Passenger Evaluator Form Driver NameDatePassenger Evaluator NameEvaluator Email AddressConfirm Email AddressDriver Positioned and Seat BeltedIdentify hazards 12-15 Seconds AheadEye lead time (seconds)Check blind spots prior to lane changes and turnsClear intersections (L – R – L – R) prior to enteringScan mirrors every 5-8 secondsMirror check intervals (seconds)Stays out of others blind spotsProper use of lightsProperly uses turn signals, flashers, brake lightsSeeks eye contact with other driversUndivided attention given to the driving taskMaintain a safe following distanceFollowing distances (seconds)Practice the safety wedgeProceed with a 3 second delayPractice safe backing techniques – Avoid where possibleSafety measures when stopping on roadwaysPark to eliminate riskCommentsTraining Successfully CompletedYesNoDriver SignatureDriverYour browser does not support e-Signature field.Evaluator SignatureEvaluatorYour browser does not support e-Signature field.Send Message
