MONTGOMERY COLLEGE VEHICLE REQUEST FORM
SUBMIT FORM 3 DAYS PRIOR TO USAGE
SECTION 1 TO BE COMPLETED BY THE REQUESTER
Requester: Contact Phone:
Department and Campus: Vehicle Pick Up Location: G R TP/SS
Date of Trip: # of Passengers:
Destination: Departure Time: Return:
Name of Driver: Contact Phone #:
Account Manager’s Name: __________________________________ (for billing purpose)
Requester Signature Date Unit Supervisor Signature Date
SECTION 2 TO BE COMPLETED BY THE FACILITIES OFFICE
Assigned Vehicle Number(s):
Germantown #: Approval/Date:
Rockville #: Approval/Date:
Takoma Park/Silver Spring #: Approval/Date:
Note: Passenger Vans are scheduled and assigned by the Germantown Facilities Office
SECTION 3 TO BE COMPLETED BY THE DRIVER
Vehicle #:
Departure Mileage: Time Out:
Return Mileage: Time In:
Total Mileage Used:
As driver of this vehicle, I agree that I am responsible for this vehicle until the keys are accepted by the Security office. I also
agree to comply with the attached Guidelines and Procedures.
Driver’s Signature/Date:
Comments/Repairs Needed:
CHECKLIST FOR SECURITY
Interior condition: Clean Dirty Littered
Fuel Level: ¼ Tank ½ Tank ¾ Tank Full
Interior/Exterior Damages: None Yes, Describe
Security Office Signature:
Officer Name Date Time
PROCEDURES AND GUIDELINES
Procedures for Requesting Montgomery College Vans
1. For each Montgomery College vehicle, the requesting department will submit a Montgomery College
Vehicle Request form, which can be requested from the Germantown Facilities Office at GB113 or
240-567-7882.
2. The requesting unit will complete Section 1 of the Vehicle Request Form for each vehicle (one vehicle per
form) and will return it to the Germantown Facilities Office for vehicle assignment. The Germantown Facilities
office will complete Section #2 and submit form copies to the requester, the assigned driver and the Security Office on
the campus where the vehicle is located. NOTE: Drivers must have their MVA driving record checked and approved
by HR before using College vehicles. (See #2 of the Guidelines below)
3. The Driver will present to the Security Officer on duty the request form and proof that he or she is a College employee
to the Security Officer on duty.
4. The Security Officer will verify that the Driver is a College employee with a valid driver’s license and will ask the Driver
to sign the Request Form before issuing the key to the assigned van.
5. At the conclusion of the trip, the Driver will complete Section 3 of the form and return it to the Security Officer
with the keys. Also, check that all food, trash, and personal belongings have been removed from the vehicle.
A copy of the Request Form must accompany the keys for acceptance. The Security Officer will complete the
checklist, sign and date the form, and return it to the Facilities Office in Germantown.
6. The Germantown Facilities Office will prepare a memo (Reimbursement for Use of College-Owned Vans) to charge the
appropriate unit/departments at $.80 per mile effective 7/1/2009.
Guidelines for use of Montgomery College Vans
1. College-owned passenger vehicles are not to be taken out of the State of Maryland. Vehicles for out-of state travel
should be arranged through the Procurement Office.
2. To operate a Montgomery College vehicle, drivers must be an employee of Montgomery College; be at least 25 years
of age, and have a valid driver’s license. Drivers must have their MVA driver’s record reviewed annually by Rowena
D’Souza or Lori Stegeman in Human Resources.
3. Operators of College vehicles must observe local, state, and federal laws, which include wearing a seat belt at all
times. There is to be no texting or hand held cell phones used while driving College owned vehicles. All applicable
College procedures must be followed.
4. It is the Driver’s responsibility to ensure that all food, trash, and personal belongings are removed from the vehicle
before returning the keys to Security. Users who return vehicles in an unsatisfactory condition will not be permitted to
use College vehicles in the future.
5. Accidents in a Montgomery College-owned vehicle must be reported as soon as possible to the campus Security Office
from which the vehicle keys were issued. Follow the directions in the memo entitled, “What To Do In Case of a Traffic
Accident,that is located in the blue zipper bag located in each van.
6. Traffic tickets related to parking, speeding, accidents, etc. are the responsibility of the person named on the ticket or
the assigned driver.
7. IMPORTANT NOTE: It is the responsibility of the Driver to ensure that the van has at least ¼ tank of gas upon
return.
8. If the College is closed due to inclement weather, no vehicle will be permitted to be taken off campus with the
exception of Security vehicles and vehicles used for snow removal.
Revised 8-26-10