Cover Sheet: Practical Exam - EMS Transport Unit Driver/Operator

Practical Exam

EMS Transport Unit Driver/Operator
Candidate Name*

First NameLast Name
Candidate FSID*
Date*

MonthDayYear
Date
Station Assigned*
Shift*
Unit #*
Unit Make*
Evaluator Name*

First NameLast Name
Exam Type*

Initial ExamRetest
The candidate must present the following prior to starting the exam. All information must be complete and signed as necessary. Any missing or incomplete items will result in postponement of the exam.
Required information*

Driver Training Log (min 6 Hours)Written AssignmentsSafe Driver Behavior Evaluations (min 3)First Due Knowledge ExamTraining Competencies
Record the starting times and ending times for each component listed.
Pre-Trip & Air Brake*

Hour Minutes

Until
until
Hour Minutes
Driving*

Hour Minutes

Until
until
Hour Minutes
Record the results and score for each exam area.
Pre-trip
Result*

PassFail
Score*
Air Brake Test
Result*

PassFail
Score*
Road Driving
Result*

PassFail
Comments
Should be Empty:

Practical Exam