Background Road accidents represent a significant public health concern in India, contributing to a substantial portion of preventable deaths and disabilities. According to national data, road accidents account for approximately 2.85% of the total Disability-Adjusted Life Years (DALYs) in the country, underscoring the urgent need for effective road safety measures. Among the diverse modes of transportation, road transport plays a pivotal role in facilitating economic growth and connectivity. However, despite their crucial role, there remains a gap in comprehensive research focusing on the specific challenges and risks associated with heavy commercial vehicles. These vehicles, due to their size and weight, are often involved in severe or fatal accidents, highlighting the importance of understanding and addressing road safety issues within this sector.

Objective The aim of this study was to assess the knowledge and practices of truck drivers related to road safety in Delhi, a key metropolitan area with significant transportation activity and road traffic challenges.

Methods A cross-sectional study to assess the awareness levels, behaviours, and actual practices of truck drivers, the study aimed to identify key areas for intervention and policy development to bridge the gap between knowledge and practice, ultimately enhancing road safety outcomes and reducing the incidence of accidents caused by heavy commercial vehicles.

Results The study’s findings indicate that the median knowledge score among drivers was 7 out of 15 questions, with an interquartile range (IQR) of 6 to 9. Regarding self-reported practices, approximately 34.29% of drivers claimed to stop at red lights, while 92.86% reported using indicators. However, upon observation at traffic junctions, the actual stopping rate at red lights was 11.80% higher than self-reported, whereas the use of indicators was significantly lower by 60.24% compared to self-reports.

Conclusions The study participants had moderate knowledge about road traffic signs and regulations, but most of them had poor knowledge in identifying some of the basic road signs for which they were penalized the most; these signs were load limit and no entry. Though the driving practices of the participants were reported as good, there was a difference between the observed and the reported practices of the participants.