Colorado School of Mines
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.
Less than 2 years
More than 2 years
Ticketed accidents (within last 3 years)
Violations/Convictions (within last 3 years)
Fail to stop & render aid/give information
Driving under the influence of alcohol or drugs
Driving without a license
Intoxication manslaughter or assault
Operating a motor vehicle during period of suspension or revocation of
driver license under any law 6
Permitting an unlicensed person to drive
Administrative license revocation
Racing or unsafe/excessive speed
Reckless, negligent or careless driving
Moving Violations (within last 3 years)
Speeding <25 mph over limit_____violations
Speeding >25 mph over limit_____violations
Failed to stop _____violations
All other moving Violations:
1 or 2
3 and over
Total Points Assigned:
Evaluation and Driving Status:
Total Points Assigned
Driver Evaluation Rating
CSM Driving Status
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.
Notified Not needed
Date of notification:
Notified by: _____________________________________Attachment B