GATEPASS FORM (EMPLOYEE)

DATE:
EMPLOYEE NAME/S: DEPARTMENT:
1. 4.
2. 5.
3. 6.

DESTINATION:

BREAK TIME : 10:00-10:15 3:00-3:15

PURPOSE: FIELDWORK PLS. SPECIFY:
OTHERS PLS. SPECIFY:
TIME OUT: TIME IN:
PLATE #:
WITH VEHICLE ODO OUT: WITHOUT VEHICLE
ODO IN:
WITH TOOLS WITHOUT TOOLS
PERSONAL TOOLS COMPANY TOOLS
QTY: ITEM/S: DESCRIPTION:

REMARKS:

APPROVED BY: CHECKED BY:

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
OF IMMEDIATE SUPERIOR / DATE OF S/G ON DUTY / DATE