Driver Safety Observation Checklist
Complete this checklist to assess and document driver safety practices during vehicle operation.
Observer's Full Name
*
First Name
Last Name
Driver's Full Name
*
First Name
Last Name
Date and Time of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Vehicle Identification (make, model, or plate)
*
Location of Observation
*
Type of Driving Activity
*
Please Select
City Driving
Highway Driving
Parking Lot
Construction Site
Other
Safety Behaviors Checklist
*
Rows
Yes
No
N/A
Uses seat belt at all times
1
2
3
Obeys speed limits
4
5
6
Uses turn signals when changing lanes or turning
7
8
9
Maintains safe following distance
10
11
12
Avoids use of mobile phone while driving
13
14
15
Performs pre-trip vehicle inspection
16
17
18
Yields to pedestrians and right-of-way
19
20
21
Stops completely at stop signs/lights
22
23
24
Checks mirrors and blind spots regularly
25
26
27
Drives defensively
28
29
30
Observed Unsafe Behaviors (if any)
Recommendations or Corrective Actions
Additional Comments
Observer's Signature (required)
*
Submit Observation
Submit Observation
Should be Empty: