Fillable Printable Form DPR-125 - Drinking Driver Program Classroom Site Inspection Report - New York

Form DPR-125 - Drinking Driver Program Classroom Site Inspection Report - New York

A. CLASSROOM

Does the classroom adequately comply with the following criteria:

Yes No

1. Clean, comfortable and conducive to learning. . . . . . . oo

2. Accessible restroom facilities. . . . . . . . . . . . . . . . . . . oo

3. Well-heated/ventilated. . . . . . . . . . . . . . . . . . . . . . . . . oo

4. Has adequate lighting. . . . . . . . . . . . . . . . . . . . . . . . . . oo

5. Good line of vision from all seats. . . . . . . . . . . . . . . . oo

6. No visual or audible distractions. . . . . . . . . . . . . . . . . oo

DDP Name______________________________________________ DDP Director________________________________

Main Office Address ___________________________________________________ Telephone ______________________

( )

(City, State, Zip Code)

(Building Name, Room Number, City, State, Zip Code)(County)

Classroom Address____________________________________________________________________________________

____________________________________________________________________ _______________________________

B. EQUIPMENT Yes No

1.oChalkboard oroFlipcharts. . . . . . . . . o o

2. TV/VCR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o o

3. Other:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o o

______________________________________

C. Class Size (sq. ft.) ______________

Number of Students Permitted in Classroom _____________

(allow 15 sq. ft. per student with a minimum of 8 students

and a maximum of 25 students)

oCheck here if classroom is Handicapped accessible

D. Remarks:____________________________________________________________________________________________________

______________________________________________________________________________________________________________

Person Interviewed________________________________________________________________ Date Inspected________________________

Inspector’s Name______________________________________________Inspector’s Signature ç________________________

Supervisor’s Signatureç________________________________________________________ Date____________________________

INSPECTOR’S CHECK LIST:

INSPECTION

Recommendation:

oAPPROVE oDENY oREINVESTIGATE

DPR-125 (3/15)

Please send to:

New York State Department of Motor Vehicles

Bureau of Driver Training Programs

6 Empire State Plaza, Room 412

Albany NY 12228

DRINKING DRIVER PROGRAM (DDP)

CLASSROOM SITE INSPECTION REPORT

Business ID Number

OFFICE USE ONLY

TO BE COMPLETED BY DRINKING DRIVER PROGRAM

TO BE COMPLETED BY DMV

(Name and Title)

(Print)

DDP Program Code

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