Title Page

  • Date of Evaluation

  • Evaluator

Driver Information

  • Name

  • Date of Hire

  • Drivers License #

  • Class

  • Endorsements

  • Restrictions

  • State

  • Expiration

  • Med Card Expiration

Equipment Used for Test

  • Truck/Tractor number

  • Trailer number

  • Trailer hitch type

  • Odometer Start

  • Odometer End

  • Total Mileage

Evaluation Type

  • Reason for Evaluation

  • Reason:

  • Number of weeks off

  • Type of Equipment

Demonstrated Behaviors

Part 1 - Pre-Trip Inspection

  • Is complete pretrip conducted during this evaluation?

  • Checks general condition approaching unit including leakage of coolants, fuel, and lubricants.

  • Checks under hood – Oil levels, fluid levels, coolant, belts, steering, and general condition of compartment.

  • Circle checks unit – Tires, lights, signals, trailer hookup, brake/light lines, body, doors, horn, and windshield wipers.

  • Full air system check (Static and dynamic air loss, build time etc.), brake action, tractor protection valve, parking brake, rolling test.

  • Knows use of jacks, tools, emergency warning devices, tire chains, fire extinguisher, spare fuses, 4-way flashers, flares/triangles

  • Checks instruments and sets mirrors.

  • Cleans windshield as needed.

  • Uses seat belt.

  • Attach completed Pretrip Evaluation form to this form

Part 2 - Coupling and Uncoupling

  • Is this evaluation conducted with a trailer?

  • Lines up units correctly

  • Secures trailer against movement

  • Backs under or up to trailer slowly

  • Secures power unit against movement

  • Checks hookup with tug test and visual inspection

  • Hooks brake and electric lines properly

  • Handles landing gear properly

Part 3 - Placing Vehicle in Motion and Use of Controls

Motor

  • Allows proper warm up

  • Understands gauges on instrument panel

  • Basic knowledge of motors - Gas/Diesel

  • Does not abuse motor (lugging or overrevving)

Clutch and Transmission

  • Check if test done in Automatic transmission equipped vehicle

  • Uses clutch properly

  • Times shifting properly and shifts smoothly

  • Uses proper gear sequence

  • Starts loaded unit smoothly

Brakes

  • Understands operating principles of air brakes

  • Understands proper use of tractor protection valve

  • Understands low air warning

Steering

  • Does not fight steering wheel

  • Does not allow truck to wander

  • Does not have poor driving posture or improper/poor grip on wheel

Lights

  • Knows lighting regulations

  • Uses proper headlight beam

  • Dims lights when following or meeting traffic

  • Adjusts speed to range of headlights

  • Understands proper use of auxiliary lights

Part 4 - Backing and Parking

Backing

  • Check if full backing evaluation given

  • Attach completed Backing Evaluation form to back of this form

  • Gets out and checks before backing

  • Looks back as well as checks mirrors

  • Gets out to recheck on long back (greater than one truck length)

  • Avoids backing from blind side

  • Signals properly when backing (flashers and horn)

  • Controls speed and direction when backing

  • Does not take many pull ups (record number of pull ups)

  • Number of pull ups taken

  • Does not hit nearby vehicles/stationary objects

Parking (City)

  • Does not hit curb

  • Does not park too far from curb

  • Secures unit - sets parking brake, puts in gear, blocks wheels, shuts off motor (as needed)

  • Shoulder checks traffic conditions and signals when pulling out of parked position

  • Does not park in illegal or unsafe location

Parking (Road)

  • Parks off pavement (completely on shoulder)

  • Avoids parking on soft shoulder

  • Uses emergency signals when needed

  • Secures unit properly

Part 5 - Slowing and Stopping

  • Uses gears properly (ascending)

  • Gears down properly (descending)

  • Stops and re-starts without rolling backwards (no rollbacks)

  • Tests brakes at top of hill

  • Uses brakes properly on hill

  • Uses mirrors to monitor traffic at rear

  • Signals following traffic

  • Avoids sudden stops

  • Stops smoothly without excessive fanning

  • Stops before crosswalk or sidewalk when coming out of driveway or alley

  • Stops clear of pedestrian crosswalks

Part 6 - Traffic Operations - Passing and Turning

Turning

  • Selects correct lane for turn as soon as possible

  • Signals well in advance

  • Monitors traffic conditions and turns only when safe to proceed

  • Does not swing wide or cut short

  • Does not have excessive lean when turning/Does not turn too fast

  • Completes turn in proper lane

  • Does not contact curb

Traffic Signs and Signals

  • Approaches signal prepared to stop if needed (aware of stale green lights)

  • Does not violate traffic signal or stop sign (running red light/turning against turn arrow signal/rolling stop)

  • Does not proceed through yellow light when able to safely stop

  • Does not start up too fast or too slow on green signal

  • Does not fail to notice or heed traffic signs

  • Stops appropriately for traffic light or stop sign (eg: does not cross stop line without stopping before line first)

Intersections

  • Adjusts speed to permit stopping if required

  • Checks for cross traffic regardless of signals or signs

  • Yields right-of-way for safety

Grade Crossings

  • Adjusts speed to conditions

  • Makes safe stop if required

  • Selects proper gear (manual only)

  • Does not shift while crossing grade (manual only)

Passing

  • Passes with sufficient clear space ahead

  • Does not pass in unsafe location: Hill, curve, intersection, etc.

  • Fails to signal lane change or changes lanes too quickly (wait at least 2 seconds before moving)

  • Tailgates waiting for chance to pass

  • Blocks traffic with slow pass

  • Cuts in too short when returning to right lane

Speed

  • Adjusts speed according to road, weather, traffic conditions or legal limits

  • Slows down for rough roads or crossings

  • Slows down in advance of curves, intersections, hazards, etc.

  • Maintains consistent speed

Courtesy and Safety

  • Does not depend on others for safety

  • Does not crowd other drivers or force way through (aggressive driving)

  • Allows faster traffic to pass

  • Keeps right and in own lane (as appropriate)

  • Does not use horn unnecessarily

  • Does not display other form of discourtesy or improper conduct

Part 7 - Miscellaneous

General Driving Habits and Ability

  • Uses seatbelt

  • Consistently alert and attentive, aware of changing traffic conditions

  • Responds appropriately to changing conditions

  • Performs routine functions without taking eyes off road

  • Checks instruments regularly

  • Not distracted by phone, radio, GPS

  • Willing to take instructions and suggestions

  • Adequate self confidence in driving

  • Not nervous, apprehensive

  • Not easily angered

  • Does not complain too much

  • Professional personal appearance, manner

  • Good physical stamina

Handling of freight

  • Checks freight properly

  • Handles and loads freight properly

  • Handles bills properly

Rules and Regulations

  • Knowledge of company rules

  • Knowledge of regulations: Federal, State, local

  • Knowledge of special truck routes

Certification

  • General Performance

  • Qualified for

  • List equipment qualified for

  • List section(s) additional training is needed in:

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. You should independently determine whether the template is suitable for your circumstances.