Vehicle Usage Form

This form, including the driver certification and acknowledgment section, must be completed when trip is confirmed. Travel information must be completed on date of travel as provided in Vehicle Log.

Keys and Vehicle Usage Form must be picked up and returned to the Transit Office, Rm #226 200 Great Hill Drive (Operations Center). Pick up keys on the day of travel unless special arrangements have been made (i.e. due to time of departure and return).

Today's Date:
Department:
Requested By:
Telephone Extension:
License Number:
 (Include State Issued)

List of People in Party:
Inclusive Dates of Use:
Destination:
Departure Time from BSC:

Return Time to BSC:

Type of Vehicle Needed
  Staff Car  Van

Vehicle Descriptions

Staff Car - 4-door compact, 5 passengers maximum including driver

Van - 15 passengers maximum including driver

For Van Use Only: Is it necessary to arrange for a driver? Yes      No

Have the appropriate travel approval forms been submitted to immediate Supervisor/Department Chairperson as required by college policy? Yes       No

Certification and Acknowledgement

By clicking the Submit button, you certify that you possess a valid driver's license and agree to the policies and procedures of Bridgewater State College.