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F. SPEED

D. USE OF SPECIAL EQUIPMENT (Specity)

Speed consistent with basic ability

Adjusts speed properly to road, weather, traffic conditions, legal limits

Slows down for rough roads Slows down in advance of curves, intersections, etc. Maintains consistent speed

REMARKS:

GENERAL PERFORMANCE:Satisfactory

Needs Training

Unsatisfactory

QUALIFIED FOR: Truck

Tractor-Semitrailer

Other

(specify)

CERTIFICATION OF ROAD TEST

Instructions to Carrier:

If the road test is successfully completed, the person who gave it must complete the following certification in duplicate.

The original of the signed road test form and the original of the Certification of Road Test shall be retained in the driver qualification file of the person

who was examined, and duplicate copies provided to the person examined. Section 391.31 (e)(f)(g)(1)(2) of the Federal Motor Carrier Safety Regulations.

This is to certify that the above-named driver was given a road test under my supervision on

__________

19

_________

consisting

of approximately miles of driving. It is my considered opinion that this driver possesses sufficient driving skill to operate safely the type of ______ commercial motor vehicle listed above.

(Carrier Name)

(Carrier Address)

(City)

(State)

(Zipcode)

(Name of Examiner)

(Signature of Examiner)

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