BARANGAY STO. DOMINGO   BARANGAY STO. DOMINGO   BARANGAY STO. DOMINGO
MOTOR VEHICLE TRIP TICKET MOTOR VEHICLE TRIP TICKET MOTOR VEHICLE TRIP TICKET
     
DATE: _________________ NO. ___ DATE: ________________ NO. ___ DATE: _________________ NO. ___
           
NAME OF DRIVER PHONE NO NAME OF DRIVER PHONE NO NAME OF DRIVER PHONE NO
                 
VEHICLE PLATE NO.     VEHICLE TYPE VEHICLE PLATE NO.     VEHICLE TYPE VEHICLE PLATE NO.     VEHICLE TYPE

DESTINATION DESTINATION DESTINATION

PASSENGER(S) PASSENGER(S) PASSENGER(S)

"I have authorized the driver signing below to use this "I have authorized the driver signing below to use this "I have authorized the driver signing below to use this
vehicle for official business only.”   vehicle for official business only.”   vehicle for official business only.”  
►             ►             ►            
    P/B MICHELLE ANN L. YU    
    P/B MICHELLE ANN L. YU     INSTRUCTIONS: Drivers shall fill-out this part properly. Further, drivers
    P/B MICHELLE ANN L. YU    
INSTRUCTIONS: Drivers shall fill-out this part properly. Further, drivers are responsible for reporting vehicle defects & accidents immediately. INSTRUCTIONS: Drivers shall fill-out this part properly. Further, drivers
are responsible for reporting vehicle defects & accidents immediately. are responsible for reporting vehicle defects & accidents immediately.
DATE ISSUED TIME OUT MILEAGE OUT
DATE ISSUED TIME OUT MILEAGE OUT DATE ISSUED TIME OUT MILEAGE OUT

DATE RETURNED TIME IN MILEAGE IN

DATE RETURNED TIME IN MILEAGE IN DATE RETURNED TIME IN MILEAGE IN

Was the vehicle This vehicle will be used for official government
Was the vehicle This vehicle will be used for official government involved in an business only. I have reviewed and complied Was the vehicle This vehicle will be used for official government
involved in an business only. I have reviewed and complied accident while in with COA Rules & Regulations re: Use of involved in an business only. I have reviewed and complied
accident while in with COA Rules & Regulations re: Use of your custody? Government-Owned Vehicle. accident while in with COA Rules & Regulations re: Use of
your custody? Government-Owned Vehicle. your custody? Government-Owned Vehicle.
□ YES □ NO          
□ YES □ NO           □ YES □ NO          
►
► ►
  SIGNATURE OF DRIVER  
  SIGNATURE OF DRIVER     SIGNATURE OF DRIVER  
INSTRUCTIONS: To be filled-out and signed by your passengers.
INSTRUCTIONS: To be filled-out and signed by your passengers. INSTRUCTIONS: To be filled-out and signed by your passengers.
DRIVER'S OVER-ALL LEVEL OF SERVICE
DRIVER'S OVER-ALL LEVEL OF SERVICE RATING SATISFACTION   DRIVER'S OVER-ALL LEVEL OF SERVICE
RATING SATISFACTION   1. Not at all 3. Moderately RATING SATISFACTION  
1. Not at all 3. Moderately   1 – Poor   satisfied   satisfied 1. Not at all 3. Moderately
  1 – Poor   satisfied   satisfied   1 – Poor   satisfied   satisfied
2. Slightly 4. Very
2. Slightly 4. Very   2 – Fair     satisfied satisfied 2. Slightly 4. Very
  2 – Fair     satisfied satisfied   2 – Fair     satisfied satisfied
5. Extremely
5. Extremely 3 – Good     satisfied 5. Extremely
3 – Good     satisfied 3 – Good     satisfied
NAME OF PASSENGER
NAME OF PASSENGER   4 – Very good ______________________________________ NAME OF PASSENGER
______________________________________ ______________________________________
  4 – Very good _   5 – Excellent SIGNATURE & DATE   4 – Very good _
MLY-ADMIN-2020-01
  5 – Excellent SIGNATURE & DATE   5 – Excellent SIGNATURE & DATE
MLY-ADMIN-2020-01 MLY-ADMIN-2020-01
 Instructions to Operators of Government Vehicles
- Employees who authorize or use a government vehicle
for purposes other than official government business will
be subject to disciplinary action up to and including
termination.
- Use of a government vehicle for transportation between
  home and place of work is not permissible.
- Passenger(s) may be transported in a government
vehicle while conducting official government business
only. Transportation of non-official passengers (spouses,
children, etc.) in a government vehicle is prohibited.
- Report all accidents.
- Always keep vehicles locked when not in use.
- When driving a government vehicle the motor vehicle
operator must have in his/her possession a (1) valid
driver’s license, (2) valid identification card, and (3) an
approved Motor Vehicle Trip Ticket (this form).
- Drivers of government vehicles are responsible for traffic
and parking violations they incur.
- Drivers and passengers are required to use seat belts
when operating government vehicles.
- Smoking and eating is prohibited in all government
vehicles.
- The use of cell phones is prohibited while driving
government vehicles.
MLY-ADMIN-2020-01
Instructions to Operators of Government Vehicles
- Employees who authorize or use a government vehicle
for purposes other than official government business will
be subject to disciplinary action up to and including
termination.
- Use of a government vehicle for transportation between
home and place of work is not permissible.
- Passenger(s) may be transported in a government
vehicle while conducting official government business
only. Transportation of non-official passengers (spouses,
children, etc.) in a government vehicle is prohibited.
- Report all accidents.
- Always keep vehicles locked when not in use.
- When driving a government vehicle the motor vehicle
operator must have in his/her possession a (1) valid
driver’s license, (2) valid identification card, and (3) an
approved Motor Vehicle Trip Ticket (this form).
- Drivers of government vehicles are responsible for traffic
and parking violations they incur.
- Drivers and passengers are required to use seat belts
when operating government vehicles.
- Smoking and eating is prohibited in all government
vehicles.
- The use of cell phones is prohibited while driving
government vehicles.
MLY-ADMIN-2020-01
 Instructions to Operators of Government Vehicles

- Employees who authorize or use a government vehicle

for purposes other than official government business will
be subject to disciplinary action up to and including
termination.

- Use of a government vehicle for transportation between

home and place of work is not permissible.

- Passenger(s) may be transported in a government

vehicle while conducting official government business
only. Transportation of non-official passengers (spouses,
children, etc.) in a government vehicle is prohibited.

- Report all accidents.

- Always keep vehicles locked when not in use.

- When driving a government vehicle the motor vehicle

operator must have in his/her possession a (1) valid
driver’s license, (2) valid identification card, and (3) an
approved Motor Vehicle Trip Ticket (this form).

- Drivers of government vehicles are responsible for traffic

and parking violations they incur.

- Drivers and passengers are required to use seat belts

when operating government vehicles.

- Smoking and eating is prohibited in all government

vehicles.

- The use of cell phones is prohibited while driving

government vehicles.

MLY-ADMIN-2020-01