Driver Name License Number Date of Test Vehicle Number Examiner Name

Test Criteria

Criteria	Pass/Fail	Remarks
Pre-Trip Inspection	Pass Fail
Loading/Unloading Procedures	Pass Fail
Railroad Crossing	Pass Fail
Turning	Pass Fail
Backing	Pass Fail
Driving in Traffic	Pass Fail
Following Distance	Pass Fail
Observance of Traffic Laws	Pass Fail

Overall Performance Pass Fail

Examiner Comments