Adult Evaluation and Road Test
Instructor's Name
*
Doug Whitmore
Tracey Wallace
Al Beltran
Darren Williams
Robert Sublett
Steve Lu
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Driver's Name
*
First Name
Last Name
Permit #
*
Issue Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Start Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
End Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Start Mileage
*
End Mileage
*
Vehicle Used
*
Blue Malibu
Tan Malibu
Black Honda
Driver's Signature
*
Evaluation:
Seat Belts
*
Yes
No
Makes Complete Stops
*
Yes
No
Pulls into intersection at traffic lights
*
Yes
No
Scanning Intersections
*
Looks both ways well
Needs to be consistent
Often does not look
Stopping at White Line
*
Just Right
Stops too far before
Stops illegally past
Lane Changing
*
Good
Slows to make the lane change
Performs all checks
Drifts
Speed Limits
*
Good Speed Control
Often too Fast
Often too Slow
Often not aware of speed changes
Uphill/Downhill Parking
*
Very good understanding
Fair Understanding
Poor Understanding
Three point turn
*
Good
Fair
Needs improvement
Understands Rule of the Road/ Right-of-way
*
Excellent
Good
Needs improvement
Straight Backing
*
Just Right
Too Fast
Veers from side to side
Does not maintain focus out the back window
Pulling away from the curb
*
Checks mirrors
Blind Spots
Uses Signals
Pulls out safely
Aware of Other Drivers
*
Good
Fair
Poor
Aware of Other Drivers
*
Reacts well to others
Does not react to other's actions
Speed Control
*
Just Right
Too Slow
Too Fast
Series of Turns
*
Just Right
Over Turns
Under Turns
Turn About
*
Very Good
Fair
Poor
Final Road Test Review
*
Very good chance of passing
Fair chance of passing
Poor chance of passing
Student/Driver is ready to take Road Test:
*
Yes or No (If no, explain above)
Road Test Results
*
Pass
Fail
Submit
Should be Empty: