Information
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Prepared by
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Mobile number
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Date of travel
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Start point
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Total Kms
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Estimated travel time
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Start date & time
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Finish date & time
Travel Plan
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Travel after a full shift?
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Travel during normal sleep time
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Travel + work hours > 14 hrs
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You need to take a 15 minute break after every 2 hours of driving. You must take additional breaks if you are showing signs of fatigue.
Break 1 (2 hours after start time)
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Break time
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Break Location
Break 2 (2 hours & 15 mins after break 1)
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Break time
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Break Location
Break 3 (2 hours & 15 mins after break 2)
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Break time
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Break Location
Break 4 (2 hours & 15 mins after break 3)
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Break time
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Break Location
Break 5 (2 hours & 15 mins after break 4)
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Break time
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Break Location
Break 6 (2 hours & 15 mins after break 5)
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Break time
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Break Location
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Did the driver get 24 hrs notice?
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Did the driver get 8 hrs in the 24hrs before travel?
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Call in Person
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Call in Person's number
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Have you informed the call in person?
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If the driver is 15 minutes late communicating, the call in person must call the driver. If there is no answer, the call in person or supervisor will try again every 5 minutes for an additional 15 minutes. After that the supervisor will contact emergency services.
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Enter Name and Signature
