Nesel Fast Freight Inc.

• Driver Assessment Form

• MVA / Claim Number

• Today's date

  Date
• Terminal
  Address

• Assessor name

• Driver Name

Driver documents

• Driver has a valid class A license?

  Yes

  No

  N/A

• Does driver have any restrictions and if so does he meet requirements?

  Yes

  No

  N/A

Driver Pre-Trip Inspection

• Driver uses 3- pt stance when entering the cab?

  Yes

  No

  N/A

• Driver completes a thorough inspection of brakes, tires, lights, engine compartment, etc.?

  Yes

  No

  N/A

• Driver properly fills out DVIR?

  Yes

  No

  N/A

General driving habits

• Consistently alert and attentive?

  Safe

  At Risk

  N/A

• Adjusts driving to meet changing conditions?

  Safe

  At Risk

  N/A

• Performs routine functions while keeping eyes on the road?

  Safe

  At Risk

  N/A

• Adjusts speed properly to road, weather and traffic conditions?

  Safe

  At Risk

  N/A

• Slows down in advance for curves, intersections, etc.?

  Safe

  At Risk

  N/A

• Yields right of way for safety?

  Safe

  At Risk

  N/A

• Signals for lane changes and turns?

  Safe

  At Risk

  N/A

• Maintains good lane control?

  Safe

  At Risk

  N/A

• Understands how to calculate proper following distance?

  Safe

  At Risk

  N/A

• Keeps a safe following distance at all times?

  Safe

  At Risk

  N/A

• Uses defensive driving techniques?

  Safe

  At Risk

  N/A

• Constantly checks mirrors and looks ahead for hazards?

  Safe

  At Risk

  N/A

Backing

• Gets out and looks before backing?

  Yes

  No

  N/A

• Looks back as well as checks mirrors?

  Yes

  No

  N/A

• Signals before backing?

  Yes

  No

  N/A

• Shows sufficient skills during back?

  Safe

  At Risk

  N/A

Post trip inspection

• Driver uses 3- pt stance when exiting the cab?

  Yes

  No

  N/A

• Driver completes thorough post trip inspection?

  Yes

  No

  N/A

• Driver completes DVIR?

  Yes

  No

  N/A

Driver Assessor Results

• Does driver have sufficient skills to safely operate the vehicle? (instructor)

  Safe

  At Risk

  N/A

• I have reviewed the above information with the driver and have coached him in any areas he is deficient in.

  Sign

• Instructor comments

Driver Field

• I have reviewed the above information and understand any areas where improvement is needed.

  Sign

• Driver comments