Mileage Form
Please complete a separate form for each service user
Date of visit
Your name:
Service user:
Journey start point:
Journey end point:
JOURNEY DETAILS
Reason for journey:
Number of miles:
Is the use of your vehicle part of the commissioned support? (This MUST be documented in the support plan)
Non Selected
Yes
No
IMPORTANT - If the answer to the above question is 'No', you must NOT use your vehicle, unless it is an emergency OR a member of the leadership team has given you one-off permission to use your vehicle. If this is the case, you MUST document who told you it was OK to use your vehicle.
Please note - if you are in any doubt whether mileage costs have been agreed, then you MUST get in touch with your team leader BEFORE submitting this form. If you have answered 'No' to the above question and the mileage has not been authorised by a member of the leadership team, you will NOT be paid
SUBMIT FORM