From Ptfs 4 Form – Fill Out and Use This PDF

Trip Information:

Incidental Costs:

Department:

Enter a description of the owning Unit.

Date:

Enter the date cost was incurred.

Vehicle Homebase:

Enter the City, Zip Code, Building, or other

Fuel/Fluid Type:

Enter type of fuel or type of fluid

location designation.

added.

Week Ended (Sunday):

Enter the date of the Sunday ending that week

Fuel/Fluid Quantity:

Enter the quantity of fuel or fluid

of reporting.

added along with the unit of

Door #:

Enter the University assigned vehicle unit

measurement.

number placarded on the side of the door. All

Fuel/Fluid Cost:

Enter the total cost of the fuel or

vehicles have a door number whether it is

fluid quantity.

visible or not.

Outsource Material:

Enter the cost of parts or

License Plate:

Enter the license plate number.

materials purchased for the

Vehicle Description:

Optional – Enter your own description or the

vehicle.

Color, Year, Make, and Type of the vehicle.

Outsource Labor:

Enter the cost of the time charged

Date of Trip:

Enter the date of vehicle use.

to you by a laborer.

# People (Incl. Driver):

Enter the number of people being carried in the

Description of Outsource:

Describe the outsourced work

vehicle including the driver.

performed.

Trip Start Time:

Enter the time the trip started.

Odometer:

Enter the odometer at the time of

Start Odometer:

Enter the odometer reading at the start of the

the cost incursion.

trip.

Trip End Time:

Enter the time the trip ended

Signature:

End Odometer:

Enter the odometer reading at the end of the trip.

Reason for Trip:

Enter the Trip Reason from the list at the bottom

Reviewed By:

The form should be reviewed and

of the form.

signed by a person responsible

Explanation/Description:

Optional comment to explain the reason for the

for the property.

trip.

Print Name of Driver:

Include at least the first initial and last name.

Initialed by Driver:

Enter the driver’s initials.