In an effort to reduce mistakes and errors all agents/instructors must use this form as a coversheet when
submitting your classes to ESC for processing. This check list has been designed to help you remember
ESC classroom procedures. Please refer to PIRP instructor training notes for further details.
MANDATORY CHECKLIST
AGENCY CODE _________
INSTRUCTOR ________________________ CLASS DATE _________________
During class the instructor should make sure:
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The top portion of the sign-in sheet (ICR3/ICR4 [IPP#24]) is neatly filled out.
All students have printed their name, signed in to class, initialed after any breaks, and signed out from
class.
The student registration forms are CLEAR, COMPLETE & CORRECT. (Please check name, date of
birth, motorist ID#, etc.).
The bottom of each registration form is signed by the student and the instructor. Each registration form
has the date of course completion and the instructor’s agency code.
The number of registration forms is equal to the number of students on the sign-in sheet. *If not please
explain.
The student evaluation forms are filled out (names are optional).
After class the instructor should:
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Identify students with out of date driver’s licenses: instruct the student to contact Bold Systems when
they get a NYS drivers license or client id number in order to be processed for point reduction benefits.
Mark student registration forms with out-of-state driver’s license ID numbers. Students with an out-ofstate driver’s license have 30 days to get a NYS drivers license, if they plan to be a NY resident.
Make copies of the student registration forms and sign-in sheet(s) for agency records.
Mail original paperwork to Empire Safety Council within 72 hours of course completion:
 Original Sign-In Sheet
 Original Registration Forms
 Original Evaluation Forms
 * Proper Payment
 Mandatory Checklist
Please don’t forget: Four month schedules (IPP#23) must be mailed to ESC on a timely basis; they must
be submitted at least 30 days in advance of the class.
* Payment Due = ____________________ X _________________ = _________________
Processing fee
# of registration forms
payment enclosed
IPP # 49