Title Page
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Date of Evaluation
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Evaluator
Driver Information
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Name
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Date of Hire
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Drivers License #
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Class
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Endorsements
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Restrictions
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State
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Expiration
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Med Card Expiration
Equipment Used for Test
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Truck/Tractor number
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Trailer number
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Trailer hitch type
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Odometer Start
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Odometer End
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Total Mileage
Evaluation Type
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Reason for Evaluation
- Initial Evaluation
- Annual Evaluation
- Post Incident
- Retraining
- Return to Work
- New Equipment
- Other
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Reason:
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Number of weeks off
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Type of Equipment
Demonstrated Behaviors
Part 1 - Pre-Trip Inspection
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Is complete pretrip conducted during this evaluation?
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Checks general condition approaching unit including leakage of coolants, fuel, and lubricants.
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Checks under hood – Oil levels, fluid levels, coolant, belts, steering, and general condition of compartment.
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Circle checks unit – Tires, lights, signals, trailer hookup, brake/light lines, body, doors, horn, and windshield wipers.
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Full air system check (Static and dynamic air loss, build time etc.), brake action, tractor protection valve, parking brake, rolling test.
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Knows use of jacks, tools, emergency warning devices, tire chains, fire extinguisher, spare fuses, 4-way flashers, flares/triangles
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Checks instruments and sets mirrors.
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Cleans windshield as needed.
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Uses seat belt.
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Attach completed Pretrip Evaluation form to this form
Part 2 - Coupling and Uncoupling
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Is this evaluation conducted with a trailer?
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Lines up units correctly
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Secures trailer against movement
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Backs under or up to trailer slowly
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Secures power unit against movement
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Checks hookup with tug test and visual inspection
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Hooks brake and electric lines properly
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Handles landing gear properly
Part 3 - Placing Vehicle in Motion and Use of Controls
Motor
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Allows proper warm up
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Understands gauges on instrument panel
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Basic knowledge of motors - Gas/Diesel
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Does not abuse motor (lugging or overrevving)
Clutch and Transmission
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Check if test done in Automatic transmission equipped vehicle
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Uses clutch properly
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Times shifting properly and shifts smoothly
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Uses proper gear sequence
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Starts loaded unit smoothly
Brakes
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Understands operating principles of air brakes
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Understands proper use of tractor protection valve
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Understands low air warning
Steering
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Does not fight steering wheel
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Does not allow truck to wander
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Does not have poor driving posture or improper/poor grip on wheel
Lights
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Knows lighting regulations
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Uses proper headlight beam
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Dims lights when following or meeting traffic
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Adjusts speed to range of headlights
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Understands proper use of auxiliary lights
Part 4 - Backing and Parking
Backing
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Check if full backing evaluation given
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Attach completed Backing Evaluation form to back of this form
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Gets out and checks before backing
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Looks back as well as checks mirrors
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Gets out to recheck on long back (greater than one truck length)
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Avoids backing from blind side
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Signals properly when backing (flashers and horn)
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Controls speed and direction when backing
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Does not take many pull ups (record number of pull ups)
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Number of pull ups taken
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Does not hit nearby vehicles/stationary objects
Parking (City)
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Does not hit curb
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Does not park too far from curb
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Secures unit - sets parking brake, puts in gear, blocks wheels, shuts off motor (as needed)
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Shoulder checks traffic conditions and signals when pulling out of parked position
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Does not park in illegal or unsafe location
Parking (Road)
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Parks off pavement (completely on shoulder)
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Avoids parking on soft shoulder
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Uses emergency signals when needed
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Secures unit properly
Part 5 - Slowing and Stopping
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Uses gears properly (ascending)
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Gears down properly (descending)
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Stops and re-starts without rolling backwards (no rollbacks)
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Tests brakes at top of hill
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Uses brakes properly on hill
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Uses mirrors to monitor traffic at rear
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Signals following traffic
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Avoids sudden stops
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Stops smoothly without excessive fanning
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Stops before crosswalk or sidewalk when coming out of driveway or alley
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Stops clear of pedestrian crosswalks
Part 6 - Traffic Operations - Passing and Turning
Turning
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Selects correct lane for turn as soon as possible
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Signals well in advance
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Monitors traffic conditions and turns only when safe to proceed
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Does not swing wide or cut short
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Does not have excessive lean when turning/Does not turn too fast
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Completes turn in proper lane
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Does not contact curb
Traffic Signs and Signals
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Approaches signal prepared to stop if needed (aware of stale green lights)
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Does not violate traffic signal or stop sign (running red light/turning against turn arrow signal/rolling stop)
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Does not proceed through yellow light when able to safely stop
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Does not start up too fast or too slow on green signal
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Does not fail to notice or heed traffic signs
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Stops appropriately for traffic light or stop sign (eg: does not cross stop line without stopping before line first)
Intersections
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Adjusts speed to permit stopping if required
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Checks for cross traffic regardless of signals or signs
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Yields right-of-way for safety
Grade Crossings
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Adjusts speed to conditions
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Makes safe stop if required
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Selects proper gear (manual only)
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Does not shift while crossing grade (manual only)
Passing
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Passes with sufficient clear space ahead
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Does not pass in unsafe location: Hill, curve, intersection, etc.
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Fails to signal lane change or changes lanes too quickly (wait at least 2 seconds before moving)
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Tailgates waiting for chance to pass
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Blocks traffic with slow pass
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Cuts in too short when returning to right lane
Speed
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Adjusts speed according to road, weather, traffic conditions or legal limits
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Slows down for rough roads or crossings
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Slows down in advance of curves, intersections, hazards, etc.
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Maintains consistent speed
Courtesy and Safety
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Does not depend on others for safety
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Does not crowd other drivers or force way through (aggressive driving)
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Allows faster traffic to pass
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Keeps right and in own lane (as appropriate)
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Does not use horn unnecessarily
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Does not display other form of discourtesy or improper conduct
Part 7 - Miscellaneous
General Driving Habits and Ability
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Uses seatbelt
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Consistently alert and attentive, aware of changing traffic conditions
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Responds appropriately to changing conditions
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Performs routine functions without taking eyes off road
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Checks instruments regularly
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Not distracted by phone, radio, GPS
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Willing to take instructions and suggestions
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Adequate self confidence in driving
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Not nervous, apprehensive
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Not easily angered
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Does not complain too much
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Professional personal appearance, manner
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Good physical stamina
Handling of freight
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Checks freight properly
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Handles and loads freight properly
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Handles bills properly
Rules and Regulations
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Knowledge of company rules
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Knowledge of regulations: Federal, State, local
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Knowledge of special truck routes
Certification
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General Performance
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Qualified for
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List equipment qualified for
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List section(s) additional training is needed in: