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Fields
DOT Certification of Road Test
Is the ride-along with a ?
*
New Hire
Current Employee
Driver Name
*
First Name
*
Last Name
*
Driver's License Number
*
Driver's License State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
DC (Washington)
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
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Ohio
Oklahoma
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Region
*
Central
East
Great Lakes
Midwest
Mountain
MSD
South
West
Driver's License Type
*
Operator License
Commerical Driver License (CDL)
Evaluation Date
*
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
Vehicle Type
*
Straight Truck
Tool Van
One Ton Dump
Five Ton Dump
Vac Rig
Box Truck
Other:
Other Value
Trailer Unit
Evaluator's Name
*
First Name
*
Last Name
*
Evaluation Section
Pretrip:
Pretrip:
Pass
Fail
Adjusts mirrors properly
Pretrip:: Adjusts mirrors properly (Pass)
Adjusts mirrors properly (Fail)
Turns on headlights.
Turns on headlights. (Pass)
Turns on headlights. (Fail)
Fastens seatbelt.
Fastens seatbelt. (Pass)
Fastens seatbelt. (Fail)
Open Road
Open Road
Pass
Fail
Maintains 15 second eye lead time.
Open Road: Maintains 15 second eye lead time. (Pass)
Maintains 15 second eye lead time. (Fail)
Eyes lead vehicle around corners and turns.
Eyes lead vehicle around corners and turns. (Pass)
Eyes lead vehicle around corners and turns. (Fail)
Scans mirrors every 5-8 seconds.
Scans mirrors every 5-8 seconds. (Pass)
Scans mirrors every 5-8 seconds. (Fail)
Moves eyes every 2 seconds.
Moves eyes every 2 seconds. (Pass)
Moves eyes every 2 seconds. (Fail)
Evaluates objects for information and makes good decisions.
Evaluates objects for information and makes good decisions. (Pass)
Evaluates objects for information and makes good decisions. (Fail)
Maintains space cushion around vehicle and avoids traveling in clusters when possible.
Maintains space cushion around vehicle and avoids traveling in clusters when possible. (Pass)
Maintains space cushion around vehicle and avoids traveling in clusters when possible. (Fail)
Avoids traveling behind larger vehicles when possible.
Avoids traveling behind larger vehicles when possible. (Pass)
Avoids traveling behind larger vehicles when possible. (Fail)
Maintains 4 second following distance.
Maintains 4 second following distance. (Pass)
Maintains 4 second following distance. (Fail)
Consistently selects "lane of least resistance".
Consistently selects "lane of least resistance". (Pass)
Consistently selects "lane of least resistance". (Fail)
Seeks eye contact and communicates when conditions suggest the need.
Seeks eye contact and communicates when conditions suggest the need. (Pass)
Seeks eye contact and communicates when conditions suggest the need. (Fail)
Speed is appropriate for conditions.
Speed is appropriate for conditions. (Pass)
Speed is appropriate for conditions. (Fail)
Appropriately adjusts to weather conditions.
Appropriately adjusts to weather conditions. (Pass)
Appropriately adjusts to weather conditions. (Fail)
Changing Lanes
Changing Lanes
Pass
Fail
Activates turn signal seconds before beginning lane change.
Changing Lanes: Activates turn signal seconds before beginning lane change. (Pass)
Activates turn signal seconds before beginning lane change. (Fail)
Checks mirrors before changing lanes.
Checks mirrors before changing lanes. (Pass)
Checks mirrors before changing lanes. (Fail)
Times lane changes to ensure adequate space cushion once in other lane.
Times lane changes to ensure adequate space cushion once in other lane. (Pass)
Times lane changes to ensure adequate space cushion once in other lane. (Fail)
Changes lanes slowly and well before needing to make a turn.
Changes lanes slowly and well before needing to make a turn. (Pass)
Changes lanes slowly and well before needing to make a turn. (Fail)
Intersections
Intersections
Pass
Fail
Demonstrates and properly executes "the point of no return".
Intersections: Demonstrates and properly executes "the point of no return". (Pass)
Demonstrates and properly executes "the point of no return". (Fail)
Scans intersections before entering and railroads before crossing.
Scans intersections before entering and railroads before crossing. (Pass)
Scans intersections before entering and railroads before crossing. (Fail)
Brakes early to activate brake lights.
Brakes early to activate brake lights. (Pass)
Brakes early to activate brake lights. (Fail)
Checks mirrors as they begin braking.
Checks mirrors as they begin braking. (Pass)
Checks mirrors as they begin braking. (Fail)
When stopped, leaves at least one car length in front of vehicle.
When stopped, leaves at least one car length in front of vehicle. (Pass)
When stopped, leaves at least one car length in front of vehicle. (Fail)
Delays start on green light until vehicle in front begins to move.
Delays start on green light until vehicle in front begins to move. (Pass)
Delays start on green light until vehicle in front begins to move. (Fail)
Waits for proper signal and ensure adequate distance before turning in front of oncoming traffic.
Waits for proper signal and ensure adequate distance before turning in front of oncoming traffic. (Pass)
Waits for proper signal and ensure adequate distance before turning in front of oncoming traffic. (Fail)
Parking & Backing
Parking & Backing
Pass
Fail
Parks to avoid backing when possible.
Parking & Backing: Parks to avoid backing when possible. (Pass)
Parks to avoid backing when possible. (Fail)
Avoids parking in congested areas.
Avoids parking in congested areas. (Pass)
Avoids parking in congested areas. (Fail)
Avoids parking next to larger vehicles to maximize visibility.
Avoids parking next to larger vehicles to maximize visibility. (Pass)
Avoids parking next to larger vehicles to maximize visibility. (Fail)
Uses a spotter or walks around vehicle if forced to back.
Uses a spotter or walks around vehicle if forced to back. (Pass)
Uses a spotter or walks around vehicle if forced to back. (Fail)
Backs at a slow rate of speed.
Backs at a slow rate of speed. (Pass)
Backs at a slow rate of speed. (Fail)
Evaluations Highlights
Areas Needing Improvement
Confirmation
Miles Driven
*
By placing my initials here, I understand I am responsible for the results for this driver evaluation. It is my opinion that this driver possesses sufficient driving skill to operate safely.
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Aaron.Hunt@millerpipeline.com
Adam.Freeman@millerpipeline.com
Adam.Gaskin@millerpipeline.com
Austin.O'Hara@millerpipeline.com
Ben.Lacy@millerpipeline.com
Beau.Moore@millerpipeline.com
Bobby.McCombs@millerpipeline.com
Brett.Carter@millerpipeline.com
Brett.Edwards@millerpipeline.com
Brooks.Scott@millerpipeline.com
Byron.McPherson@millerpipeline.com
Carl.Tucker@millerpipeline.com
cburns@ksenergyservices.com
Chad.Smith@millerpipeline.com
Chris.Dunham@millerpipeline.com
Chris.Moses@millerpipeline.com
Chris.Snoeberger@millerpipeline.com
Chuck.Phair@millerpipeline.com
Daniel.Hopkins@millerpipeline.com
Darlene.Hauck@millerpipeline.com
Dave.Miller@millerpipeline.com
David.Shirley@millerpipeline.com
David.Almond@millerpipeline.com
Eric.Warfield@millerpipeline.com
Eric.Winters@millerpipeline.com
ezra.carpenter@millerpipeline.com
Greg.Moore@millerpipeline.com
jack.cline@millerpipeline.com
Jason.Allday@millerpipeline.com
Jason.Ramsey@millerpipeline.com
Jay.Wise@millerpipeline.com
Jeffrey.Stout@millerpipeline.com
Jeremy.Hoover@millerpipeline.com
Jeremy.Price@millerpipeline.com
Jeremy.Strayer@millerpipeline.com
Jeremy.Wyatt@millerpipeline.com
jmassey@ksenergyservices.com
Joe.Hirst@millerpipeline.com
John.Williams@millerpipeline.com
josh@ksenergyservices.com
Justin.Bray@millerpipeline.com
Justin.Hutchens@millerpipeline.com
Kenny.RileyJr@millerpipeline.com
Kerry.Welford@millerpipeline.com
Kevin.Middleton@millerpipeline.com
Leslie.Hunt@millerpipeline.com
Leslie.Wilson@millerpipeline.com
Mike.Lang@millerpipeline.com
mnorris@ksenergyservices.com
Paul.Alvarado@millerpipeline.com
Paul.Brown@millerpipeline.com
pparry@ksenergyservices.com
randy.sagante@millerpipeline.com
Richard.Bowles@millerpipeline.com
richard.grinstead@millerpipeline.com
Richard.York@millerpipeline.com
rob.houston@millerpipeline.com
Ryan.Dillon@millerpipeline.com
samerling@ksenergyservices.com
Scott.Oaster@millerpipeline.com
Stephen.Blevins@millerpipeline.com
Steven.Ryan@millerpipeline.com
todd.duncan@millerpipeline.com
Timothy.Morgan@millerpipeline.com
Tony.Reynolds@millerpipeline.com
Tony.Turner@millerpipeline.com
Travis.Nail@millerpipeline.com
Webster.Bailey@millerpipeline.com
William.Barcus@millerpipeline.com
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