Abstract Review Form
Review Date
-
Month
-
Day
Year
Date
Employee Name
*
Last Name
First Name
Abstract For
*
Commercial Driver
Assigned Vehicle Driver
Automatic Disqualifications?
*
Yes
No
Automatic Disqualifications
*
Suspension
Impaired
Distracted Driving
Other
Select one
*
1) Excellent Rating, Clean Abstract
2) Good Rating, Zero Demerits
3) Fair Rating, Under 6 Demerits less than 2 moving violations
4) Probationary, More than 2 moving violations/more than 6 demerits
Action Plan
*
Action A: Driver to take Demerit Reduction Course, Monitor for 6 months
Action B: Signature Required
Authorization
*
All Vehicles
Vehicles as identified by Action Plan
Not authorized for DeFord Vehicles
Action Plan Signature
Action Plan Comments
Signature
Comments
Reviewer Signature
Should be Empty: