Fillable Printable Individual Travel Assessment Worksheet - United States Army

Individual Travel Assessment Worksheet - United States Army

INDIVIDUAL TRAVEL ASSESSMENT WORKSHEET

This individual travel assessment is designed for use when TRiPS is not available. Soldiers should complete

this worksheet and discuss with their leaders prior to travel in order to mitigate risk.

PRE-TRIP CHECKLIST FOR LEADERS

Use this checklist when trips are planned. Apply risk management controls if

needed. Identify hazards, risk, and controls in right column.

Point of Origin to Destination

Point of origin_____________________________________________________

Destination_______________________________________________________

Planned rest stops/breaks_____________________________________________

Anticipated weather conditions_________________________________________

Travel distance one way____________________________ ________________

Mode of travel____________________________________________________

If driving POV: # of licensed drivers___________________________________

Name______________________________Unit____________________

Will you wear your seatbelt at all times? _______________________________

How much sleep will you have in the 12 hrs prior to starting your trip? ________

Are you currently taking any over-the-counter or prescribed medications?_____

Have you checked to make sure the medication will not affect driving?________

Will the majority of your trip take place during day or night?_________________

Planned rest stops/breaks___________________________________________

Point of origin departure date and time_________________________________

Expected destination arrival time______________________________________

Return from Destination to Point of Origin

Mode of travel____________________________________________________

Planned rest stops/breaks____________________________________________

Anticipated weather conditions_________________________________________

If driving POV: # of licensed drivers___________________________________

Name______________________________Unit____________________

Will you wear your seatbelt at all times? ________________________________

How much sleep will you have in the 12 hrs prior to starting your trip? ________

Will the majority of your trip take place during day or night?_________________

Destination departure date and time___________________________________

Expected arrival time at point of origin___________________________ _______

VEHICLE CONDITION: OLD NEW Vehicle Inspected?

INSURANCE: Is Soldier's car insurance coverage up to date/current?

DRIVER'S LICENSE: Does Soldier possess a valid driver's license?

SIGNATURES

Soldier Planning Trip:

Name/Rank/Signature:_________________________ DATE_______________

Supervisor:

Name/Rank/Signature:_________________________ DATE_______________

Discuss Hazards, Risk, &

Controls

Hotel

Name______________________

City________________________

Date Check-In________________

Hotel

Name______________________

City________________________

Date Check-In________________

Yes No