Colorado School of Mines
Fleet Services

Vehicle Operator Rating Evaluation Form

To be used in conjunction with the Vehicle Operator Approval Request.
Facilities Management Department – Fleet Services will pull Motor Vehicle Records (MVR) and complete this form based on the information
received from the Vehicle coordinator and the MVR.
Total points will be rounded down.

Applicant Name:


DL #

State
Review Date




Points Assignable
Points Assigned
Less than 2 years
2
More than 2 years
0
Ticketed accidents (within last 3 years)
1 accident
1.5
2 accidents
3
3 accidents
6
Violations/Convictions (within last 3 years)
Fail to stop & render aid/give information
6
Driving under the influence of alcohol or drugs
6
Driving without a license
6
Intoxication manslaughter or assault
6
Operating a motor vehicle during period of suspension or revocation of
driver license under any law 6
Permitting an unlicensed person to drive
2
Administrative license revocation
4
Racing or unsafe/excessive speed
6
Reckless, negligent or careless driving
6

Moving Violations (within last 3 years)
Speeding <25 mph over limit_____violations

1.5 each
Speeding >25 mph over limit_____violations

3 each
Failed to stop _____violations

1 each

All other moving Violations:
1 or 2

1
3 and over
_____violations

1 each









Total Points Assigned:
Evaluation and Driving Status:

Total Points Assigned
Driver Evaluation Rating
CSM Driving Status

0
Superior
1-2
Good
Approved
3-4
Average
5-6
Probationary
Not Approved
6+
Unacceptable
15-Passenger Van Operator? No more than one moving violation in 12 months allowable.

Operators receiving a "Probationary" or "Unacceptable" rating are not allowed to operate CSM vehicles.
Status:

Notified Not needed
Yes
Date of notification:
/
/


Supervisor notified:
__
Notified by: _____________________________________Attachment B