Driving Record Abstract Review Form

Give HR staff a structured way to review an employee's driving record abstract, flag automatic disqualifications, and document the resulting action plan with signatures.

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Review Date

Employee Name*

Nombre

Apellido

Abstract For*

New Hire Annual Review Post-Incident Random Check

Automatic Disqualifications?*

Yes No

Automatic Disqualifications*

DUI Conviction License Suspension Reckless Driving At-Fault Accident

Select One*

Approved Denied Pending Review

Action Plan*

Monitor Retrain Suspend Terminate

Authorization*

Approved by Manager Approved by HR Requires Further Review

Action Plan Signature

Sign here

Action Plan Comments

Signature

Sign here

Comments

Reviewer Signature

Sign here

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