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Click ‘Get Form’ to open the violation and review record in the editor.
Begin by entering the driver's name at the top of the form. Ensure it is printed or typed clearly for accuracy.
In the 'CERTIFICATION OF VIOLATIONS' section, list any traffic violations from the past 12 months. Fill in each field with the date, offense, location, and type of vehicle operated.
If there are no violations to report, check the box indicating that you have not been convicted or forfeited bond during this period.
Sign and date the certification section where indicated. Also, provide your motor carrier's name and address.
In the 'REVIEW AND EVALUATION OF DRIVER'S RECORD' section, ensure all information has been reviewed as per regulations. Document any actions taken regarding the driver's safety operations.
Finally, have a reviewer sign off on this section along with their title and date of review.

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