Mileage / Odometer Log Template
[Business / Individual Name]
[Department / Position]
[Street Address]
[City, State/Province, ZIP/Postal Code, Country]
Phone: [Phone Number]
Email: [Email Address]
1. Log Overview
Log Title: Mileage / Odometer Log
Log Period Start Date: [MM/DD/YYYY]
Log Period End Date: [MM/DD/YYYY]
Primary Use of Vehicle: [Business / Personal / Mixed]
Vehicle Type: [Sedan / SUV / Truck / Van / Other]
Make: [Make]
Model: [Model]
Year: [Year]
Color: [Color]
Vehicle Identification Number (VIN): [VIN]
License Plate Number and Jurisdiction: [Plate Number and State/Province/Country]
Primary Driver Name: [Driver Full Name]
Driver License Number: [License Number]
Issuing State/Province/Country: [Jurisdiction]
3. Odometer Summary for Log Period
Starting Odometer Reading (at beginning of period): [Odometer Reading]
Ending Odometer Reading (at end of period): [Odometer Reading]
Total Distance Driven During Period (miles or kilometers): [Total Distance]
Of this total:
Business Distance: [Business Miles / Kilometers]
Personal / Commuting Distance: [Personal Miles / Kilometers]
4. Trip Log Entries
(Repeat this block for each trip taken during the log period.)
Trip No.: [Trip Number]
Date: [MM/DD/YYYY]
Trip Type: [Business / Personal / Commuting]
Starting Location: [City / Address / Point of Departure]
Destination: [City / Address / Point of Arrival]
Starting Odometer: [Odometer Reading]
Ending Odometer: [Odometer Reading]
Distance for This Trip (miles or kilometers): [Distance]
Purpose / Description of Trip:
[Short description, e.g., client meeting, delivery, site visit, supply run, commuting, personal errand]
Additional Notes (optional):
[Notes]
5. Daily / Weekly Summary (Optional)
(Use this section if you want to summarize mileage by day or week.)
Summary Period: [Date or Week Range]
Total Trips This Period: [Number of Trips]
Total Business Distance: [Miles / Kilometers]
Total Personal / Commuting Distance: [Miles / Kilometers]
Comments:
[Summary comments or notes]
6. Approval and Reimbursement (If Applicable)
Requested by (Driver / Employee): [Name]
Position / Department: [Position]
Date Submitted: [MM/DD/YYYY]
Approved Business Distance for Reimbursement: [Miles / Kilometers]
Reimbursement Rate: [Currency and Amount] per [mile / kilometer]
Total Reimbursement Amount: [Currency and Amount]
Approver Name: [Manager / Supervisor Name]
Title: [Title]
Signature: _______________________________
Date: [MM/DD/YYYY]
7. Certification
I certify that the mileage and trip information recorded in this log is accurate and that the trips marked as business were driven for legitimate business purposes.
Driver / Employee Name: [Name]