Faculty Handbook
State Vehicle Sign-Out Form
PARKING/TRANSPORTATION OFFICE
DRIVER_____________________________________________VEHICLE______________________ DATE OF USE_______________________ PICK UP__________ RETURN___________ DESTINATION___________________________________________________________ OFFICIAL STATE BUSINESS _______________________________________________ Out of State Travel Authorization YES_____ NO_____ Student Life authorization YES_____ NO_____ Authorization by______________________________________ Date_______________ |
POLICE COMMUNICATIONS CENTER Vehicle not picked up__________________________________ Date_______________ Valid Driver’s License: YES______________________ NO _______________________ BEFORE RELEASING VEHICLE Gas cards ____________ Mileage Sheet _____________ Police Signature _______________________________________ Date ______________ UPON VEHICLE RETURN: Keys Returned ___________ Gas cards returned __________ Mileage Sheet Completed ___________ |
*****PLEASE BE SURE MILEAGE FORM IS COMPLETED*****
DRIVER’S RESPONSIBILITY STATEMENT
It is the driver’s responsibility to read and understand all state policies concerning the use of a state vehicle. The willful neglect or misuse of any state-owned vehicle is cause for disciplinary action under the provisions of state statutes or applicable collective bargaining contracts, and such misuse or false statements about the use of said vehicles may subject the employee to civil action. (See Connecticut General Statutes 4-165 and regulations of Connecticut State Agencies 5-240-1a(c) 7.) Continued violation of policy by an agency may result in suspension of all motor pool privileges. The driver must obey all state motor vehicle laws. A seatbelt must be worn at all times. It is the driver’s responsibility to keep the vehicle interior clean and return the vehicle to the University Police Department with at least one-half of a tank of gas. Vehicle must be parked on the lower level of the midtown garage or outside of the University Police Department. Should you find any problems with the vehicle upon signing it out, please make a notation on the sign-out form indicating any damage or trash found in the vehicle. I have read the above statement and agree to comply with vehicle policies.
DRIVER’S SIGNATURE____________________________________ DATE_____________
Please read the W.C.S.U. State Vehicle Manual before operating any state motor vehicle. A copy of the manual can be found inside of the vehicle or obtained from the University Police Department Parking Office at Westside 247D.
Rev. 6/02
