Form 5 Probation Period 2 Benchmark Certification

O MB Number: TBD

Expiration date: TBD

Apprentice Driver Safety Benchmark Certification Form: 280-hour Certification

Carrier name (please print): _________________________

Apprentice driver’s name (please print): _________________________

Benchmark	Representative’s Initials	Date
Backing and maneuvering in close quarters
Pretrip inspections
Fueling procedures
Weighing loads, weight distribution, and sliding tandems
Coupling and uncoupling procedures
Trip planning, truck routes, map reading, navigation, and permits

Carrier representative’s name (please print): ____________________

Carrier representative’s signature: _____________________________ Date: ____________