Van usage Report

Please fill this form every time you use the van.

Van Report

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:

Was there an accident of any kind?*

Yes

No

Accident Report

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

Signature

By typing my name below, 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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