HTML Preview Daily Vehicle Maintenance Log page number 1.
Month Unit #
PA HS Make Model Model Year
Gallons Down
Trip Mileage of Fuel Days
TOTAL EXPENSE FOR MONTH $
Final Reading:
Monthly Totals
TITLE
AUTHORIZED SUPERVISORPERSON SIGNING THE REPORT OR THE TRANSPORTATION OFFICER SHALL SUBMIT THIS REPORT TO HIS/HER SUPERVISOR BY THE
THIRD WORKING DAY OF EACH MONTH, WHO SHALL REVIEW, SIGN THE BOX (RIGHT) IF APPROVED, AND FORWARD TO THE AGENCY
TRANSPORTATION COORDINATOR WITHIN THREE ADDITIONAL DAYS.
SIGNATURE OF ASSIGNED DRIVER (IF APPLICABLE)
No Assignment
THE ABOVE RECORD REFLECTS AN ACCURATE ACCOUNTING OF THE USE OF THIS STATE-OWNED VEHICLE, AS ATTESTED TO BY THE
OPERATOR'S INITIALS BY EACH ENTRY (POOL CARS) OR, FOR PERSONALLY ASSIGNED VEHICLES, THE DRIVER'S SIGNATURE. THE LAST
Location where trip began, all points visited, unless did not leave state
grounds; where trip ended & purpose of trip (meeting, site visit, etc.)
Beginning Odometer: Maint. & Repair Cost
Driver
(Detail on Reverse Side)
Other Costs (Detail
on Reverse Side) Date Trip Ending Reading Fuel Cost Initials
License Plate
Year
DO NOT INCLUDE INSURANCE COSTS
Revision 12/2010
MV3/MV4/SafetyChecklist
DAILY VEHICLE LOG
STATE OF LOUISIANA
(AGENCY NAME GOES HERE)
Property Tag Number
VIN
N N