City of El Dorado
Vehicle Request Form
Please complete the form in its entirety.
GENERAL INFORMATION
Requestor’s Name: Suzie Locke
Department: Administration
Phone #: 104
E-Mail: [email protected]
VEHICLE USE
Departure Date: 03/29/2016
Time:8:00
Approx. Mileage: Approx. 75 Miles
Purpose of Use (Be Specific) And Destination:
Returning Date:03/29/2016
Time:1:00PM
Number Of Passengers: 2
KP&F Session at WSU Eugene Hughes Metroplex
ADDITIONAL PASSENGER INFORMATION
Passenger #1 Suzie Locke
Passenger #2 Kyla Catlett
Passenger #3
Any Exterior Body Marks?
Interior Condition: Clean
Comments:
YES
VEHICLE CHECKOUT
(If Yes, indicate damage on attached body sketch sheet)
NO
Dirty
(If dirty, be specific in the comments field below)
OFFICE USE ONLY
Verified by:
Date:
Date of Departure:
Time:
Odometer Reading:
Date of Return:
Time:
Odometer Reading:
Returned in acceptable condition? YES NO
Comments:
Updated 9/15/15
CITY OF EL DORADO
Loaner Vehicle - Body Inspection Form
Please note condition of vehicle by utilizing the Legend. Damage NOT noted may become the
responsibility of the user.
Destination___________/ Date of Use ______ / Time checked out _____ / Time checked in ______
USER INITIALS _______
Legend
S…Scratched
D…Dented
L…Loose
PC ….Paint Chip
B…Bent
CR …Cracked
WR ….. Wrecked (Results in IMMEDIATE deadline of vehicle)
T …Torn
City of El Dorado
Vehicle Use Policy
1. The Vehicle Request form must be filled out in its entirety prior to use of vehicle for any
trips outside of the City of El Dorado and/or that are expected to exceed one hour. The Body
Inspection Form must be filled out for all trips, regardless of the time of loan or distance of
travel. New forms must be completed for each separate request.
2. Check-out must be scheduled through the City Administration Office, specifically either
through the Assistant to the City Manager or the City Clerk. Although immediate requests are
accepted (when scheduling is available), a notice of at least 24 hours is preferred.
3. Any tickets, (Moving violations, parking violations or otherwise) given by police, are the sole
responsibility of the driver of the vehicle. City funds will not be used to pay for tickets or
fines.
4. Keys MUST be returned directly after use. Failure to do so may result in termination of future
use of vehicle.
5. The car must be returned CLEAN and in similar condition as checked out. All accidents and
damage must be reported to the City Clerk and their supervisor immediately and
accident/incident forms must be turned in to the City Clerk within 24 hours. In the case of an
accident and/or injury involving a city vehicle, a drug test will be performed at the discretion of
the supervisor.
6. Vehicle must be returned with a full tank of gas, assuming the vehicle was driven over 20
miles. It is the user’s responsibility to refuel the vehicle.
7. It is the responsibility of the driver to inspect the car prior to accepting the keys. If there are
any body damages (Dings, dents, etc.), please fill in the Body Damage section of the Check-In
/ Check-out Form. If the body damages exist before departure, you must specify this on the
check-out form. Damages that occur after departure, or those that are unaccounted for on the
form, may become the responsibility of the requesting department.
8. All drivers must be on the approved drivers list for the City of El Dorado.
9. The car is for city related business ONLY. Personal use of vehicle may result of termination of
future use.
10. City funds will not be used to clean the vehicle. There are facilities at the Public Works
Department, which may be used to clean the vehicle (7:00 a.m. - 5:00 p.m. M-F). If the
employee does not utilize the Public Works resources, they will be responsible for cleaning at
their own expense. If Public Works is closed during vehicle return, please clean the vehicle
prior to check-in.
11. All other Human Resources Policies not covered under this policy are applicable. Please use
your best judgement while operating this vehicle. Use of this vehicle is a privilege, not a right.