Ds 872 Form – Fill Out and Use This PDF

The DS-872 form serves as a comprehensive assessment tool for carriers to annually review their employees' driving records under Article 19-A, focusing on driving history, accident involvement, and any convictions not listed on the driver's abstract. It collects detailed information about the driver's identity, vehicle accidents, and any traffic violations or crimes, ensuring that all necessary disclosures are made for the safety and compliance of commercial driving operations. For those needing to complete or update their DS-872 form, click the button below to get started.

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Ds 872 Form PDF Details

Ensuring the safety of drivers and the public on the roads is a critical responsibility for carriers, especially those operating buses and large vehicles. The DS 872 form, a vital tool in this mission, serves as an annual review of a driver's record under the specific guidelines of Article 19-A. This form captures detailed driver information including their name, birth date, driver's license details, and any endorsements or restrictions. Furthermore, it requires carriers to report any motor vehicle accidents within the past 12 months that haven't appeared in the driver's abstract, along with a section for recording any traffic violations or crimes. This includes the type of vehicle operated and the location of the violation, aiming to paint a comprehensive picture of the driver's recent history on the road. The DS 872 also facilitates an affirmation process where both the driver and the carrier representative certify the accuracy and completeness of the information provided. This process not only promotes transparency but also ensures that drivers meet the standards for safe driving as stipulated in Article 19-A. By meticulously filling out the DS 872 form, carriers take a proactive step in upholding public safety and maintaining high standards of driver responsibility and accountability.

Question	Answer
Form Name	Ds 872 Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	ds872 19a form, ds record 19, ds annual 19, nys dmv ds 872

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CARRIER’S ANNUAL REVIEW OF EMPLOYEE’s

DRIVING RECORD UNDER ARTICLE 19-A

DRIVER INFORMATION

Driver’s Last Name	First			M.I.	Date of Birth (Month/Day/Year)

License ID Number		State	Class of Driver’s License	Endorsements		Restrictions	Expiration Date
(from Driver License)

CARRIER INFORMATION

Carrier/DBAName

Federal ID Number

19-ABusiness ID Number

Legal Name (if different)

Were you involved in ANY motor vehicle accident(s) during the past 12 months that do not appear on your abstract? YES NO If YES, completeAccident Information section below:

ACCIDENT INFORMATION (ifadditionalspaceisneeded,usethebackofthisform)

Date
of	Location
Accident	City, State, Zip Code, County

Briefly describe property damage, type of vehicle involved and

approximate dollar value of damage for each vehicle

Number of

People

Injured

Were there

any fatalities?

YES or NO

Were you convicted of ANY traffic violation(s) (other than parking) or any crime(s) during the past 12 months that do not appear

on your abstract? YES		NO If YES, complete Record of Convictions section below:
RECORD OF CONVICTIONS (ifadditionalspaceisneeded,usethebackofthisform)
Date of	Date of	Of What Charge	Type of	Court Location
Violation	Conviction	Were You Convicted?	Motor Vehicle Operated	City, State, Zip Code, County

			CMV
			Non-CMV
			CMV
			Non-CMV
			CMV
			Non-CMV

DRIVER CERTIFICATION

I certify that the information above is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months, and accidents I was involved in during the past 12 months. If no violations or accidents are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months, or have been involved in any accidents during the past 12 months that is not already listed on my license abstract.

(Driver Signature)

(Date)

CARRIER CERTIFICATION

I have compared the information given by the driver with the attached driver’s abstract of operating record. I have ensured that all accident and conviction details not appearing on the driver’s abstract are listed on this form. I HAVE ATTACHED THE DRIVER’S

ABSTRACT(S),WHICH MUST BE DATED WITHIN 30 DAYS PRIOR TO THE DATE OF THIS INTERVIEW.

I interviewed this employee and certify that this driver meets the standards for safe driving, has been instructed in, and is in compliance with, the provisions ofArticle 19-A, and is qualified to drive a bus.

	(Print Name of Carrier Representative)		(Title)
X
	(Authorized Signature of Carrier Representative)		(Date of Interview)
DS-872 (5/16)		dmv.ny.gov	reset/clear
			reset/clear

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Completing this form requires attentiveness. Make sure that all mandatory areas are done properly.

1. To start off, while filling in the nys dmv form ds 872, start out with the page that includes the following blanks:

2. Just after filling in the last step, go to the next stage and fill in the essential particulars in these blank fields - Date of Violation, Date of Conviction, Of What Charge, Were You Convicted, Type of, Court Location, Motor Vehicle Operated, City State Zip Code County, CMV NonCMV CMV NonCMV CMV, DRIVER CERTIFICATION, I certify that the information, Driver Signature, Date, and CARRIER CERTIFICATION I have.

A lot of people frequently make some mistakes while completing Motor Vehicle Operated in this part. Ensure you double-check whatever you type in right here.

3. Completing I interviewed this employee and, Print Name of Carrier, Title, Authorized Signature of Carrier, dmvnygov, Date of Interview, and resetclear is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

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Ds 872 Form – Fill Out and Use This PDF

Ds 872 Form PDF Details

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