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_______________________________________
3820 Senator J. Bennett Johnston Ave.
Lake Charles, LA 70615
Office: 337 421-6535
Fax: 337 491-2874
www.sowela.edu
Vehicle Usage Form
Name:
Department:
Valid Driver’s License #:
Destination:
Name of event or function for which vehicle is to be used:
Department Head Approval:
Date(s) of use, including date and approximate time by which the vehicle will be returned:
Date of use: Returned by date: Pick- up Time: Return Time:
Name and phone number of person to contact in the event of an emergency
Name: Phone #:
Additional Passengers:
Request Approved: Request Denied:
Employee must adhere to the following guidelines:
• Must have taken the Office of Risk Management (ORM) Defensive Driving course and have a DA-1041 on file
with photocopy of current driver’s license.
• Possess current vehicle liability and comprehensive insurance; or, if driving on behalf of Sowela, that Sowela
possesses current liability insurance sufficient to cover the risks associated with the use of the vehicle.
• Have not been convicted of any DUI or other major traffic offense (not including moving violations or minor
citations), or had a suspension or revocation of drivers license within three years prior to the date of use.
• Must be in sufficiently good physical condition to operate the vehicle in a safe manner and comply with
emergency protocols.
• Will adhere to all speed limits, traffic laws, and other applicable laws while operating the vehicle.
• Will hold the Sowela Technical Community College and the State of Louisiana harmless from any and all
liability for any claims or damages arising out of the Sowela’s use of the vehicle.
• Will adhere to all applicable policies, emergency protocols, and laws governing use of the vehicle.
• No additional passengers will be allowed in vehicle unless they have signed the Indemnification Agreement for
the State of Louisiana. Human Resources will have copies of the Indemnification Agreement available.
Name and signature of employee who will be driving vehicle:
Printed Name Signature
Name and signature of Director of Facilities/or authorized representative to grant permission for use of vehicle:
_______________________________________ _____________________________________
Printed Name Signature
Vehicle Use Form
Rev: 03-31-2016
