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Van usage Report

Please fill this form every time you use the van.

Driver and Trip Info

Driver's name:*

Driver's phone number:*

Name of ministry/group using the van:*

Number of passengers:*

Date(s) of use:*

Destination(s):*

Purpose of trip:*

Departure time:*

Return Time:*

Beginning mileage:*

Ending mileage:*

Vehicle Condition

Before trip:

Fuel level noted

No visible damage

Tires appear normal

Lights work

Exterior is reasonably clean

After trip:

Fuel level upon return

Van is reasonably clean (both interior and exterior)

No new damage

Maintenance and Issues

Did any warning lights appear at any time?*

Yes (describe below)

No

Any mechanical concerns?*

Yes (describe below)

No

If you responded "yes" to any of these, please describe it below:

Accident Report (if applicable)

If there was an a accident or any type of notable incident, please describe it in this section. Otherwise, you may skip to the end.

Date and time of incident:

Location:

Description of what happened:

Other vehicles or individuals involved:

Police Report No. (if applicable):

Please attach any photos here:

Acknowledgement and Signature

I confirm that the above information is accurate and that I operated this vehicle in accordance with church policy

Driver's Signature:*

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Date:*

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