Cab Evaluation Form
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Rationale
Bi-annual
Post Incident
Pre-hire
Name
First Name
Last Name
License
Vehicle Number
Facility Location
Please Select
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
System Type
Please Select
Route Number
Appearance
Attitude
Driving Ability
Dependability
Position
Please Select
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
Dawn
Daytime
Dusk
Dark
B2. Driving Conditions - Weather
Rain
Dry
Snow
Foggy
B3. Driving Conditions - Road Surface
Gravel
Asphalt
Concrete
Dirt
B4. Driving Conditions - Road Conditions
Bare
Icy
Wet
Other
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
High Viz Apparek
Safety Boots
Safety Glasses
Hard Hat
Gloves
Uniform
Heel Spikes
3 Point Contact
Checks Mirrors and camera before moving
Sounds horn before backing
Does not operate equipment around pedestrians
Uses helper when backing
Hytower alarm operational
Back up alarm operational
Watches for tripping hazards
Notes
E. Equipment Operations - Check the box if satisfactory
Hydraulic Controls
PTO/RPM
Aligns truck with container
Watches overhead obstructions
Back Door secured
Bin Placement
Bin Lifting
Bin Lowering Cleans up Spillage
Warning devices
Leaves bin in safe correct position
Hydraulics in correct travel position Inspects and prepares container for lifting
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
Other
Notes
Check
Observes site rules
Cleans seals after dumping
Alert to site equipment
Preparing Truck for Travel
Alert to site peronnel
Dumps on solid/level ground
Follows dumping procedures
Wears PPE
Secures rear door
3 Points of Contact
Notes
H. Cab
Windows Clean
Mirrors Clean
Exterior Damage
Cab interior clean
Headlights/Signals clean
Rails clear of debris
Interior damage
Bulk Head Clean
Other
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
Please Select
A = Exceptional
B = Very Good
C = Good
D = Needs Improvement
E = Unsatisfactory
Follow up required
Yes
No
Copy to Driver
Yes
No
Observer's Name
First Name
Last Name
Email
example@example.com
Submit
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