NEMT Driver Evaluation Form: A Free Quarterly Review With a Coaching Plan

Your brokers already grade every driver you send out, one trip at a time: a late pickup, a complaint, a seat belt left open, a tracking app switched off. A quarterly evaluation puts those same numbers on one page for each driver, adds what you see yourself, and turns each problem into a plan with a due date. This form holds the review, the driver’s own feedback, the coaching plan, and both signatures.

How to use this template

1. Set the review dates for the year. Put every driver on the same four quarter-end dates. MTM Health measures on-time performance by calendar quarter for its Virginia bonus (handbook approved August 10, 2026), so calendar quarters line your reviews up with its scorecard. New drivers also get a review at 90 days.
2. Pull the numbers before the meeting. Use your trip logs, each broker’s portal, your complaint log, and the quarter’s incident reports. Fill in Part 2 from records, never from memory.
3. Write in your brokers’ targets. The target column in Part 2 comes from each broker’s handbook or contract. If you work with more than one broker, use the strictest number. The table of broker standards below shows published examples.
4. Check the driving record. Pull the motor vehicle record at least once a year, and again after any ticket or crash. Compare it with your state and broker limits in Part 3.
5. Watch at least one trip each quarter. Score what you see in Part 4 with the driver ride-along checklist. A camera clip, a dispatcher’s note, or a rider’s report counts too, but write down where each score came from.
6. Ask before you tell. Go through the driver’s questions in Part 7 before you share your scores. Drivers see problems in routes, vans, and schedules that the office misses.
7. Write the coaching plan together. Each problem gets a likely cause, one action, a person who helps, a due date, and a way to check that it worked. Record any retraining in the driver training log.
8. Sign, copy, and file. The driver and the reviewer both sign. Give the driver a copy and keep the original in the personnel file.

The template

Part 1: Driver and review details

Field	Write the entry here in pen
Driver’s full name
Role (driver, attendant, lead driver, or trainer)
Date hired
Review period (from and to)
Review type (quarterly, 90-day, or after an incident)
Vehicle types driven this quarter (sedan, wheelchair van, stretcher van)
Brokers and health plans served
Reviewer’s name and title
Date of the review meeting

Part 2: The quarter in numbers

Measure	How to count it	Driver’s number	Target	Met (yes or no)
Trips completed	Completed legs in the quarter
On-time first pickups	On-time first pickups ÷ all first pickups × 100
Late appointment arrivals	Riders dropped off after the appointment time
Trips the driver failed to run	Assigned trips missed or refused because of the driver
Substantiated complaints	Complaints the broker or you found to be true
Complaint rate	Substantiated complaints ÷ trips completed × 100
Compliments	Praise from riders, families, and facility staff
Tracking on for the whole ride	Tracked trips ÷ trips completed × 100
Complete trip records	Trips with every time, signature, and status entered ÷ trips × 100
Claims sent back for this driver’s entries	Denied or returned claims caused by missing or wrong trip data
Incidents and accidents	Count, and whether each was reported on time
Broker infraction points	Points a broker assessed for this driver’s trips

Part 3: Safety and driving record

Item	Result	Date checked	Initials
Driving record pulled (where from and date)
Moving violations in the last 12 months
At-fault crashes in the last 12 months
Crashes on NEMT trips this quarter (preventable or not)
Record within every state and broker limit (yes or no)
License valid for each vehicle type driven
Driver reported every ticket and crash to you
Camera or tracking alerts reviewed (speeding, hard braking)
Seat belt and phone rules followed on camera or ride-along

Part 4: Riders and conduct

Score each line M (meets), W (needs work), or N (not observed). In the second column, write where you saw it: ride-along, camera, complaint, or dispatch.

Behavior	Score	Where you saw it	Notes
Arrives within the pickup window and calls dispatch about any delay
Shows ID and announces at the door when the pickup is not curbside
Gives the level of assistance on the manifest
Buckles every rider and secures every wheelchair before moving
Keeps the van stopped until every rider is secure
Drives smoothly, with no handheld phone or headphones
Confirms each rider is inside before leaving
Keeps rider information out of sight of other passengers
Treats riders, families, and facility staff with courtesy
Accepts no money, gifts, or favors from riders
Gives complaint contact details whenever a rider asks
Calls dispatch and waits the required time before any no-show

Part 5: Trip paperwork and vehicle care

Item	Score (M, W, or N)	Notes
Daily vehicle inspection done and signed every shift
Defects reported the same day
Lift, ramp, and securement straps kept clean and working
Interior clean, with no debris or odors
Required equipment on board (extinguisher, first aid kit, spill kit, belt cutter, belt extenders)
Heat and air conditioning working, and problems reported
Pickup, drop-off, and odometer entries made at the time of the trip
Rider signatures collected where the broker requires them
Incident and accident reports filed the same day

Part 6: Training and credentials coming due

Item	Expiration or due date	Class or renewal booked (date)
Driver’s license
Passenger assistance (PASS or the course your broker names)
Wheelchair securement
Defensive driving
First aid and CPR
Broker compliance modules
Yearly background check, driving record, and drug test
Any other course due in the next 90 days

Part 7: The driver’s view

Question	Driver’s answer
What went well this quarter?
Which route, rider, or van gives you the most trouble?
What makes you late when you are late?
What training or equipment would help?
What should dispatch or the office change?

Part 8: Coaching plan

Problem	Likely cause	Action	Who helps	Due date	How we will check	Done (date)

Part 9: Result and signatures

Field	Write the entry here in pen
Result (meets standards, coaching plan needed, or off member trips)
Strengths to note in the file
Bonus or recognition earned, if your pay plan has one
Next review date
Driver’s comments
Driver’s signature and date (signing means the review was discussed)
Reviewer’s signature and date

Broker standards to write in as targets

Start with the numbers in your own contracts. These published examples were current in September 2026.

Measure	MTM Health, Virginia (handbook approved August 10, 2026)	MTM Health, Rhode Island (handbook updated July 1, 2026)
On time	On-time performance above 95%. A first pickup is on time from 15 minutes before to 15 minutes after the scheduled pickup	Timeliness scored under 4.99% green, 5% to 6.99% yellow, 7% or more red (lower is better)
Complaints	Substantiated complaints under 0.1% of completed trips	Under 0.09% green, 0.1% to 0.49% yellow, 0.5% or more red
Trips the provider failed or refused to run	Under 0.25%	Under 0.29% green
GPS tracking	More than 90.01% of trips	More than 90.01% green, under 75% red
Claims with missing or wrong information	Under 0.99%	Under 0.99% green
Denied claims	Under 0.29% of claims	Under 0.29% green, counting denials for uncredentialed drivers or vehicles

MTM Health serves Virginia’s fee-for-service members for trips on or after October 1, 2026. It also requires riders to be dropped off no later than the appointment time, and the 15-minute window applies only to the first pickup. Its field monitor reviews each measure with you regularly. Missing them can bring a performance improvement plan, liquidated damages, or removal from the network.

Company targets become driver targets with simple math. Say a full-time driver completes 700 trips in a quarter and draws one substantiated complaint. That is about 0.14 percent (1 ÷ 700 × 100), above Virginia’s 0.1 percent line. If 20 of the same driver’s 350 first pickups were late, the on-time rate is 94.3 percent (330 ÷ 350 × 100), just under 95. For the company-wide view, see NEMT KPIs and NEMT broker scorecards.

What one driver can cost you in broker points

Part 2 asks for infraction points because a broker can charge one driver’s mistakes to your whole company. MTM Health’s Virginia handbook (approved August 10, 2026) assigns points per instance. They last one year from the day they are assessed, and they can come from an in-person field audit, a complaint, or state monitoring.

Points	Examples tied to a driver
1	Driver seen without the MTM Health name tag. Passenger seat belts not buckled. Van not kept stopped until the rider is secure. Van not parked in a safe place for loading.
2	Each expired driver or vehicle credential used. A substantiated wheelchair or stretcher securement complaint. A complaint about a vehicle safety problem, such as a torn seat belt or broken heat or air conditioning.
3	A driver never credentialed in MTM’s system. Failure to report an incident or accident. Substantiated abandonment, such as dropping a rider at the wrong place or skipping the hand-to-hand handoff.

At 3 points your access to MTM’s trip marketplace is suspended until the points come off. At 5 you get a 5-day suspension, at 8 a 10-day suspension and the loss of any recurring trips assigned to you, and at 10 removal from the network. Level 2 problems can also bring required driver retraining, a vehicle reinspection, or loss of payment for the trips. Level 3 brings an immediate suspension of at least 5 days.

Which rules call for driver evaluations

• Oregon. CareOregon’s provider manual (version 1.3, February 2024) is the template its NEMT brokerages use to set provider standards. It requires transportation providers to plan regular performance evaluations for all paid and volunteer drivers, and encourages a schedule that covers road performance, vehicle operations, and customer service. Each evaluation and discussion should be documented, signed, and made a permanent part of the driver personnel file, with positive notes included, and a plan of correction and more training should follow when needed. GOBHI’s provider manual (revised July 2025) carries the same requirement.
• New York ambulettes. The state’s Medicaid transportation manual (effective August 25, 2023) requires ambulette drivers to be qualified under Article 19-A of the Vehicle and Traffic Law. Section 509-g then requires regular observation of each driver’s defensive driving while carrying passengers, with written reports kept in the driver’s file, a behind-the-wheel test every two years, and a yearly check of the driving record with a personal interview. As of September 2026, the DMV describes the observations as yearly, done by certified examiners, and carriers file an affidavit of compliance by July 1 each year.
• Minnesota. A special transportation provider keeps a record of every complaint, report, or allegation of misconduct against a driver or attendant, investigates it, and writes down the result and any action taken (Rules 8840.5900, subpart 17). If a driver stops meeting the state standards, the provider stops using that driver immediately and reports it to the state (subpart 16).
• Commercial vans under federal rules. A van designed or used to carry 9 or more people, including the driver, for pay, or one with a gross vehicle weight rating of 10,001 pounds or more, is a commercial motor vehicle when it runs in interstate commerce (49 CFR 390.5). For those drivers you pull the driving record at least every 12 months, give great weight to speeding, reckless driving, and impaired driving, and keep a note with the reviewer’s name and the date in the driver qualification file (49 CFR 391.25). See do NEMT drivers need a CDL.

Driving record limits to check at each review

A driver who qualified at hire can drift out of bounds later. Compare each new record with the limits for every program the driver serves.

Program	Limit
Virginia fee-for-service (DMAS, updated May 26, 2026)	No more than two chargeable accidents or moving violations in the last 3 years, a DMV point balance no worse than -2, and no suspension or revocation for moving violations in the last 5 years
MTM Health, Virginia (handbook approved August 10, 2026)	The same record limits, plus a minimum age of 21 with two years of driving experience
Georgia (DCH manual, version date July 1, 2026)	A driver convicted of two moving violations or at-fault accidents on NEMT trips must be removed. No suspended or revoked license in the last 5 years.
Texas Medicaid health plans (NEMT Services Handbook, version 2.0.1)	No more than one moving violation, on or off the job, in a rolling 12 months. No DWI or DUI conviction within 7 years before hire or any time after.
Louisiana (manual section 10.3, issued July 14, 2025)	No 3 or more moving violations and no DWI conviction in the past 3 years, with a criminal history check every year

CareOregon also lets its brokerages disqualify a driver at once for repeated collisions or a single serious collision. How to read a record and order one is in NEMT driver background checks.

Turning a problem into a coaching plan

A good plan fixes the cause, not only the symptom. CareOregon’s manual lists the reasons its brokerages may order intervention training: moving violations, a preventable collision or a series of collisions, a complaint about driving or customer relations, observed changes in mental condition, health, or stamina that affect the job, and improper program paperwork. Use the same list to start a coaching plan yourself, before the broker does.

Build each plan from the same parts CareOregon requires in a provider’s corrective action plan: the factors behind the problem, the person responsible, the specific actions, a deadline, and how progress will be checked. Part 8 has a column for each. See corrective action plan for how brokers use them with your company.

1. Look for the cause first. A driver who is late every Tuesday may have an impossible Tuesday route. MTM Health’s Virginia handbook says safety must never be compromised to meet scheduling requirements, so fix the schedule before you blame the driver.
2. Match the action to the problem. A securement complaint calls for hands-on retraining in your own van. Georgia removes a driver after one confirmed failure to secure a wheelchair until you send the broker documentation of securement training (DCH manual, section 907.16).
3. Ride along again before the due date. Check the fix on real trips and write the result in the last column.
4. Know where retraining ends. Under MTM Health’s Virginia handbook, a driver who completes required retraining after a serious violation and then commits another violation can no longer drive for any health plan MTM Health manages.
5. Use steps you set in advance. OSHA’s employer guidelines, written with NHTSA and NETS, describe corrective action programs that mostly assign points for moving violations, with progressive discipline when a pattern starts and set actions at a set count of violations or preventable crashes in a set period. Put yours in the driver handbook so every driver knows them.

If a decision to reassign or let a driver go rests on a background or driving report from a screening company, the FTC (October 2016) says to give the driver a copy of the report and “A Summary of Your Rights Under the Fair Credit Reporting Act” first. After you decide, send a notice naming the screening company and explaining the driver’s right to dispute the report.

Pay, bonuses, and the review meeting

OSHA’s employer guidelines say safe driving works best when it is part of the overall job evaluation. They describe rewards such as recognition, money, and special privileges. Keep the pay rules in mind when you add them.

• The meeting is paid time. Meetings count as work unless attendance is outside regular hours, voluntary, not directly related to the job, and involves no productive work (29 CFR 785.27). A review you require is not voluntary (29 CFR 785.28).
• A promised bonus raises the overtime rate. A bonus promised in advance, including one for a good review score, is not discretionary. The rule puts most attendance bonuses, bonuses for quality of work, and bonuses for staying with the company in the regular rate of an employee who earns overtime. A bonus stays out as discretionary only when you decide both whether to pay it and how much at or near the end of the period, with no earlier promise (29 CFR 778.211). See NEMT driver overtime.
• Recognition costs little. A note in the file, first pick of routes, or a lead driver role rewards the numbers brokers grade. NEMT driver retention covers what keeps good drivers.

Keeping evaluation records

Rule	What to keep, and how long
CareOregon and GOBHI manuals (Oregon)	Each signed evaluation, including positive notes, should be a permanent part of the driver personnel file
New York Article 19-A (VTL 509-g)	Written reports of each defensive driving observation, in the driver’s file
Minnesota Rules 8840.5900, subpart 17	Every complaint against a driver, the investigation, and the action taken, in the driver file or a separate file
MTM Health standard agreement (Pennsylvania copy, January 1, 2023)	Complete records of your operations for 10 years, or longer if a law or client requires it
Federal commercial van rules (49 CFR 391.51)	The driver qualification file for the whole job and 3 years after. Yearly driving records and review notes may be removed 3 years after they were made.

File the evaluation behind the driver’s credentials in the driver qualification file, so an auditor sees the whole history in one place.