Instructions: Fill this Log Report whenever you make a major stop such as: Parking at the end of day’s work Picking up and Dropping of Members from Home Buying Gas etc. NameDaniel AddyShanteze LewisTiffany SimonSelect your nameDate *Enter the date for the requestTime of ArrivalHours-120102030405060708091011Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859AMPMEnter the time you arrived at the destinationStreet Address *CityAddress *Choose FileNo file chosenDelete uploaded fileUpload a picture of the front door or address post of your locationDashboard - Odometer *Choose FileNo file chosenDelete uploaded fileUpload picture of your Dashboard showing your Odometer and Fuel GuagePurposePickup Member from HomeDrop off Member at HomePickup Member from Hospital / CenterDrop off Member at Hospital / CenterPark Vehicle (close of day)Start Vehicle (start of day)Pharmacy StopOtherEnter the purpose for this tripMember *_Ernesti MooreCharles HidgonFrank CampbellTiffany SimonPhalind CliftonRicky TopeJerome HasselmanDixon DorotheaFatimah DialloHolly NelsonLoyd MerchantWilliam DillardPiper O' NealLelie EstepDerick WoodforkJacqueline B. ReedZahed HusseinLorri HubbardDavid PaynePrem DhunganaNot on ListName of Member *Notes *Enter the purpose of the tripSignature *Choose FileNo file chosenDelete uploaded fileUpload Your SignatureSubmit Log ReportSave as Draft RequestPlace a request for Gas or any necessary item. Upload ReceiptFill this form for every purchase of Gas or other items.
