Form DS-873 at a glance
What it is: Form DS-873 (10/25) is the Report on Annual Defensive Driving Performance for Driver under Article 19-A.
Who signs: Enter the Driver's Signature and the Date. The Certified Examiner signs as the Certified Examiner's Signature and enters the Date of Observation.
A filled-in Form DS-873 example: an examiner rates a bus driver
How to fill out Form DS-873, box by box
Section 1 - Driver Information
In Section 1 - Driver Information, enter the Driver's Last Name, First, M.I. and Date of Birth (Month/Day/Year).
Enter the License Class, Endorsements, Restrictions, Expiration Date, Driver License ID Number and State Licensed.
Section 2 - Carrier Information
In Section 2 - Carrier Information, enter the Carrier/DBA Name.
Enter the Legal Name (if different), the Federal ID Number and the 19-A Business ID Number.
Section 3 - Vehicle Information
In Section 3 - Vehicle Information, enter the Type of Vehicle, Adult Seating Capacity, GVWR, Vehicle Plate Number and State.
Section 4 - Observation
Regular observation of a driver's defensive driving performance must be conducted while the driver is operating the vehicle with passengers.
This observation shall NOT be conducted on the same day as the biennial Behind-the-Wheel Road Test.
Under Observation Conducted, mark Inside or Outside; observation may be conducted either inside or outside of the bus that the driver is operating.
Mark SATISFACTORY or NEEDS IMPROVEMENT for each of 1. Observation, 2. Traffic Lane Use (include center line violation), 3. Speed, 4. Properly Signals Intention, 5. Turning, 6. Vehicle Control, 7. Obeys Traffic Signs, Signals and Road Hazard Signs, 8. Observes Proper Following Distance, 9. Procedures for Receiving and Discharging Passengers and 10. Traffic Interaction.
For 11. Pre-Trip Safety Briefing Proficiency for Stretch Limo Operators, mark SATISFACTORY, NEEDS IMPROVEMENT or NOT APPLICABLE.
Comments
Enter Comments: (required if Needs Improvement is checked above, in Section 4 - Observation).
Section 5 - Driver Acknowledgement
In Section 5 - Driver Acknowledgement, the driver acknowledges discussion of the driver's defensive driving performance with the examiner who observed and rated the driver's performance.
Enter the Driver's Signature and the Date.
Section 6 - Examiner's Certification
In Section 6 - Examiner's Certification, enter the Certified Examiner's Name and the Certified Examiner's Driver License ID Number, Certificate Number, Certification Class, Expiration Date, Endorsements and Restrictions.
The Certified Examiner certifies that the report is, to the best of the examiner's knowledge, true and correct, that the examiner personally observed the driver's defensive driving performance, that the examiner currently holds a valid examiner certification as required in accordance with Article 19-A of the New York State Vehicle and Traffic Law, and that the examiner holds the appropriate class driver's license with the proper endorsements.
For this report under Article 19-A, the examiner acknowledges and understands that knowingly making a false statement in connection with this report or in any proofs or reports in connection with it may subject the examiner to criminal prosecution for a misdemeanor or felony under the Vehicle and Traffic Law and/or Penal Law. This applies to knowingly making a false statement for the purpose of deceiving or substituting, or causing another person to deceive or substitute, in connection with this examination or report.
The Certified Examiner signs as the Certified Examiner's Signature and enters the Date of Observation.
More rules for Form DS-873
Instructions to Certified Examiner: Discuss performance with the driver, and complete the Observation, Driver Acknowledgement, and Examiner's Certification sections.
Sources
[1] Form DS-873 (10/25), Report on Annual Defensive Driving Performance for Driver under Article 19-A, New York State Department of Motor Vehicles (the Official source link on this page).