- Form DS-879 - Article 19-A Carrier Application - New York
- Form DS-875 - Article 19-A Biennial Behind the Wheel Road Test - New York
- Form DS-103 - Report of Passing Stopped School Bus - New York
- Form DS-3.3 - Article 19-A Motor Carrier Annual Statistical Report - New York
- Form IRP-5 - Schedule B Mileage Information (2013) - New York
- Form IRP-33 - IRB Renewal Checklist - New York
Fillable Printable Form DS-875 - Article 19-A Biennial Behind the Wheel Road Test - New York
Fillable Printable Form DS-875 - Article 19-A Biennial Behind the Wheel Road Test - New York
Form DS-875 - Article 19-A Biennial Behind the Wheel Road Test - New York
CARRIER INFORMATION
5. SIMULATED PROCEDURES FOR RECEIVING/
DISCHARGING PASSENGERS
A. Failed to use caution at approaching/departing,
receiving/discharging points DQ
B. Failed to properly activate warning lights/devices
(where applicable) DQ
C. Lacked knowledge of proper crossing procedures
as required by NYS Education Department
(where applicable) DQ
D. Failed to observe pedestrians/passengers or other
hazards at receiving and discharge points DQ
4. PARKING AND BACKING
A. Failed to leave the vehicle to check rear before
backing (no observer) 10
B. Failed to observe (backing) DQ
C. Unable to park DQ
D. Failed to properly position the vehicle 5
E. Stopped too far away from, or hit, curb 5
F. Excessive maneuvers in parking 5
2. DEPARTING
A. Failed to signal 5
B. Failed to observe 10
C. Failed to use caution 10
3. EN-ROUTE
A. Failed to properly signal 5
B. Failed to observe 10
C. Failed to demonstrate proper judgment approaching/at
intersection; speed, turning, stopping, observing, etc. 10
D. Failed to make proper lane changes; signals ______,
observes _______, procedure _______ 5
E. Failed to regularly check mirrors while driving 5
F. Failed to stop properly at RR crossing DQ
G. Failed to use proper clutch/engine control 5
H. Failed to use proper judgment in traffic 10
I. Failed to demonstrate proper following distance DQ
ARTICLE 19-A BIENNIAL BEHIND THE WHEEL ROAD TEST
www.dmv.ny.gov
INSTRUCTIONS TO CERTIFIED EXAMINER
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This test shall not be conducted on the same day as the annual defensive driving performance observation. The test should be taken without
passengers in the vehicle.
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If the driver fails the test, he/she is disqualified from driving under Article 19-A. He/she may make a request to the carrier for a reexamination.
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Examiner will circle the point value of those items not properly performed. Driver is disqualified if 40 or more points are circled or, if a DISQUALIFICATION (DQ)
item is circled, or if any two 10-point items are circled.
1. PRE-TRIP TEST
Point Value
A. Failed to check wheels, tires 5
B. Failed to check validation of required vehicle stickers 5
C. Failed to check lights 5
D. Failed to check windshield, wipers, horn, and steering 5
E. Failed to check emergency equipment:
fire extinguisher, and emergency reflectors 5
F. Failed to check seats and restraints when equipped. 5
G. Failed to check passenger entry and emergency exits 5
H. Failed to check all gauges, heater, and defroster 5
I. Failed to check all mirrors and adjust as needed 5
J. Failed to perform static brake check 5
K. Failed to properly use seat belt 5
L. Failed to perform 50 ft. brake test 10
EN-ROUTE (Continued) Point Value
J. Failed to use proper speed - impedes traffic 5
K. Failed to use proper steering control 5
L. Failed to use proper braking 5
M. Failed to use proper acceleration 5
N. Failed to use proper speed for conditions DQ
O. Failed to anticipate and/or identify hazards 5
P. Failed to yield right-of-way DQ
Q. Failed to use proper lane/s 10
R. Failed to properly use transmission 5
S. Failed to observe traffic control devices DQ
SCORING: Total Points Circled Above ______ Disqualification (DQ) Circled Above o YES o NO
Two 10-point items Circled Above o YES o NO
CERTIFIED EXAMINER’S COMMENTS: (write or type on reverse side)
RESULTS:
o QUALIFIED
o DISQUALIFIED
Certified Examiner’s Name
Certificate Number Certification Class Expiration Date
DS-875 (6/15)
Endorsements
Restrictions
Certified Examiner’s Signature
-
DRIVER INFORMATION
Driver’s Last Name
Street Address
Type of Vehicle Adult Seating Capacity GVWR
Vehicle Plate Number State
City State
State
Zip Code
Class of Driver’s License Endorsements Restrictions Expiration Date
Client/License ID Number
(from Driver License)
Client/License ID Number
(from Driver License)
Driver Signature
First
M.I. Date of Birth (Month/Day/Year)
VEHICLE INFORMATION
EXAMINER’S CERTIFICATION
Date of Test
Carrier/DBA Name Legal Name (if different)
Street Address City State Zip Code
Federal ID Number 19-A Business ID Number
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