• Driver Name and Employee ID:

  • Driver origin:

  • Driver picture:

  • Vehicle Type :

  • Indonesian lisence applicable

  • Vehicle Transmission type:

  • Weather Conditions:

  • Eye condition right:

  • Eye condition left:

Before Driving

  • Inspects Vehicle POWER

  • Adjusts Seats and Mirrors?

  • Wears Safety Belt?

  • Wears Safety Belt for pax

  • Accelerates Smoothly?

  • Accelerates Smoothly after traffic lights

While Driving

  • Eye movement 8-10 Second

  • Stops Smoothly?

  • Maintains Legal Speeds?

  • Adjusts Speed to Conditions?

  • Uses Turn Signals Appropriately?

  • Stops Completely at Stop Signs and Red Lights?

  • Leaves Sufficient Space when Stopping in Traffic?

  • Obeys All Traffic Laws?

  • Backs Safely?

Hazards

  • Scans Ahead?

  • Checks for Cross Traffic and Intersections?

  • Maintains Safe Distance from Other Vehicles? (3 second rule)

  • Merges Smoothly Into Traffic?

  • Changes Lanes in a Controlled Manner?

  • Avoids Following Oversized Vehicles?

  • Avoids Driving in Other Driver's Blind Spots?

  • Shows Awareness of Pedestrians and Cyclists?

  • Reacts Early Enough to Respond to Potential Hazards?

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

  • Hand position 9-3

  • Steering wheel pull&push

  • Commentary drive

  • Module 1

  • Module 2

  • Module 3

  • Module 4

  • Module 5

  • Driver Signature:

  • Assessors Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.