INDIVIDUAL TRAVEL ASSESSMENT WORKSHEET
Thi s i nd i vi du al tra v el as se ssmen t i s de si gn ed fo r us e w he n TRi PS is no t av a i l ab l e. S ol d i er s sh ou ld co m p le te
t hi s wo rksh ee t a nd d is cus s wi th t he ir l ea de rs p ri or t o tr a v e l i n ord er t o mit ig at e r is k.
PRE-TRIP CHECKLIST FOR LEADERS
Use thi s chec klist when trip s are pla nned. Appl y ri sk ma nagement controls if
needed. Identi fy hazards, ris k, and c ontrols i n ri ght colu mn.
Point of Origin to Destination
Point o f origi n________ _________ _________ _________ ______ ____________
Destin ation___ _________ _________ _________ ___ ______________________
Pl ann ed re st st op s/ br eak s__ ___ __ __ __ __ __ __ __ ____ ______________________
An tic ip ate d w ea th er co nd it ion s__ ___ __ ___________________ __ _____________
Trav el d istance one w ay_____ _ ______________________ ______ _ _________
M o de of travel___ _________ _________ _________ ____ _____ _ ____________
If driving PO V: # o f licens ed drivers__ _________ ___ _________________ _ ___
Name__ ________ _________ _________ __Unit_____ _ ______________
Name__ _____ _______________________Unit____________________
Name__ ________ _________ _________ __Unit_____ __ _____________
W ill you wear your s eatbelt at all time s? _____ _________ _________ ________
How much s leep will you have in the 12 hrs prior to s tarting your trip ? __ _ _____
Are you cu rrently taking any over- the-counte r or presc ribed med ication s? _____
Have you chec ked to m ake su re the medi cation will n ot affect d riv ing? ________
W ill t he majori ty of your tri p take pl ace du ring day or n ight?____ _______ ______
Planne d rest s tops/bre aks____ _________ _______ _______________________
Point o f origin d eparture date and tim e________ ____ ________________ _ ____
Ex p ected des tination arrival time _________ ______ __________ _ ____________
Return from Des tination to Point of Origin
M o de of travel___ _________ _________ _________ __ ____________________
Pl ann ed re st st op s/ br eak s__ ___ __ __ __ __ __ __ __ __ _______________________
An tic ip ate d w ea th er co nd it ion s _________________ _ _______________________
If driving PO V: # o f licens ed drive rs___ _________ _________ _ _____________
Name__ ________ _________ _________ __Unit_____ ____ ___________
Name__ ________ _________ _________ __Unit_____ _______ ________
Name__ ________ _________ _________ __Unit_____ _____ __________
W ill you wear your s eatbelt at all times ? ______ _________ _________ __ _ _____
How much s leep will you have in the 12 hrs prior to s tarting your trip ? __ _ _____
W ill t he majori ty of your tri p take pl ace durin g day or nigh t?________ __ _______
Destin ation dep arture date a nd time_ _________ ___ ___ _ __________________
Ex p ected arri v a l time at point of o rigin_____ ________ __ ____________ ______ _
VE HI CLE C ON DI TI ON : O LD NE W V ehi cle I nspe cte d ?
IN SU RA NC E : Is Sol die r' s ca r ins ur ance co v er age u p t o d at e/ cur re nt?
D RI VE R' S L IC EN SE : Do e s S old ie r poss ess a v al id d riv er 's lic en se ?
SI GN A TU RE S
So ldi er P la nn in g Tr ip:
N ame /Ra nk/ Si gna tu re: ___ __ __ __ _ _______________ D AT E __ __ __ __ _ _____ _
Su per vi sor :
N ame /R an k/ Si gna tu re: ___ __ __ __ __ __ __ __ __ __ __ _ _ D AT E __ __ _ __________
Discuss Ha zards, Ris k, &
