Transcription of EQUIPMENT OPERATOR'S QUALIFICATION RECORD (EXCEPT …
1 LAST, FIRST January 1975 BlackBrown6'2"185 Duty PositionSedan & S/WTrk UtilTrk CarryallTrk PU, PA5-8 Pax1/2 Ton12 Pax1/2-1 TonA1A1A1A1 USAGY, TMPUSAGY, TMPUSAGY, TMPUSAGY, TMPS edan5PC&RInterviewTrainingTrainingTraini ngTest/LicensingCommanderQualificationsW inter DrivingAAACS tandardCompleted Commander Interview IAWAR 600-55. Cert. by:Completed Driver Trianing AR 600-55,8th Army Suppl 1 to AR 600-55 &USFK Pam. 385-2 Cert by:IAW 8th Army Suppl 1 to AR 600-55 USAGY, TMP Driver Testing Verified 8th Army Suppl 1 to AR I - OFFICIAL QUALIFICATIONSS pecial EQUIPMENT , special operations or conditionsCity, rural, long haul, OF EQUIPMENTSIZEQUALIFIED ATNAME OF EXAMINERDATE QUALIFIEDDATECREDITSDEBITSTYPE OR NATUREACTION TAKENSECTION III - PERFORMANCE RECORDSECTION II - BACKGROUND AND EXPERIENCETYPE OF EQUIPMENTSIZETYPE OF DRIVINGOR OPERATIONADDITIONALDRIVER'S LICENSESNUMBER OF OTHERDRIVER'S LICENSESSATISFACTORY EXPERIENCEVERIFIED BYNUMBERDATE ISSUEDTYPESEXDATE OF BIRTHCOLOR HAIRCOLOR EYESHEIGHTWEIGHT212DA FORM 348.
2 AUG 2011 PREVIOUS EDITIONS ARE PE QUALIFICATION 1 EQUIPMENT OPERATOR'S QUALIFICATION RECORD (EXCEPT AIRCRAFT)(List chronologically as "credits" - awards, training, retraining, testing, retesting, roadeos, permit renewal, relicensing, etc; and as "debits" - accidents, arrests, violations, warnings, revocations, suspensions, etc.) PERMIT (Initial)(State or agency)NAME (Last, first, initial)LIMITATIONS (Physical or operational)POSITION TITLE (If civilian)(Extract from personnel file tomaintain at operating level.)Page 1 of 2 For use of this form, see AR 600-55; the proponent agency is DCS, G3/5 IV - EXAMINATION FINDINGSSTARTOIL LEVEL STICKTACHOMETERTEMPERATUREGAGEOIL PRESSUREGAGEVOLTOMETERAIR PRESSURE GAGEFUEL TIRESHORNHANDBRAKESCLEANHEADLIGHTSFOOTBR AKESOILLEVELBAT-TERYWATERLEVELLOCAL LAWSOPERATINGPROCEDURESACCIDENTREPORTING MY DRIVING WEAKNESSES HAVE BEENMADE KNOWN TO ME AND I HAVE BEENSHOWN HOW TO OVERCOME OR ADJUST THEM.
3 ROAD TEST SCORENUMBER OF TALLY MARKS ON1007. ADDITIONAL REQUIREMENTS FORLICENSE(Two feet from target)5. DEPTH PERCEPTION(Location and use)3. EMERGENCY EQUIPMENTROAD TEST - PREREQUISITE" if successful, "x" if failed and corrective training is needed)DA FORM 6122DA FORM 6123DA FORM 6124 BATTERY II -NOYESSUCCESSFUL COMPLETIONENTER SCORE FROMITEM 24 OF INDIVID-UAL'S DA FORM 20 TOTAL STANDARD SCORE- IF QUALIF'D- IF EVALUATION MEASURESSIGNATURE OFEXAMINER1. INSTRUMENTS2. BEFORE OPERATION CHECK4. CONTROLS - "DRY RUN"AMMETERII1. VISUAL ACUITY2. FIELD OF VISION3. HEARING4. REACTION TIME5. DEPTH PERCEPTION6. COLOR PERCEPTIONooRAW SCORESTANDARD SCORECOMMENTS AND RECOMMENDATIONS ONSUBSTANDARD ITEMS/100 SEC/100 SEC/20/20 HIGHWAY WARNING KITTHIRD TRYSECOND TRYFIRST TRYFRONT AXLECLUTCHBRAKEGEARSFIRE OUTSHIFT3 STOPSTURNSBACKINGDA FORM 348, AUG 2011 STANDARD SCORELEFT EYERIGHT EYERIGHT EARLEFT EARLEFT EYE20/ RIGHT EYE20/ SIGNATURE OF MEDICAL AUTHORITYCOMMENTS AND RECOMMENDATIONS OF ROAD TEST EXAMINERSIGNATURE OF ROAD TEST EXAMINERDATESIGNATURE OF APPLICANT CHECK LIST PRT 2678 (Subtract) ROAD TEST - SCORED PHASE (DA PRT 2678)6.
4 PRACTICE RUN ( mile)DRIVING PERFORMANCE TEST (Check " BATTERY I - (AdministeredSTANDARD SCORE FOR BATTERY II (Divide Total Standard Score by 3)OTHER (Describe)EXAMINATION ADMINISTERED BY (Last name - first name - middle initial)OTHER (Describe)(To be administered to all applicants for Driver Permit SF 46) (To transfer raw score to standard scoresee DA Pamphlet 611-119)as a part of reception pro-cessing, at reception stations)(Location, correct read-ing, action for abnormalreading)/APD PE 2 of 2)
