Highway Patrol Officer Driver Assessment Form
Use this form to record a highway patrol driver assessment, observations, compliance checks, and final outcome.
Driver and Assessment Details
Driver's Name
*
First Name
Middle Name
Last Name
Contact Phone or Email
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Assessment
*
Hour Minutes
AM
PM
AM/PM Option
Assessment Location or Route
*
Vehicle Type
*
Please Select
Passenger Car
SUV/Truck
Motorcycle
Commercial Vehicle
Bus
Emergency Vehicle
Other
Vehicle Description / Plate Details
Driving Behavior Evaluation
Lane discipline
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Speed control
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Signaling
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Following distance
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Attention to surroundings
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Vehicle handling
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Compliance with traffic instructions
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Response to patrol directions
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Compliance and Safety Observations
Seat Belt Use
*
Worn correctly
Not worn
Unable to confirm
Not applicable
Mobile Device Use While Driving
*
None observed
Handheld use observed
Hands-free use observed
Unable to confirm
Observed Safety Concerns
Signs of impairment
Signs of fatigue
Traffic violations observed
Safety hazards present
Documentation presented as requested
Other
Documentation Presented (if applicable)
Driver license
Vehicle registration
Proof of insurance
Not applicable
Other
Immediate Intervention Required
*
No
Yes
Unable to determine
Notes on Violations or Unusual Behavior
Assessment Outcome and Assessor Details
Overall assessment result
*
Pass
Conditional Pass
Fail
Needs Follow-Up
Overall rating
*
1
2
3
4
5
Summary comments
Recommended action / follow-up
Please Select
No further action
Coaching recommended
Retest required
Supervisor review
Follow-up inspection
Other
Assessor name
*
First Name
Middle Name
Last Name
Assessor title / badge or employee reference
Submit Assessment
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