JASKO - Hours of Service Record for First-Time or Intermittent Drivers

Prior Seven Days Hours Statement — EMP-FRM-012

JASKO ENTERPRISES, INC. · FORM EMP-FRM-012 · REV. 0 · EFFECTIVE NOVEMBER 1, 2026

When JASKO uses a driver for the first time or intermittently, record and certify the driver’s total time on duty during the immediately preceding seven days and the driver’s last period of release from duty. Safety must reconcile the statement with available records before dispatch.

DRIVER CERTIFICATION AND SIGNATURE

I certify that the information in this record is true and complete to the best of my knowledge and belief, including my total time on duty during the immediately preceding seven days and my last period of release from duty.

Your information

Driver name * CDL number and state * First work date * Motive driver ID Day 1 — Date * Day 1 — Motor carrier or activity * Day 1 — Driving hours * Day 1 — On duty not driving hours * Day 1 — Off duty or sleeper hours * Day 1 — Notes Day 2 — Date * Day 2 — Motor carrier or activity * Day 2 — Driving hours * Day 2 — On duty not driving hours * Day 2 — Off duty or sleeper hours * Day 2 — Notes Day 3 — Date * Day 3 — Motor carrier or activity * Day 3 — Driving hours * Day 3 — On duty not driving hours * Day 3 — Off duty or sleeper hours * Day 3 — Notes Day 4 — Date * Day 4 — Motor carrier or activity * Day 4 — Driving hours * Day 4 — On duty not driving hours * Day 4 — Off duty or sleeper hours * Day 4 — Notes Day 5 — Date * Day 5 — Motor carrier or activity * Day 5 — Driving hours * Day 5 — On duty not driving hours * Day 5 — Off duty or sleeper hours * Day 5 — Notes Day 6 — Date * Day 6 — Motor carrier or activity * Day 6 — Driving hours * Day 6 — On duty not driving hours * Day 6 — Off duty or sleeper hours * Day 6 — Notes Day 7 — Date * Day 7 — Motor carrier or activity * Day 7 — Driving hours * Day 7 — On duty not driving hours * Day 7 — Off duty or sleeper hours * Day 7 — Notes Total driving hours for seven days * Total on duty not driving hours * Total time on duty for seven days * Last release from duty began — hour and date * Last release from duty ended — hour and date * Total duration of last release * Email address * Phone number Date *

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