Journey Risk Management Checklist

Journey Risk Management Checklist
Driver's Full Name

First NameLast Name
Driver's Phone Number

Area CodePhone Number
Date form is complete

MonthDayYear
Trip from location:
Destination
Departing Time:
Expected arrival time:

A. HIGH RISK criteria which requires consultation with your manager

Are your driving abilities currently free from impairment?

(i.e.: no alcohol, drugs including prescription or over the counter medication which may cause impairment, health problems, or less than 5 hours sleep)

Do you feel confident that you can complete this trip safely without incident?

If no to any of these questions do not begin trip until consulting with your manager.

B. Driver Self-Assessment Criteria
Select all that apply
5 Checks

Proceed and re-evaluate if road or weather changes

3- 4 Checks

Proceed with caution and re-evaluate in 2 hours or as soon as weather or road conditions change.

0- 2 Checks

Do not proceed. Consult your manager. The trip should only proceed after a complete assessment of hazards, the need for the trip, and the fitness of driver.
Trips in excess of 100 km require a journey to be booked.
Route to be taken:
Person your reporting to"

First NameLast Name
Person your report to E-mail
Person your reporting to Phone Number

Area CodePhone Number
Should be Empty: