The official Indiana paperwork is State Form 54706 Log of Supervised Driving — the output is expected to match the form exactly. This sheet is not an official form: it is a dated
record you can keep as you go and copy onto, or attach to, whatever Indiana asks for.
Official source.
Learner name
Permit / licence number
Supervising adult
Adult licence number
| Date | Start | End | Total min | Night min | Road / weather | Adult initials |
|---|---|---|---|---|---|---|
| Page totals | ||||||
I confirm that the drives listed above took place as recorded and that I supervised them.
Supervising adult signature
Date
Learner signature
Date