Brentwood Legion Ambulance
Driver Training Evaluation
Name:
*
First Name
Last Name
Date:
*
-
Month
-
Day
Year
Date
Run #:
Rig 2-25-:
*
Crew Chief/ Driver Trainer:
*
Road Condition:
*
Dry
Rain
Heavy Rain
Fog
Snow
Ice
Slush
Hail
Visibility:
*
Daylight
Dawn
Dusk
Night
Check One Signal:
*
2C
2H
5
15 To
18C
18H
Retraining Level:
2
3
Please Evaluate The Following: Overall Driving: 1 Meaning Poor and 10 Excellent
*
1
2
3
4
5
6
7
8
9
10
Under 5 Explain:
Cornering Skills:
Maneuvering Skills: 1 Meaning Poor and 10 Excellent:
*
1
2
3
4
5
6
7
8
9
10
Under 5 Explain:
Backing Rig Into Bay:
Did Trainee Park Rig in Area Appropriate To Call:
*
Yes
No
Not Applicable
Comments and Critique:
Please Explain Negative Comments:
Evaluator's Name:
*
First Name
Last Name
Evaluator's Signature:
*
Below For Official Use Only
Action Taken:
Instructor's Name:
First Name
Last Name
Instructor's Signature:
Date:
-
Month
-
Day
Year
Date
Enter the Message As It's Shown:
*
Submit
Should be Empty: