PHILIPPINE INFORMATION AGENCY PHILIPPINE INFORMATION AGENCY PHILIPPINE INFORMATION AGENCY

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

______ City Driving _______________________________ ______ City Driving _______________________________ ______ City Driving _______________________________
______ Provincial With S.O. No. & Date _____________ ______ Provincial With S.O. No. & Date _____________ ______ Provincial With S.O. No. & Date _____________
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.”
► ► ►

Chief, Motorpool Chief, Motorpool Chief, Motorpool

INSTRUCTIONS: Drivers shall fill-out this part properly. Further, drivers INSTRUCTIONS: Drivers shall fill-out this part properly. Further, drivers 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. 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 Was the vehicle This vehicle will be used for official government
involved in an business only. I have reviewed and complied involved in an business only. I have reviewed and complied involved in an business only. I have reviewed and complied
accident while in with COA Rules & Regulations re: Use of accident while in with COA Rules & Regulations re: Use of accident while in with COA Rules & Regulations re: Use of
your custody? Government-Owned Vehicle. 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 DRIVER'S OVER-ALL LEVEL OF SERVICE
RATING SATISFACTION RATING SATISFACTION RATING SATISFACTION
1. Not at all 3. Moderately 1. Not at all 3. Moderately 1. Not at all 3. Moderately
1 – Poor satisfied satisfied 1 – Poor satisfied satisfied 1 – Poor satisfied satisfied
2. Slightly 4. Very 2. Slightly 4. Very 2. Slightly 4. Very
2 – Fair satisfied satisfied 2 – Fair satisfied satisfied 2 – Fair satisfied satisfied
5. Extremely 5. Extremely 5. Extremely
3 – Good satisfied 3 – Good satisfied 3 – Good satisfied

NAME OF PASSENGER NAME OF PASSENGER NAME OF PASSENGER

4 – Very good ______________________________________ 4 – Very good ______________________________________ 4 – Very good ______________________________________
5 – Excellent SIGNATURE & DATE 5 – Excellent SIGNATURE & DATE 5 – Excellent SIGNATURE & DATE
ADMIN-F-011 rev0 ADMIN-F-011 rev0 ADMIN-F-011 rev0
 Instructions to Operators of Government Vehicles Instructions to Operators of Government Vehicles Instructions to Operators of Government Vehicles

- Employees who authorize or use a government vehicle - Employees who authorize or use a government vehicle - Employees who authorize or use a government vehicle
for purposes other than official government business will for purposes other than official government business will for purposes other than official government business will
be subject to disciplinary action up to and including be subject to disciplinary action up to and including be subject to disciplinary action up to and including
termination. termination. termination.

- Use of a government vehicle for transportation between - Use of a government vehicle for transportation between - Use of a government vehicle for transportation between
home and place of work is not permissible. home and place of work is not permissible. home and place of work is not permissible.

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

- Report all accidents. - Report all accidents. - Report all accidents.

- Always keep vehicles locked when not in use. - Always keep vehicles locked when not in use. - Always keep vehicles locked when not in use.

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

- Drivers of government vehicles are responsible for traffic - Drivers of government vehicles are responsible for traffic - Drivers of government vehicles are responsible for traffic
and parking violations they incur. and parking violations they incur. and parking violations they incur.

- Drivers and passengers are required to use seat belts - Drivers and passengers are required to use seat belts - Drivers and passengers are required to use seat belts
when operating government vehicles. when operating government vehicles. when operating government vehicles.

- Smoking and eating is prohibited in all government - Smoking and eating is prohibited in all government - Smoking and eating is prohibited in all government
vehicles. vehicles. vehicles.

- The use of cell phones is prohibited while driving - The use of cell phones is prohibited while driving - The use of cell phones is prohibited while driving
government vehicles. government vehicles. government vehicles.

ADMIN-F-011 rev0 ADMIN-F-011 rev0 ADMIN-F-011 rev0