 2 (Name)

  • Destination?

  • Reason for the Journey

  • IVMS installed and working ?

  • Road Journey Manager/Contact


  • Is this the driver's first time journey on this route? If yes=15 If no=0

  • Is the driver a Short Service Employee If No =0 If 7months to 12 months=15 If 6 months or less=40

  • How many hours has the driver been on duty before starting the journey? 8 hours to 12 hours= 10 More than 12 hours but less than 16 hours=30 16 hours and greater=75

  • How many hours of sleep has the driver had in the last 24hours? *4 hours or less=40 *More than 4 hours but less than 6=5 *6 or greater hours=0

  • What is the anticipated driving time (hours) for the journey? Less than 2 hours=0 2 hours to 4 hours=10 Greater than 4 hours to 6 hours=15 Greater than 6 hours=20

  • Is there a backup driver for journeys over 10 hours If Journey not over 10 hours=0 If answer is yes=0 If answer is no=5

  • Will the journey require driving in darkness? If less than 4 hours=0 If 4 hours to 6 hours=20 Over 6 hours=40

  • Will the journey cause the driver to exceed their normal work schedule or drive during a elevated traffic risk periods? If no=0 If yes=5

  • What are the weather conditions and visibility for the journey? Good=0 Fair=10 Poor=25

  • What is the road surface condition and topography? Good=0 Fair=5 Poor=15

  • Are there security issues? No=0 Yes mitigated=40 Yes=75

  • Are hazardous materials shipped with appropriate documentation and qualified drivers?<br><br>N/A =0<br>Yes=0<br>No=Stopwork


  • Total score

  • Risk Level<br><br>Low=less than 30<br>30 to 49=moderate<br>50 to 75=medium<br>Greater=75

Passenger Information

  • Passenger 1

  • Passenger 2

  • Passenger 3


  • Route description


  • Contact Person

  • Contact frequency Daily? Every 4 hours? Every 2 hours? Every 1 hour?


  • Authorizing manager (if required)

  • Drivers printed name

  • Drivers signature

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.