Level: L4 - Form Tier: GLB - Global

Document Type: Forms

Sub Element: Develop and Manage HR
Planning, Policies, Strategies
Doc Number: HR-GLB-En-100225
Rev: C
Effective Date: 15 February 2015

United States Form – Transportation Policy Acknowledgement

Purpose
The purpose of this form is to ensure employees acknowledge receipt of the United States
Transportation Policy.

Scope
This form applies to all employees, including interns, regular or external (i.e. temporary, contract or
consultant) individuals, who work in the United States. This form is also applicable to assignees
working in the United States and excludes Rotators.

Responsibility and Authority

 Employee
 Sign and submit the U.S. Transportation Policy Acknowledgement Form to the Human
Resources Service Center (“HRSC”) via MyHR.
 Human Resources
 Will provide support if there are questions about the policy as well as the form
 Human Resources Service Center (“HRSC”)
 Retain completed and signed form in the employee’s personal file for document retention
 Manager
 Responsible for understanding the policy and form
 Ensure that all employees comply with the policy, and submit his or her completed form

Revision History
Rev. RDR Amendment Detail Reviewer Approver Effective Date
Current Revision
RDR-HR- Migration to BHOS template; removal of transition
C HR Policy Team Jill Shelton 15 Feb 2015
278 allowance/repayment agreement
Three Previous Revisions
B Doc # HR-GLB-En-100286 1 Nov 2013
A Initial Release

MA-GLB-En-100030 Rev. E.3

Copyright 2015 BAKER HUGHES INCORPORATED—Unpublished—This document (together with the information thereon) is the property of Baker Hughes
Incorporated (Baker Hughes). By accepting or accessing this document the recipient agrees this document (together with its contents) is confidential and is an
unpublished copyright work with all rights reserved to Baker Hughes and is further subject to return on demand. It may not be copied, reproduced, or disclosed in
any form, in whole or in part, without express consent of Baker Hughes. It may not be used directly or indirectly in any way detrimental to Baker Hughes’s interest
and is not rented, loaned or sold, either alone or in conjunction with equipment or product, and does not comprise a part of any customer project or service.

Page 1 of 4
Uncontrolled when printed—confirm the correct revision is used Baker Hughes—Company Confidential
 HR-GLB-En-100225 Rev: C
Effective Date: 2/15/2015
United States Form – Transportation Policy Acknowledgement

Terms and Definitions

Baker Hughes Enterprise Glossary
 Company Driver: Any employee or external (i.e., temporary or contract) employee who is
identified as Baker Hughes Driver or Baker Hughes Professional Driver, as defined by the HS&E
Driver and Vehicle Safety Procedure, and operates a Company-Provided Vehicle, or receives a
Vehicle Allowance for use of a personal vehicle on Company business.
 N+1: 1st Line Manager, with approval authority – Chief of respective Organization Unit in SAP.
FOR EXAMPLE: N is the employee and N+1 is the employee’s direct manager.

Resources
 MyHR - submit a question or a request to Human Resources

Related Documents

 HS&E Driver and Vehicle Safety Procedure

 United States Transportation Policy

Page 2 of 4
Uncontrolled when printed—confirm the correct revision is used Baker Hughes—Company Confidential
 HR-GLB-En-100225 Rev: C
Effective Date: 2/15/2015
United States Form – Transportation Policy Acknowledgement

United States Transportation Policy Acknowledgement Form

Date
Employee Name
(Please Print)
SAP Person ID

Please select the option that applies to you:

Company Provided Vehicle Vehicle Allowance

For Employees with a Company Provided Vehicle or Vehicle Allowance

Driver’s Responsibility
I understand my responsibilities include, but are not limited to, the following:
 I must have a valid driver’s license in order to operate any vehicle. If I have a suspended or
invalid driver’s license, I will not be eligible to use a Company-Provided Vehicle or receive a
Vehicle Allowance. It is my responsibility to notify my manager when my license is suspended or
revoked.
 I must complete relevant courses specified in the HS&E Driver and Vehicle Safety Procedure
before the Company-Provided Vehicle or Vehicle Allowance is issued.
 I understand that I may be subject to a motor vehicle record check on an annual basis.
 I will always use good judgment and conduct myself in a professional manner at all times by
obeying the law and driving responsibly.

Employee initials _____

For Employees with Company Provided Vehicles Only

 I understand that only a Company Driver is allowed to drive Company-Provided Vehicles
employees unless there is an emergency situation.
 I understand that I may only use my Company-Provided vehicle for reasonable personal use.
 I understand that I am not allowed to use my Company-Provided Vehicle to tow other vehicles,
campers, boats, etc. However, towing Company equipment for business purposes is permitted,
subject to the N+1 manager’s approval.
 I understand that I may not use my Company-Provided Vehicle for vacations, holiday/weekend
trips, personal trips or personal recreation.

Employee initials _____

Page 3 of 4
Uncontrolled when printed—confirm the correct revision is used Baker Hughes—Company Confidential
 HR-GLB-En-100225 Rev: C
Effective Date: 2/15/2015
United States Form – Transportation Policy Acknowledgement

I understand that I should retain a copy of this document for my personal records.

I, _________________________________, certify and agree to having received, read and understood

the provisions outlined in the United States Transportation Policy.

_______________________________________ _______________________________________
Employee Signature Date

Page 4 of 4
Uncontrolled when printed—confirm the correct revision is used Baker Hughes—Company Confidential