Form Mv-279 - Request For Classroom Premises Check For Prelicensing Course Page 2
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1
2PREMISES CHECK REPORT
NOTE: This page to be completed only by DMV Personnel!
School or Organization
Classroom Address
(Include Building Name & Room Number)
(City)
(State)
(Zip Code)
INSPECTOR’S CHECK LIST:
A. CLASSROOM
Does the classroom adequately comply with the following criteria?
Yes
No
Yes
No
o o
o o
1. Accessible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Well-lit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o o
o o
2. Minimum size - 150 square feet. . . . . . . . . . . . . . .
7. Good line of vision from all seats . . . . . . . . . . . . .
o o
o o
3. Clean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. No visual or audible distractions . . . . . . . . . . . . . .
o o
4. Accessible Toilet Facilities. . . . . . . . . . . . . . . . . . .
9. Room can be darkened for best
o o
o o
5. Well-heated/ventilated . . . . . . . . . . . . . . . . . . . . . .
viewing of visual aids. . . . . . . . . . . . . . . . . . . . . . .
Yes
No
B. EQUIPMENT
o
o
o o
1.
Chalkboard or
Flipcharts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o o
2. TV/VCR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Other ____________________________________ __________________________________________________________
o o
___________________________________________________________________________________________________
C. Classroom Size (sq. ft.) _____________ Number of Students Permitted in Classroom ______________
(allow 15 sq. ft. for each student with a maximum of 36 students)
D. Number of Pre-licensing Courses offered weekly: ________________
E. Projected 2-month supply of MV-278 books: _________________
(Multiply number of classes per week by maximum number of students per class. Multiply this number by 8 and divide total by 50)
F. Remarks: ____________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
INITIAL INSPECTION
Person Interviewed
__________________________________________________________________________________
(Name and Title)
Examiner’s Signature ____________________________________Shield Number __________________________ Date ______________
FOLLOW-UP INSPECTION
Person Interviewed
__________________________________________________________________________________
(Name and Title)
Examiner’s Signature ____________________________________Shield Number __________________________ Date ______________
NOTE: If premises are disapproved, school owner must reapply when ready for another inspection.
o
o
RECOMMENDATION:
APPROVED
DISAPPROVED
ç
Date
P.M.V.L.E.’s Signature
______________________________________________________________________________________________
(Please send to the Bureau of Driver Training Programs)
PAGE 2 OF 2
MV-279 (9/16)
RESET/CLEAR
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