Overall Safety Release
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Name *
Date *
MM
/
DD
/
YYYY
Comments *
Scoring: *
   1 = Poor            5 = Excellent
1
2
3
4
5
Pre-Trip
Coupling
Tandem/Reefer
Basic Controls (Triangles)
Mirrors
Gauges
Hazards
Focus
Planning
Highway
City
Backing
Overall Score (Average) (1-5) *
Further Review Notes:
Parties concerned agree this driver can safely drive a truck and understands and is proficient in FMCSA rules and requirements. This file is complete. (Enter Your Full Name Below) *
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