Driver Safety Field Observation

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Driver Information

• Driver name

• Truck number

• Trailer

• Select date

  Date

• Was driver present at time of inspection

  Yes

  No

  N/A

Vehicle observations

• Type of location observation made

  Station

  Terminal

  On road in transit

  Yards

• Condition of vehicle interior

  Trash on floor

  Excessive dirt on floor

  Unpleasant odor in cab

  Clean and serviceable

• Notes on interior

• Image of cab interior

  Media

• Condition of vehicle exterior

  Clean and free of damage

  excessive dirt

  minor damage

  unreported major damage

  unservicable

• Image of exterior

  Media

• Image of any damage to exterior

  Media

Fuel delivery equipment

• Fuel drop hoses servicable

  Safe

  At Risk

  N/A

• Loading head caps and plugs safe and secured properly

  Yes

  No

  N/A

• Fuel drops in serviceable condition

  Yes

  No

  N/A

• Number of internal vapor drops

  1

  2

  3

  4

• Number of standard drops

  1

  2

  3

  4

• Number of vapor return fittings

  1

  2

  3

  4

• Image of defective equipment

  Media

Fuel delivery safety observations

• Driver using proper PPE

  Yes

  No

  N/A

• Safety cones in use protecting work area

  Yes

  No

  N/A

• Driver was at loading/drop heads while in use

  Yes

  No

  N/A

• Noticeable leakage from fittings, drops, hoses

  Yes

  No

  N/A

Driving observations

• Vehicle operated in generally safe manner

  Yes

  No

  N/A

• Unsafe actions observed

  Select Traffic control device Improper lane change Failure to yield Following to closely Excessive speed Reckless operations

  • Traffic control device
  • Improper lane change
  • Failure to yield
  • Following to closely
  • Excessive speed
  • Reckless operations

• Unsafe actions observed

  Select Traffic control device Improper lane change Failure to yield Following to closely Excessive speed Reckless operations

  • Traffic control device
  • Improper lane change
  • Failure to yield
  • Following to closely
  • Excessive speed
  • Reckless operations

• Unsafe actions observed

  Select Traffic control device Improper lane change Failure to yield Following to closely Excessive speed Reckless operations

  • Traffic control device
  • Improper lane change
  • Failure to yield
  • Following to closely
  • Excessive speed
  • Reckless operations

• Unsafe actions observed

  Select Traffic control device Improper lane change Failure to yield Following to closely Excessive speed Reckless operations

  • Traffic control device
  • Improper lane change
  • Failure to yield
  • Following to closely
  • Excessive speed
  • Reckless operations

• Unsafe actions observed

  Select Traffic control device Improper lane change Failure to yield Following to closely Excessive speed Reckless operations

  • Traffic control device
  • Improper lane change
  • Failure to yield
  • Following to closely
  • Excessive speed
  • Reckless operations

• Notes on driving observations

General notes and comments on review

• Notes and comments

• Driver signature

  Sign

• Observer signature

  Sign