Delivery Driver Safety Evaluation Form
Use this form to assess delivery driver safety practices, vehicle condition, and on-road conduct.
Driver Name
*
First Name
Last Name
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Route or Shift Details
*
Vehicle Condition at Start of Shift
*
Rows
Excellent
Good
Fair
Poor
N/A
Tires
1
2
3
4
5
Brakes
6
7
8
9
10
Lights
11
12
13
14
15
Mirrors
16
17
18
19
20
Horn
21
22
23
24
25
Windshield/Wipers
26
27
28
29
30
Observed On-Road Safety Behaviors
*
Rows
Always
Often
Sometimes
Rarely
Never
Wears seatbelt
31
32
33
34
35
Obeys speed limits
36
37
38
39
40
Signals when turning/changing lanes
41
42
43
44
45
Maintains safe following distance
46
47
48
49
50
Avoids distractions (e.g., phone use)
51
52
53
54
55
Yields to pedestrians
56
57
58
59
60
Any Incidents or Near-Misses During Shift?
*
No incidents or near-misses
Minor incident (no injury/damage)
Major incident (injury/damage)
Near-miss (no contact)
PPE (Personal Protective Equipment) Compliance
*
Fully compliant
Partially compliant
Not compliant
Not applicable
Adherence to Delivery Protocols
*
1
2
3
4
5
Communication with Dispatch/Customers
1
2
3
4
5
Overall Safety Performance
*
Excellent
Good
Satisfactory
Needs Improvement
Additional Comments or Recommendations
Submit Evaluation
Should be Empty: