School District Checklist - Idaho State Department of ...



Idaho Public Driver EducationAnnual Program Plan PacketDue Before Any Instruction BeginsSchool District ChecklistSchool District NumberApproved Instructor ListCurrent Proof of Vehicle InsuranceVehicle Inspection Form(s) Signed by a Certified MechanicMedical Examiners Certificate for all Instructors ListedChecked off by District Coordinator/Lead TeacherIf the District leases or will be leasing a vehicle, please check the box below. No behind the wheel instruction may take place until a copy of the insurance policy and vehicle inspection is on file at the SDE.We Lease a VehicleDate Vehicle will be Picked UpExpected Class Starting DateRevised 12/2018Revised 12/2018Public Schools: This annual Program Plan Packet must be submitted at least 30 days prior to the start of your program as a condition for reimbursement of costs incurred in your driver training program. The State Department of Driver Education Division will approve or disapprove this plan within ten days after receipt. A School district operating any driver training program without prior written approval from the State Department of Education shall not be entitled to reimbursement (Idaho Code Section 33 – 1704 and 33 – 1707).Contact InformationDriver Education Coordinator/Lead Teacher/Primary program contact: .Address with city and zip code:Work and Cell phone number:Email Address:School name and address with zip code:Additional School name and Address w/zip code (if applicable):Financial Contact Name, email address, and phone number:Address including zip code where permits are to be sent:Academic Year:District Number:Instructor Information: Provide instructor information below, including you if you will be teaching, for those that need to be approved to work for your district. Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires: Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Instructor Information: Provide instructor information below, including you if you will be teaching, for those that need to be approved to work for your district. Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Proof of InsuranceName on Policy:School District Name and Number:Address on Policy:District Phone Number:Email:Insurance Company:Insurance Agent:Insurance Agent’s Phone Number:Minimum CoverageCurrent statute states that the policy will have a limit of not less than $500,000 for bodily or personal injury, death, or property damage or loss as the result of any one (1) occurrence or accident, regardless of the number of persons injured or the number of claimants. Does the policy cover these requirements? Yes ?No ?Vehicles Covered:MakeModelYearVIN Number.BlankBlankBlankBlankBlankblankPolicy Holder’s Signature: Date: Policy Holder’s Printed Name: Annual Driver Education Vehicle CheckEvery driver education vehicle shall be inspected annually to determine compliance with Idaho Code requirements for motor vehicles and the Idaho State Board of Education Rules (IDAPA). No school shall use any vehicle in a driver education program unless that vehicle is in proper operating condition (Operating Policies and Procedures manual section 5.3).School and Vehicle InformationSchool Name and District Number: Vehicle Make: Vehicle Model: Vehicle Year:License Plate Number: Odometer Reading: Required EquipmentThe signs to the rear and sides have “Driver Education,” “Student Driver”, or “Driver’s Training” with not less than two (2) inch high lettering. Yes: ? No: ?The signs and lettering are of contrasting colors so as to be clearly readable at one hundred (100) feet in clear daylight. Yes: ? No: ?Dual Control Brakes when tested at 20 mph, vehicle shall stop within the guidelines of Idaho Code 49-933(7). Yes: ? No: ?Instructor inside rear view mirror (for the exclusive use of the instructor). Yes: ? No: ?Mechanic VerificationVehicles must be inspected by a certified mechanic.I verify I have inspected this vehicle and completed this form.Printed Name: Title: Type of Certification: Certification Number (if applicable): Signature: Date: Annual Vehicle Inspection FormUse this form if your mechanic does not have an inspection form. These checks are recommended by the American Association of Motor Vehicle Administrators as minimum inspection standards for passenger vehicles and are required in the Idaho Driver Education Public and Commercial School Standards.School Name and District Number: Date: VIN Number: Year: Make: Model: Odometer: Passenger CompartmentO.K.PoorRepairRemarksDate of RepairRegistration/InsuranceLoose ArticlesInstruments/GaugesDome LightsBrake SystemO.K.PoorRepairRemarksDate of RepairService Brake Road TestStopping Distance (20 mph)Dual Control BrakesStopping Distance (20 mph)Service Brake Stationary TestHydraulic SystemsO.K.PoorRepairRemarksDate of RepairPedal ReserveHydraulic LeaksMaster CylinderHydraulic hoses and/or linesWheel cylinders – drum brakesCaliper – disc brake assemblyDrums and discsBrake drumsLinings, Pads, and Mechanical ComponentsO.K.PoorRepairRemarksDate of RepairCondition of mechanical componentsBrake lining and pad wearHydraulic and Vacuum BoostersO.K.PoorRepairRemarksDate of RepairHydraulic system operationHydraulic booster power brake systemIntegrated hydraulic booster/anti-lock system operationIntegrated hydraulic booster/anti-lock systemVacuum System OperationO.K.PoorRepairRemarksDate of RepairPedal PressureVacuum booster power brake systemParking BrakeO.K.PoorRepairRemarksDate of RepairParking Brake operationsCondition of mechanical componentsBrake failure warning lightDual Control BrakeO.K.PoorRepairRemarksDate of Repair.Tires and WheelsO.K.PoorRepairRemarksDate of RepairTire PressureTire condition and wearTire size and typeWheels and valve stemSuspension and SteeringO.K.PoorRepairRemarksDate of RepairWheel bearing movementSteering linkage, lash/travel, steering assemblySteering linkage playLash/travelSteering gearPower steeringSteering system travelFront wheel alignmentTorsion bars, springs, shock absorbers/struts & bumper heightO.K.PoorRepairRemarksDate of RepairSprings and torsion barsShock absorbers/shock strutsBumper heightBall Joint WearO.K.PoorRepairRemarksDate of RepairBall joints without wear indicatorsPre-loaded ball jointsBall joint wear (see AAMVA table)Ball joints with wear indicatorsOther ball joint systemsLighting and ElectricalO.K.PoorRepairRemarksDate of RepairLightsHigh BeamLow BeamParking LightsDaytime running lightsTurn signalsBack up lightsFog lights (if equipped)Hazard lightsStop/brake lightsTail lightsInstrument panel lightsEmergency/Hazard lightsLicense plate lightSystem failure warning lightsOther lightsHeadlight aimingHigh BeamLow BeamFog light and auxiliary driving light aimingElectrical SystemsO.K.PoorRepairRemarksDate of RepairHornElectrical switchesElectrical wiringElectrical connectionsStarting system – automatic transmissionStarting system – manual transmissionVehicle GlazingO.K.PoorRepairRemarksDate of RepairProper markingsLeft front window opens easilyStickers and tintingCracks, chips, and discolorationSpecial glazingWindshieldWindshield, vent, front doorRear windowsVisibility & Interior Body ComponentsO.K.PoorRepairRemarksDate of RepairMirrorsSide view – right & leftInside rearviewInside instructor mirrorWindshield wipersWasherDefrosterHeaterVisorsSeatsSeatbelts for all occupantsAir bag readiness lightExterior Body Parts, Doors, Hood, and Sheet MetalO.K.PoorRepairRemarksDate of RepairProtruding metalBumpersHoodDoors and locksFendersFloor pan and inner panelsLicense plate – front and rearFuel & Exhaust SystemO.K.PoorRepairRemarksDate of RepairFuel SystemExhaust systemExhaust gas cautionEmission control componentsI certify that the items checked in ‘Repair’ column of this form were repaired on the date indicated.Technician name: Technician signature: Date: Instructor Information: Provide instructor information below, including you if you will be teaching, for those that need to be approved to work for your district.Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Instructor Information: Provide instructor information below, including you if you will be teaching, for those that need to be approved to work for your district. Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Instructor Information: Provide instructor information below, including you if you will be teaching, for those that need to be approved to work for your district. Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ?Personal Information for Instructor:Full Name: Driver’s License Number: Full Address:Phone number:Email Address: Date of Birth MM/DD/YY: SDE Section – Do not complete:Date Physical Expires:Clear Driving Record: ? Background Check: ? Professional Development: ? SDE APPROVED: ? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download