Driver’s Performance Evaluation Questionnaire

‫ﻧﻤﻮﺫﺝ ﺗﻘﻴﻴﻢ ﺃﺩﺍﺀ ﺍﻟﺴﺎﺋﻖ‬

Thank you for your time. It is important to us to receive your feedback regarding driver safety
performance. Please fill this form and send it by mail to Fleet manager and/or responsible.

Driver Information (‫)ﻣﻌﻠﻮﻣﺎﺕ ﺍﻟﺴﺎﺋﻖ‬

Driver name (‫)ﺍﺳﻢ ﺍﻟﺴﺎﺋﻖ‬:Mohamed Ahmed Date (12:10:44 27-04-2024:(‫ﺗﺎﺭﻳﺦ ﺍﻟﺘﻘﺮﻳﺮ‬
Mohamed Mustafa
(‫)ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬Plate number :7185 ‫ﻕ ﺍ ﻝ‬ Supplier Company(‫)ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﻮﺭﺩﺓ‬:sky

Question (‫)ﺍﻟﺴﺆﺍﻝ‬ YES NO Comment

Does driver comply with road speed limits? √
‫ﻫﻞ ﺍﻟﺴﺎﺋﻖ ﻣﻠﺘﺰﻡ ﺑﺎﻟﺴﺮﻋﺔ ﺍﻟﻤﺤﺪﺩﺓ ﻟﻠﻄﺮﻳﻖ؟‬
Does driver fasten his seatbelt while driving? √
‫ﻫﻞ ﻳﻘﻮﻡ ﺍﻟﺴﺎﺋﻖ ﺑﺮﺑﻂ ﺣﺰﺍﻡ ﺍﻷﻣﺎﻥ ﺃﺛﻨﺎﺀ ﺍﻟﻘﻴﺎﺩﺓ ؟‬
Do all car passengers (including you) fasten their seat √
belts?
‫ﻫﻞ ﻳﻘﻮﻡ ﺟﻤﻴﻊ ﺭﻛﺎﺏ ﺍﻟﺴﻴﺎﺭﺓ (ﺑﻤﺎ ﻓﻲ ﺫﻟﻚ ﺃﻧﺖ) ﺑﺮﺑﻂ ﺣﺰﺍﻡ ﺍﻷﻣﺎﻥ؟‬
Does driver use the handheld mobile while driving? X
‫ﻫﻞ ﻳﻘﻮﻡ ﺍﻟﺴﺎﺋﻖ ﺑﺎﻟﺘﺤﺪﺙ ﻓﻲ ﺍﻟﻤﺤﻤﻮﻝ ﺑﺎﻟﻴﺪ ﺃﺛﻨﺎﺀ ﺍﻟﻘﻴﺎﺩﺓ؟‬
Is the car clean? √
‫ﻫﻞ ﺍﻟﺴﻴﺎﺭﺓ ﻧﻈﻴﻔﺔ؟‬
Do driver/any passenger smoke inside the car? X
‫ﻫﻞ ﻳﻘﻮﻡ ﺍﻟﺴﺎﺋﻖ ﺃﻭ ﺍﺣﺪ ﺍﻟﺮﻛﺎﺏ ﺑﺎﻟﺘﺪﺧﻴﻦ ﺩﺍﺧﻞ ﺍﻟﺴﻴﺎﺭﺓ‬
Does driver leave enough distance between his car and √
the car in front of him?
‫ﻫﻞ ﻳﺘﺮﻙ ﺍﻟﺴﺎﺋﻖ ﻣﺴﺎﻓﺔ ﻛﺎﻓﻴﺔ ﺑﻴﻦ ﺳﻴﺎﺭﺗﻪ ﻭﺍﻟﺴﻴﺎﺭﺓ ﺍﻟﺘﻲ ﺃﻣﺎﻣﻪ ﻃﻮﺍﻝ ﻣﺪﺓ ﺍﻟﺮﺣﻠﺔ؟‬
Does driver use signals and mirrors frequently and when √
necessary?
‫ﻫﻞ ﻳﺴﺘﺨﺪﻡ ﺍﻟﺴﺎﺋﻖ ﺍﻹﺷﺎﺭﺍﺕ ﻭﺍﻟﻤﺮﺍﻳﺎ ﺑﺼﻮﺭﺓ ﺻﺤﻴﺤﺔ؟‬
Does driver follow safety rules in changing lanes? √
‫ﻫﻞ ﻳﺘﺒﻊ ﺍﻟﺴﺎﺋﻖ ﻗﻮﺍﻋﺪ ﺍﻟﺴﻼﻣﺔ ﻓﻲ ﺗﻐﻴﻴﺮ ﺍﻟﺤﺎﺭﺍﺕ ؟‬
Does driver pay full attention to other vehicles, and road √
users?
‫ﻫﻞ ﻳﻘﻮﻡ ﺍﻟﺴﺎﺋﻖ ﺑﺎﻻﻧﺘﺒﺎﻩ ﺍﻟﻜﺎﻣﻞ ﻟﻠﻤﺮﻛﺒﺎﺕ ﻭﻣﺴﺘﺨﺪﻣﻲ ﺍﻟﻄﺮﻕ ﺍﻷﺧﺮﻯ؟‬
Does driver keep lane as much as possible? Does he use √
the proper lane?
‫ﻫﻞ ﻳﺴﺘﺨﺪﻡ ﺍﻟﺴﺎﺋﻖ ﺍﻟﺤﺎﺭﺓ ﺍﻟﺼﺤﻴﺤﺔ ﺍﻟﻤﺨﺼﺼﺔ ﻟﻪ ﺑﺄﻣﺎﻥ؟‬
Assessor Information (‫)ﻣﻌﻠﻮﻣﺎﺕ ﺍﻟﻘﺎﺋﻢ ﺑﺎﻟﺘﻘﻴﻴﻢ‬
Assessor Name (‫ )ﺍﻻﺳﻢ‬:Mohamed Hamdy Ali Your Title (‫)ﻟﻘﺒﻚ ﺍﻟﻮﻇﻴﻔﻲ‬:Engineer
Hussein
Your Company(‫ )ﺃﺳﻢ ﺷﺮﻛﺘﻚ‬:FSO-MS (‫)ﺭﻗﻤﻚ ﺍﻟﻮﻇﻴﻔﻲ‬Your Company ID : 5187
(‫)ﺭﻗﻢ ﺗﻠﻴﻔﻮﻧﻚ ﺍﻟﻤﺤﻤﻮﻝ‬Your Mobile No :
‫ﺗﻮﻗﻴﻊ ﺍﻟﻘﺎﺋﻢ ﺑﺎﻟﺘﻘﻴﻴﻢ‬Assessor Signature :