Commercial Motor Vehicle Driver Performance Evaluation Form DRIVER IDENTIFYING INFORMATION ___________________________________________________________________________ Name of Employer ____________________________________ _________________________________ Driver Name Evaluation Date ____________________________________ _________________________________ Driver License # and State of Issue Expiration Date
Check each item that driver performs in a satisfactory manner. All un-checked items require additional driver training. ------------------------------------------------------------------------------------------PRE-TRIP INSPECTION (Checks by the Driver) J Fully evaluates condition of vehicle J Checks for oil, water, fuel leaks J Checks fuel, oil, and water levels J Checks tires, lights, reflectors J Checks air hoses, electrical connections J Checks suspension points, steering linkage J Checks service and parking brakes; hand valve J Checks wipers, mirrors, horn, and gauges J Checks emergency equipment J Cleans windows, mirrors, lights J Uses DVIR PLACING VEHICLE IN MOTION J Checks mirror adjustment J Puts transmission in neutral J Shifts gears smoothly J Starts motor without difficulty J Allows proper warm-up J Builds full air pressure before starting J Checks brakes within 100 ft. of starting J Checks and understands instruments J Uses clutch properly J Maintains proper engine RPM J Times gearshift properly J Uses proper gear sequence J Uses seat belt BRAKING AND SLOWING J Brakes as soon as need is recognized J Avoids sudden stops J Stops smoothly without rolling back J Tests brakes at top of hills J Gears down to descend grades J Uses brake properly on grades J Keeps check on air gauges
CONTROLS AND EQUIPMENT J Knows proper use of parking brake J Knows proper use of hand valve J Understands “low air” warning J Understands use of 4-way flashers J Uses proper headlight beam J Dims lights when following others J Dims lights when meeting others J Adjusts speed to range of lights J Knows how to replace fuses J Knows how to use fire extinguisher J Knows placement of warning devices J Knows placement position of chocks J Knows operation of engine brake (if equipped) OPERATING IN TRAFFIC Intersections and Turning J Enters intersections prepared to stop J Checks for cross traffic J Yields to others J Signals direction changes in advance J Gets in proper lane well in advance of turn J Turns only when way is clear J Blocks traffic from curb side of turn Signs and Signals J Starts slowly from stopped position J Looks ahead for signs and signals J Comes to a complete stop at stop signs J Approaches signs and signals prepared to stop J Slows vehicle gradually R.R. Grade Crossings J Adjusts speed to crossing conditions J If required, comes to a complete stop J Stops required distance from crossing J Avoids shifting gears while crossing
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BACKING AND PARKING Backing J Avoids backing from blind side J Avoids unnecessary backing J Warns others when backing J Checks area before backing J Uses mirrors to advantage J If in doubt, gets out and looks J Proper backing maneuvers
Vehicle Parking J Selects safe area to park J Parks to avoid backing when leaving J Parks correct distance from curb or roadway J Turns on warning flashers J Secures unit: J Turns wheels J Sets brakes J Puts in gear J Shuts off engine J Uses chocks J Locks unit J Checks traffic when pulling out
OPERATING IN TRAFFIC (continued…) Passing J Allows sufficient space for passing J Passes only when there is long-term advantage J Passes only in safe location J Signals when changing lanes J Signals before passing J Proceeds in proper lane Speed J Observes posted speed limit J Uses timed interval following distance J Observes speed limit consistent with conditions J Maintains steady speed on open road J Adjusts speed for curves, other danger zones General J Grips steering wheel properly J Good driving posture J Centers vehicle in driving lane J Reads traffic lights in advance J Evaluates traffic patterns early J Aware of traffic around unit J Frequent use of mirrors J Avoids being boxed in J Makes eye contact with others J Alert to live parking J Makes good driving decisions
Driver Performance Evaluation Results Based on this examination, is this driver qualified to operate commercial motor vehicles for this company? ( ) Yes ( ) No If “No”, explain additional training planned for this driver: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Name of examiner: _______________________________________________________ Signature of examiner: ____________________________________________________ Date of examination: __________________
