SECTION IV - EXAMINATION FINDINGS
BATTERY II - (To be administered to all applicants for Driver Permit SF 46) (To transfer raw score to standard score
BATTERY I - (Administered
see DA Pamphlet 611-119)
as a part of reception pro-
RAW SCORE
STANDARD SCORE
cessing, at reception stations)
DA FORM 6122
DA FORM 6123
ENTER SCORE FROM
DA FORM 6124
ITEM 24 OF INDIVID-
UAL'S DA FORM 20
TOTAL STANDARD SCORE
STANDARD SCORE FOR BATTERY II (Divide Total Standard Score by 3)
STANDARD SCORE
SUCCESSFUL COMPLETION
EXAMINATION ADMINISTERED BY (Last name - first name - middle initial)
YES
NO
COMMENTS AND RECOMMENDATIONS ON
?
SIGNATURE OF
- IF QUALIF'D
I
PHYSICAL EVALUATION MEASURES
SUBSTANDARD ITEMS
X
- IF SUBSTAND.
EXAMINER
LEFT EYE
RIGHT EYE
1. VISUAL ACUITY
20/
20/
LEFT EYE
RIGHT EYE
o
o
2. FIELD OF VISION
/
/
LEFT EAR
RIGHT EAR
3. HEARING
/20
/20
4. REACTION TIME
/100 SEC
/100 SEC
SIGNATURE OF MEDICAL AUTHORITY
5. DEPTH PERCEPTION
6. COLOR PERCEPTION
II
DRIVING PERFORMANCE TEST
(Check "? " if successful, "x" if failed and corrective training is needed)
A.
ROAD TEST - PREREQUISITE
TEMPERATURE
OIL PRESSURE
OIL LEVEL STICK
VOLTOMETER
1. INSTRUMENTS
(Location, correct read-
GAGE
GAGE
ing, action for abnormal
reading)
AMMETER
TACHOMETER
FUEL GAGE
AIR PRESSURE GAGE
VEHICLE
CONDITION
CLEAN
OIL
BAT-
SEAT
DAMAGE
OF TIRES
HEADLIGHTS
LEVEL
TERY
ADJUSTMENT
2. BEFORE OPERATION CHECK
MIRROR
HAND
FOOT
WATER
HORN
WIPER
ADJUSTMT.
BRAKES
BRAKES
LEVEL
FIRE EXTINGUISHER
HIGHWAY WARNING KIT
OTHER (Describe)
3. EMERGENCY EQUIPMENT
(Location and use)
GEARS
BRAKE
CLUTCH
FRONT AXLE
4. CONTROLS - "DRY RUN"
FIRST TRY
SECOND TRY
THIRD TRY
5. DEPTH PERCEPTION
(Two feet from target)
START
PULL OUT
SHIFT
3 STOPS
TURNS
BACKING
6. PRACTICE RUN (½ mile)
OPERATING
ACCIDENT
LOCAL LAWS
PROCEDURES
REPORTING
OTHER
(Describe)
7. ADDITIONAL REQUIREMENTS FOR
LICENSE
B.
ROAD TEST - SCORED PHASE (DA PRT 2678)
100
COMMENTS AND RECOMMENDATIONS OF ROAD TEST EXAMINER
NUMBER OF TALLY MARKS ON
CHECK LIST PRT 2678 (Subtract)
ROAD TEST SCORE
SIGNATURE OF ROAD TEST EXAMINER
DATE
SIGNATURE OF APPLICANT
MY DRIVING WEAKNESSES HAVE BEEN
MADE KNOWN TO ME AND I HAVE BEEN
SHOWN HOW TO OVERCOME OR ADJUST THEM.
Page 2 of 2
DA FORM 348, AUG 2011
APD LC v1.00