Form 4 Form 4 Probation Period 1 Benchmark Certification

Safe Driver Apprenticeship Pilot Program

Attachment I_SafeDriverAPP_Probation Period 1_BenchmarkCert

IC-4: Carrier submits one time certifications for each apprentice driver.

OMB: 2126-0075

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Apprentice Driver Safety Benchmark Certification Form: 120-hour Certification

Carrier name (please print): _________________________

Apprentice driver’s name (please print): _________________________



Benchmark

Representative’s Initials

Date

Interstate, city traffic, rural 2-lane, and evening driving



Safety awareness



Speed and space management



Lane control



Mirror scanning



Right and left turns



Logging and complying with rules relating to hours of service





Carrier representative’s name (please print): ____________________



Carrier representative’s signature: _____________________________ Date: ____________

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorDykstal, Andrew CTR (FMCSA)
File Modified0000-00-00
File Created2022-01-11

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