Form DLD-117 template
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Unsafe Driver Review Form
This form is used by the Utah Driver License Division to report drivers who may pose a threat to road safety. The informant, acting in good faith, has immunity from damages resulting from reporting. Reports regarding physical, mental, or emotional impairments are classified as protected records under Utah law, and the identity of the notifier remains confidential. The form requires the name, date of birth, Utah license number or relationship, and driving privilege card number of the subject, as well as specific observations leading to the report. The statement must be true and correct to the best of the informant's knowledge, with penalties for false statements or malicious intent.
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