Off Site Trip Ticket Request

For any questions contact the BNL Transportation Office at x2535
Off-Site Trip Ticket
Brookhaven National Laboratory
  • You are responsible for reporting vehicle defects and accidents immediately.
  • You must present this completed form to the officer at the main gate upon return to BNL.

Name of Driver:*


Vehicle Plate #:*

Driver's Phone #:*

Purpose of Trip:*


Today's Date:*

Estimated Date of Return:*

Estimated Time of Return:*


Will the vehicle be at the residence of an employee?*

Yes No

This vehicle will be used for official government business only: I have reviewed and complied with BNL's Standards-Based Management System Subject Area on Government Vehicles.

Signature of Driver(s):


Date Out:


Time Out:


Mileage Out:


Date In:


Time In:


Mileage In:


Was the vehicle in an accident while in your custody?

Yes No


Department Chair/Manager/Designate Approval Signature:
"I have authorized the driver(s) signing above to use this vehicle for official business only"

Use of Government vehicles: is restricted to official Laboratory business; their use for private purposes is a violation of federal law (US Code, Title 40, Section 491 and Title 18, Section 64) as well as of Laboratory instructions. Government vehicles may not be used for personal errands at any time. Government vehicles may be used only for such transportation as would entitle the user to reimbursement if he used some form of public transportation. Unauthorized persons may not operate be carried as passengers and a Government vehicle should not be parked overnight on a public street if it can be avoided.

No employee may operate a Government vehicle without having a valid operator's license. The driver is responsible for operating the vehicle conservatievly in order to minimize upkeep expense. The driver of a Government vehicle must obey applicable state and local traffic laws and is personally liable for any fine assessed for any violation.

In the event of an accident, the driver of a Government vehicle must comply with applicable laws relating to accidents and must complete an accident report form (blanks can be found in the glove compartment) at the scene of the accident and as soon possible deliver it in person to Police Headquarters. In case of a serious accident off site or an accident which involves personal injury, the Laboratory Police Headquarters should be notified immediately by telephone.

BNL's Insurance Policy Number: CA-5196259