Title Page
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Site conducted
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Conducted on
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Person Conducting the Evaluation
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Location of Evaluation
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Driver being Evaluated
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Driver Address (List Full Address)
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Driver DL #
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Driver DL Class
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Truck # Used for Evaluation
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Reason for Evaluation
- Initial Evaluation
- Re-Training
- Annual Evaluation
- Post - Accident / Injury
- New Equipment
- Contractor Evaluation
- Other
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List reason
PRE-TRIP INSPECTION CHECKLIST
PRE-TRIP INSPECTION CHECKLIST
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General Conditions of Vehicle
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Proper Operation of Parking Brake and Brakes
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Steering and Blinkers work Properly
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All Lighting Devices and Reflectors are in working order
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Condition of Tires
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Horn and Windshield Wipers including Washer Fluid are Operational
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Rear View Mirror and Side Mirror Adjustment Works
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Emergency Equipment
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In Camera Cab Camera Operational
PLACING VEHICLE IN OPERATION
PLACING VEHICLE IN OPERATION
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Does a Walk-Around the Vehicle before he enters the Vehicle
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Uses Seat Belt Properly and Fastens it before placing Vehicle in Gear
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Starts Vehicle Properly and Observes all Gauges
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Checks Traffic Patterns and Observes all Traffic Signals
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Does Not Allow Vehicle to Roll while stopped and looks both directions before taking off
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Drives with both hands on the Steering Wheel and is Focused on the Road Ahead
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Steers smoothly and is Aware of their surrounding
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Maintains Proper Speed and Distances from other Vehicles
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Adjust Driving Speed and Distances based on Driving Conditions
BACKING AND PARKING OF VEHICLE
BACKING AND PARKING OF VEHICLE
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Stops in Correct Position
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Avoids Backing from Blindside
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Does a Walk-Around of the Vehicle, Checking Entire Area, including Overhead
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Uses All Mirrors Properly (and Back-Up Cameras if equipped with them)
INTERSECTIONS
INTERSECTIONS
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Prepared to STOP Vehicle in Case of an Emergency even if Traffic Light is Green
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Checks in All Directions for Traffic Conditions and is Aware of Potential Hazards
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Stops Vehicle in Proper Location and Maintains the Proper Distance from other Vehicles
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Does Not Allow Vehicle to Roll while Stopped and looks in Both Directions before Taking Off. NEVER ROLLS INTO AN INTERSECTION AND PROCEEDS WITHOUT A COMPLETE STOP
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Takes off at the Proper Speed and is aware of Hard-Braking at each Stop
TURNING
TURNING
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Make sure Vehicle is in Proper Lane for turn
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Signal Intentions for Turn well in Advance of Turn
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Approaches Turn at proper Speed and does not Hard-Brake prior to Turn
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Checks Intersection in all directions and only proceeds to Turn when intersection is Safe
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Keeps Vehicle in proper Lane through entire Turn
PASSING OTHER VEHICLES
PASSING OTHER VEHICLES
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Only Pass in Safe Area where Legally Permitted
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Check Ahead and Behind to make sure passing distance is adequate
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Warns Vehicle ahead of passing and does not tail-gate other Vehicle before passing
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Uses Directional Signals Properly before passing and re-entering Lane
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Leave Sufficient Space between Vehicles before re-entering into Lane
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Does not Exceed Speed Limit until time to pass other Vehicle
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Does not Drive in the Passing Lane (Left Lane)
CELL PHONE USAGE
CELL PHONE USAGE
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Never Text, Talk or Email while Vehicle is moving
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Uses Cell Phone only when safely stopped in a safe area off the street or highway
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Does not Check Phone while Vehicle is moving
WORKING WITH HOPPERS
WORKING WITH HOPPERS
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Sees helpers in mirrors when Backing
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Stops for mounting and dismounting of workers
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Uses hoppers for traffic control and directions
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Hoppers help in the backing process
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Hoppers face the driver when backing
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Hoppers use 2 hands on handrail and face the truck when riding on the platform
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Hoppers ride inside when speeds are +10mph or during distance of +.02 miles
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Hoppers are not allowed to double side any street at any time
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Hoppers are not allowed to ride on the driver or passenger step ups at any time
ADDITION COMMENTS / OBSERVATIONS
ADDITION COMMENTS / OBSERVATIONS
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Please use this section fto expand on any addition comments or observations made during the inspection.
PERMORNANCE AND QUALIFICATION
PERMORANCE AND QUALIFICATION
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General Performance
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Check all trucks below that this driver is qualified to operate.
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Side Load
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Front Load
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Rear Load
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Boom Truck
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Roll-Off
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Other - Please Specify
SIGNATURES
SIGNATURES
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Supervisor / Qualified Person Signature
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Driver's Signature
