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]

2. Vehicle and Driver Information

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]

Signature: _______________________________
Date: [MM/DD/YYYY]