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Vehicle Usage Report

  1. Report the use of ALL vehicles used for community to and from work other than authorized emergency vechicles.

  2. Number of Days Used Each Month

  3. By checking "I agree" you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.*

  4. The employee is responsible for reporting vehicle usage to risk management.

  5. Leave This Blank:

  6. This field is not part of the form submission.