Driver Evaluation Checklist for Bimanusantara

• Client/site

• Conducted on

  Date

• Prepared by

• Driver Name and Employee ID:

• Driver origin:

• Driver picture:

  Media

• Vehicle Type :

  Select light vehicle heavy-duty 4WD

  • light vehicle
  • heavy-duty
  • 4WD

• Indonesian lisence applicable

  Yes

  No

  N/A

• Vehicle Transmission type:

  Select manual automatic

  • manual
  • automatic

• Weather Conditions:

  dry

  wet

  hazy

  dusty

• Eye condition right:

  Select 7 8 9 10

  • 7
  • 8
  • 9
  • 10

• Eye condition left:

  Select 7 8 9 10

  • 7
  • 8
  • 9
  • 10

Before Driving

• Knows and checks all important items (oil, water, brake fluid, batteries & tires pressure)<br>

  Yes

  No

  N/A

• Seat adjustment (Distance to pedal & steering wheel) / Seating Posture<br>

  Yes

  No

  N/A

• Mirror Adjustment<br>

  Yes

  No

  N/A

• Used the safety belt and be sure the passengers too<br>

  Yes

  No

  N/A

• Positive check of gauges, dash board warnings & operate controls commands <br>

  Yes

  No

  N/A

• Vehicle Character check (Brake, power & steering)<br>

  Yes

  No

  N/A

• Check and ensure parking brake is on<br><br>

  Yes

  No

  N/A

• Vehicle Character check (Brake, power & steering)<br>

  Yes

  No

  N/A

• Check and ensure gear is neutral prior to start the engine with gear 1<br>

  Safe

  At Risk

  N/A

While Driving

• Looks as far as he can see<br>

  Safe

  At Risk

  N/A

• Looks regularly in mirrors (every 5 to 8 sec)<br>

  Safe

  At Risk

  N/A

• Moves eyes from side to side (every 2 sec)<br>

  Safe

  At Risk

  N/A

• Checks mirrors prior to maneuver (when starting, braking & indicating)<br>

  Safe

  At Risk

  N/A

• Glance over the shoulder when changing lane<br>

  Safe

  At Risk

  N/A

• Stops Completely at Stop Signs and Red Lights?

  Safe

  At Risk

  N/A

• Clears blind spot (Be sure & Careful)<br>

  Yes

  No

  N/A

• Obeys All Traffic Laws?

  Safe

  At Risk

  N/A

• Looks for indications (look far for steady traffic light, wheel of parked vehicle / on coming vehicles)<br>

  Safe

  At Risk

  N/A

• Checks deep inside cross road (between building, trees & traffic)<br>

  Safe

  At Risk

  N/A

• Keeps vehicle away from being trap (keep safety cushion all around the vehicle)<br>

  Safe

  At Risk

  N/A

• Maintains following distances ( 3 seconds rule)<br>

  Safe

  At Risk

  N/A

• Stops at good distance behind vehicle (able to see the back wheels of vehicle ahead)<br>

  Safe

  At Risk

  N/A

• Waits when vehicle in front move (3 seconds rule)<br>

  Safe

  At Risk

  N/A

• Uses the right communication device (indicator, lights, brake lights, horn & warning signal)<br>

  Safe

  At Risk

  N/A

• Uses signals well in advance (when turning, overtaking & stopping)<br>

  Safe

  At Risk

  N/A

• Overtakes safely ( speed & space)<br>

  Safe

  At Risk

  N/A

• Uses clutch only when needed (remove foot out of the clutch when not needed)<br>

  Safe

  At Risk

  N/A

• Brakes smoothly & release brake just before stopping<br>

  Safe

  At Risk

  N/A

• Selects gears according to conditions (according to engine rpm & environment)<br>

  Safe

  At Risk

  N/A

• Keeps hands correctly on steering wheel (never put hand / finger inside wheel)<br>

  Safe

  At Risk

  N/A

• Modifies speed in advance (before traffic lights, obstructions & bends)<br>

  Safe

  At Risk

  N/A

• Follows traffic regulations (Traffic light, speed limit..)<br>

  Safe

  At Risk

  N/A

• Keeps good position on the road & Uses proper lane<br>

  Safe

  At Risk

  N/A

• Commentary driving<br>

  Safe

  At Risk

  N/A

ADD ON

• Obeys All Traffic Laws?

  Safe

  At Risk

  N/A

• Backs Safely?

  Safe

  At Risk

  N/A

• Merges Smoothly Into Traffic?

  Safe

  At Risk

  N/A

• Changes Lanes in a Controlled Manner?

  Safe

  At Risk

  N/A

• Avoids Following Oversized Vehicles?

  Safe

  At Risk

  N/A

• Avoids Driving in Other Driver's Blind Spots?

  Safe

  At Risk

  N/A

• Shows Awareness of Pedestrians and Cyclists?

  Safe

  At Risk

  N/A

• Reacts Early Enough to Respond to Potential Hazards?

  Safe

  At Risk

  N/A

• Avoids Distractions? (Cell Phones/Eating/Conversations)

  Safe

  At Risk

  N/A

• Hand position 9-3

  Safe

  At Risk

  N/A

• Steering wheel pull&push

  Safe

  At Risk

  N/A

• Module 1 forward slalom

  Safe

  At Risk

  N/A

• Module 2 backward slalom

  Safe

  At Risk

  N/A

• Module 3 Parking

  Safe

  At Risk

  N/A

• Module 4 circle around

  Safe

  At Risk

  N/A

• Module 5 breaking

  Safe

  At Risk

  N/A

• Module 6 turning

  Safe

  At Risk

  N/A

• Module 7 uphill start

  Safe

  At Risk

  N/A

• Module 8 downhill start

  Safe

  At Risk

  N/A

• Module 9 mud escape

  Safe

  At Risk

  N/A

• Module 10 water escape

  Safe

  At Risk

  N/A

• Driver Signature:

  Sign

• Assessors Signature

  Sign