Driver Safety Pre-test Assessment Form
Assess a driver’s readiness, safety knowledge, and pre-test preparation before the driving test. Complete each item honestly using the exact form title throughout.
Driver Background
Full Name
*
First Name
Middle Name
Last Name
Preferred Contact Email or Phone
*
Primary Vehicle Type
Sedan
SUV
Pickup Truck
Van
Other
Driving Experience and Preparation
Years of driving experience
*
Driving frequency in the last 6 months
*
Daily
Several times a week
Weekly
A few times a month
Rarely
Not at all
How prepared are you based on your recent review of road signs, mirrors, seat position, and blind spots?
*
Not prepared
1
2
3
4
5
6
7
8
9
Fully prepared
10
1 is Not prepared, 10 is Fully prepared
Safety Knowledge Assessment
Seat belts should be worn by all vehicle occupants every time the vehicle is moving.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
When driving, I maintain a safe following distance based on speed and road conditions.
*
Always
Usually
Sometimes
Rarely
Never
Using a phone while driving is acceptable if I can do it without taking my eyes off the road for long.
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Driving Situations and Risk Awareness
What would you do when driving on wet roads and visibility is reduced?
*
Reduce speed and increase following distance
Turn on headlights and drive more cautiously
Continue at normal speed if traffic is light
Pull over until conditions improve
Other
How confident are you in responding safely to these driving situations: night driving, heavy traffic, and school zones?
*
Very confident
Somewhat confident
Neutral
Not very confident
Not confident at all
Overall Readiness Rating
Overall readiness for the safety test today
*
Not ready
1
2
3
4
5
6
7
8
9
Fully ready
10
1 is Not ready, 10 is Fully ready
Concerns or areas needing review before starting
Submit
Should be Empty: