Form Csma 19 - In-Car Maneuvers Observation Record

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CSMA 19 (07/01/2016)
IN-CAR MANEUVERS
OBSERVATION RECORD
Purpose:
Learning drivers age 18 who hold a learner’s permit must use this form to verify the observation and completion of safe driving
maneuvers before applying to take the road skills test at DMV. Learning drivers age 19 and older who hold a learner’s permit but have
not completed a Virginia approved driver training course and qualifying home-schooled students use this form to verify the observation
and completion of safe driving maneuvers before applying to take the road skills test at DMV.
Instructions:
Each maneuver must be checked and signed by the licensed driver who observes the learning driver while practicing the
maneuvers. Submit the completed form to any DMV customer service center to take the road skills test.
DRIVER INFORMATION
LEARNING DRIVER NAME (print)
LEARNER’S PERMIT NUMBER
EXPIRATION DATE (mm/dd/yyyy)
SAFE DRIVING MANEUVERS
Check box and sign name when maneuver is completed. If the same driver observes all the maneuvers, sign only the Driver/Observer
Certifications section.
LICENSED OBSERVING DRIVER CERTIFICATION
By signing below I/we certify that I/we have observed the learning driver identified above performing the safe driving maneuver checked.
I/we further certify and affirm that all information presented in this form is true and correct, that any documents I/we have presented to DMV are
genuine, and that the information included in all supporting documentation is true and accurate. I/we make this certification and affirmation under
penalty of perjury and I/we understand that knowingly making a false statement or representation on this form is a criminal violation
1. Basic Skills -
9. Overtaking/Passing -
Is attentive, alert, aware of surroundings and traffic conditions,
Controls vehicle in proper lane while passing on multi-lane
follows instructions well, observes conditions in time to compete a
street, judges distance, signals intention, accelerates
maneuver safely.
properly, uses horn if necessary
OBSERVING DRIVER SIGNATURE
DRIVER LICENSE NUMBER
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
2. Starting -
10. Intersection -
Demonstrates ability to start engine, engages and uses
Is able to negotiate and drive through controlled and
proper gear, demonstrates proper use of brake.
uncontrolled intersections, reduces speed when approaching,
checks intersection traffic, controls vehicle, looks both ways.
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
3. Backing - (DO NOT PRACTICE ON STREET WITH TRAFFIC)
Looks at mirrors, looks over both shoulders, uses brake and
11. Signs & Signals -
accelerator well, controls vehicle while driving in reverse, backs
Observes and obeys stop signs and other signals, stops at
vehicle smoothly in a straight line without weaving.
indicated place, proceeds to gain clear vision but stops again
if necessary.
OBSERVING DRIVER SIGNATURE
DRIVER LICENSE NUMBER
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
4. Posture -
Sits upright, arms and legs are in easy reach of controls, adjusts
12. Traffic Lights -
mirrors and seat to best position for vision and driving.
Observes the red, yellow, green traffic lights, interprets and
obeys the meaning of the light's color and the location on the
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
traffic light, comes to smooth stop in ample time, observes
crosswalks, starts promptly when light turns green.
5. Gears -
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
Shifts gears or uses automatic transmission smoothly,
accelerates smoothly, changes gears smoothly, keeps eyes on the
road while shifting, shifts gears at correct speed.
13. Turns -
Makes proper signal of intention to turn, gets into proper lane,
OBSERVING DRIVER SIGNATURE
DRIVER LICENSE NUMBER
reduces speed as required and completes turn satisfactorily.
OBSERVING DRIVER SIGNATURE
DRIVER LICENSE NUMBER
6. Following -
Maintains proper distance and speed in traffic.
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
14. Turn-about or U-turns -
Shows ability to perform U-turns, controls steering and
operates vehicle in close quarters, watches traffic, signals
7. Right of Way -
correctly, changes gears and reduces speed and accelerates
Yields without hesitating when necessary, shows consideration of
properly, stops for traffic.
pedestrians, attention to signals, makes proper use of right-of-way in
traffic, stops behind crosswalks.
OBSERVING DRIVER SIGNATURE
DRIVER LICENSE NUMBER
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
15. Parking -
8. Lanes -
Drives into a parking lot and parks vehicle, checks for any
Stays in proper lane, checks traffic before changing lanes, changes
traffic, signals when necessary, maintains proper speed,
lanes easily, does not change lanes excessively, does not straddle
parks within lines.
lanes.
OBSERVING DRIVER SIGNATURE
DRIVER LICENSE NUMBER
DRIVER LICENSE NUMBER
OBSERVING DRIVER SIGNATURE
DRIVER/OBSERVER CERTIFICATIONS
I certify that at all times while holding a learner’s permit and operating a motor
By signing below I certify that I was the only person who observed the learning
vehicle, I have been accompanied by a licensed driver. I further certify that the
driver identified above performing the safe driving maneuvers.
licensed driver was authorized under Va. Code § 46.2-325 to accompany me.
DRIVER LICENSE NUMBER
LEARNING DRIVER SIGNATURE
OBSERVING DRIVER SIGNATURE
LEARNER'S PERMIT NUMBER

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