In Cab Evaluation Form
Date
-
Month
-
Day
Year
Date
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
Rationale
Bi-annual
Post Incident
Pre-hire
Name
First Name
Last Name
License
Facility Location
CR+ Lachine
CR+ Ottawa
CR+ Southern Ontario
CR+ Edmonton
CR+ Calgary
CR+ Vancouver
CR+ Prince George
CR+ Victoria
CR+ Rochester
CR+ Buffalo
CR+ Metro Retail
Vehicle Number
System Type
Route Number
Appearance
Attitude
Driving Ability
Dependability
Position
Rear Packer
Straight Truck
Roll Off
Tailgate
Tractor Trailer
Other
A. Pre/Post Trip Inspection - Check the box if inspected
Oil
Radiator
Belts
Lights
4/way
Test Horns
Exhaust
Transmission
Steering (play)
Adjust mirrors
Signals
Tires/Rims
Hoses
Body Damage
Alarms
Seatbelt
Mud Flaps
Safety Decals
Fifth Wheel (Tractor)
Light Check Box
Mirror Condition
Windows
Frist Aid Kit
Registration
Fire Extinguisher
Air build up
Differentials
Dumper (Packer)
Hook Ups (Tractor)
Windshield Wipers
Back Up Camera
Gauges
Brake Test
Leaks
Hydraulics
Documentation
HVAC
Load Restraints
Fuel (s/be>1/2)
Seat (adjustments
Notes
B1. Driving Conditions - Light Conditions
B2. Driving Conditions - Weather
Rain
Dry
Snow
Foggy
B3. Driving Conditions - Road Surface
B4. Driving Conditions - Road Conditions
C. Defensive Driving - Check the box if satisfactoy
Passing
Choice of lanes
Seatbelt
Corners
Blind Spots
Speed
Use Horn
Braking
Lane Positioning
Use of Signals
Does driver know 6 CR+DD keys? Ask Driver to list them
Maintains minimum 5 second following distance
Scans mirrors every 5-8 seconds
Aims at least 15 seconds ahead
Maintains space cushion on all sides of vehicle
Maintains a full circle of awareness
Aware of cyclists/pedestrians
Backs slowly and Carefully
Makes eye contact when possible
Uses lights properly
Notes
D. Safety - Check the box if satisfactory
Notes
E. Equipment Operations - Check the box if satisfactory
Notes
F. Moffet/Forklift Operations - Check the box if satisfactory
3 points contact On/Off
Seat Belt
Scanning 3-5 seconds
Watches for overhead obstructions
Moffett Securement
Load Securement
Strapping Procedures
Cleans Spillage
Warning devices
Secures work area
Notes
Notes
H. Cab
Windows Clean
Mirrors Clean
Exterior Damage
Cab interior clean
Headlights/Signals clean
Rails clear of debris
Interior damage
Bulk Head Clean
Notes
In Cab a result of incident
Yes
No
If yes, date and type of incident
J. Comments / Coaching
Grading - Based on average grade from selection below
A = Exceptional
B = Very Good
C = Good
D = Needs Improvement
E = Unsatisfactory
Follow up required
Yes
No
Copy to Driver
Yes
No
Email
example@example.com
Observer's Name
*
Submit
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