Travel Risk Assessment

Travel Details

• Name:

• Reason for travel:

Departing Journey

• Departing From

• Mode of transport

• Date of travel

  Date

• Will you be staying in accommodation?

  Yes

  No

  N/A

• Details of the accommodation (name and address)

• How many nights will you be staying at this accommodation?

Return Journey

• Departing From

• Mode of transport

• Date of travel

  Date

• Arriving at

Travel Risk Assessment

• Consult with your manager to review your itinerary and assess whether the following factors are safe, risky, or not applicable.

  Yes

  No

  N/A

• Vehicle familiarity

  Safe

  At Risk

  N/A

• Vehicle selection

  Safe

  At Risk

  N/A

• Vehicle breakdown/accident contact details

  Safe

  At Risk

  N/A

• Driving conditions

  Safe

  At Risk

  N/A

• Long distance

  Safe

  At Risk

  N/A

• Dusk/dawn driving

  Safe

  At Risk

  N/A

• Remote location

  Safe

  At Risk

  N/A

• Unsealed roads

  Safe

  At Risk

  N/A

• Drivers ability/confidence

  Safe

  At Risk

  N/A

• Fatigue

  Safe

  At Risk

  N/A

• Post shift work

  Safe

  At Risk

  N/A

• Destination familiarity

  Safe

  At Risk

  N/A

• Other factors (eg medical conditions)

  Safe

  At Risk

  N/A

Contact Details

• Emergency contact name and telephone

• Travel manager (if not your manager)

• Check in time daily to journey manager (if this time is missed by more than 30 minutes the travel manger needs to escalate to manger and or emergency contact)

Approval & Sign Off

• Signature of traveller

  Sign

• Approval by Manager

  Sign