PDT Hours of Service Record Driver Data Sheet

Hours of Service Record Driver Data Sheet

First time or Intermittent Drivers
Name
Driver's License Number
Type of License
Issuing State
At the time of initial employment as a driver, the regulations of the Department of Transportation require you to furnish a statement of time worked during the preceding (7) seven consecutive days. In the spaces below, show the number of hours worked in each of the last 7 days.
Preceding 7 Day Record before Driving
Day 1
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Duty
Day 2
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Duty
Day 3
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Duty
Day 4
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Duty
Day 5
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Duty
Day 6
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Duty
Day 7
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Duty
Total Hours
I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was
Date of Last Day Worked

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Driver Signature
Should be Empty:

Preceding 7 Day Record before Driving