Title Page

  • Conducted on

  • Prepared by

  • Location

Employee Information

  • Employee Name

  • Date:

  • Day of week:

  • Supervisor/Foreman

  • Project Manager/Approval

Job 1

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 2

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 3

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 4

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 5

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 6

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 7

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 8

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 9

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

Job 10

  • Job Number:

  • Job Address

  • Start Time:

  • End Time:

  • Total Hours

  • Injured on the job?

  • Was lunch taken?

  • Driver or Non-Driver?

  • Total Drive Time

  • Vehicle Number

  • Starting Mileage

  • Ending Mileage

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.