Authorization to Drive Form
The front and back of this form must be completed and turned in with the keys at the end of
the trip
College Vehicle
12-Passenger Rental Van
Office Use Only:
Vehicle #
Driver ID #
I, _, certify that my license issued in
which expires on
(Name of Driver) (State of Issue) (Expiration Date)
is valid, is not under suspension, and is not revoked.
I, _, certify that my
license issued in
which expires on
(Name of Alternate Driver, if applicable) (State of Issue) (Expiration Date)
is valid, is not under suspension, and is not revoked.
Passenger Names:
Note: All passengers must be listed on this form or on a separate attachment.
Trip Date(s): Departure Time: Return Time: Approximate Mileage:
Destination and Purpose:
Project #: Sponsoring Department/Organization:
Printed Name *Signature of Authorizing Faculty or Staff Member Date
Printed Name *Driver’s Signature Date
Printed Name *Alternate Driver’s Signature Date
Printed Name Signature of Person Checking Credentials Date
* Driver, Alternate Driver, and Authorizing Individual have read and agree to abide by all terms, conditions, rules
and
regulations contained in the current Bowdoin College Motor Vehicle Use Policy, dated June 2019, and on this form and certify
that
all
information provided on this form is
accurate.
Driver(s) Agree To The Following:
o Cell phone use (including texting) is not permitted while operating a College owned, leased or rented vehicle.
o Vehicles are for official business and college purposes only. Examples of authorized travel include official athletic team
travel, faculty sponsored field trips, and official outing club trips. Uses must be approved by the relevant supervisor or
sponsor in advance. Personal use for errands, medical appointments, shopping or any other personal use is strictly
prohibited. Business and personal use of vehicles should not be combined. If vehicles are used for personal use, driver
shall be subject to loss of driving privileges and/or disciplinary action. If you have any questions on permitted use, please
check with the Fleet Scheduler.
o Drivers must abide by and enforce all rules, regulations, terms and conditions as outlined in the Bowdoin College Motor
Vehicle Use Policy and must know and obey all applicable campus, local, state and federal traffic laws, regulations, and
ordinances.
o Drivers are responsible for immediately notifying local police in the city or town where an accident occurs and also
notifying the Office of Safety and Security Communications Center at 207-725-3314.
o If the vehicle breaks down or becomes disabled at any time follow the attached vehicle breakdown procedures.
o Drivers may not operate a College vehicle under the influence of alcohol or illegal drugs or while using a prescription
medication that has any warning of any impairment, including without limitation, a warning for
dr
owsiness or not to use
when operating heavy machinery.
o Before leaving the parking area or garage, drivers must do a “walk around” inspection of the vehicle and report any
existing damage to the Fleet Scheduler or the Office of Safety and Security Communications Center. Drivers must
confirm that the following parts and components are in good working order: service brakes, parking brakes, steering
mechanism, horn, windshield wipers/washers, rear-vision mirrors, lights/reflector devices, and tires/wheels.
o Following a trip drivers must return a completed authorization to drive form along with the fuel card, gas receipts and
the keys to the vehicle.
Y
Y
Y
N
N
N
Was this vehicle used for towing? (Circle one):
Was vehicle
checked for damage before leaving Bowdoin College parking lot? (Circle one):
Did damage occur as a result of this trip? (Circle one):
Please indicate any damage(s) before or after the trip on the pictures and describe in the space provided.
____________________
___________________________________________________
_______________________________________________________________________
Mileage at End of Trip
Mileage at Start of Trip
Tot
al Miles Driven
Fuel Level Start of Trip
(circle amount) E- - ¼ - -1/2 - - ¾ - - F
Fuel Level End of Trip (circle amount) E- - ¼ - -1/2 - - ¾ - - F
• Was gas and/or automobile supplies purchased? (Circle one)
Y N
• Was the vehicle washed
before returning to campus? (Circle one)
Y N
• Was the vehicle
vacuumed before returning to campus? (Circle one)
Y N
If yes,
please attach receipts to this
form. Only
gas or related supplies or a car wash may be charged on the fuel card, other charges
will be assessed to your department.
Vehicles need to be returned with a minimum of 3/4 fuel.
_______________________________________________________________________
Trip Report
