Driver Evaluation Checklist

• 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

• Inspects Vehicle POWER

  Yes

  No

  N/A

• Adjusts Seats and Mirrors?

  Yes

  No

  N/A

• Wears Safety Belt?

  Yes

  No

  N/A

• Wears Safety Belt for pax

  Yes

  No

  N/A

• Accelerates Smoothly?

  Yes

  No

  N/A

• Accelerates Smoothly after traffic lights

  Safe

  At Risk

  N/A

While Driving

• Eye movement 8-10 Second

  Safe

  At Risk

  N/A

• Stops Smoothly?

  Safe

  At Risk

  N/A

• Maintains Legal Speeds?

  Safe

  At Risk

  N/A

• Adjusts Speed to Conditions?

  Safe

  At Risk

  N/A

• Uses Turn Signals Appropriately?

  Safe

  At Risk

  N/A

• Stops Completely at Stop Signs and Red Lights?

  Safe

  At Risk

  N/A

• Leaves Sufficient Space when Stopping in Traffic?

  Yes

  No

  N/A

• Obeys All Traffic Laws?

  Safe

  At Risk

  N/A

• Backs Safely?

  Safe

  At Risk

  N/A

Hazards

• Scans Ahead?

  Safe

  At Risk

  N/A

• Checks for Cross Traffic and Intersections?

  Safe

  At Risk

  N/A

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

  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

• Commentary drive

  Safe

  At Risk

  N/A

• Module 1

  Safe

  At Risk

  N/A

• Module 2

  Safe

  At Risk

  N/A

• Module 3

  Safe

  At Risk

  N/A

• Module 4

  Safe

  At Risk

  N/A

• Module 5

  Safe

  At Risk

  N/A

• Driver Signature:

  Sign

• Assessors Signature

  Sign