Professional, affordable driving lessons with Hills Driver Training

Hills Driver Training Ltd

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The purpose of this Assessment form

The purpose of this Assessment form is to ensure that both yourself as a candidate, and myself as your Driving Instructor, are fully informed of any health conditions or concerns you have regarding personal safety during driving lessons.

It is also to ensure any questions you have are answered and necessary planning and equipment are put in place before we commence all Driving Lessons.

If applicable, please take the time to discuss this form with your family members or those in your household before completing this form to ensure everyone in your home understands the questions and that your answers are accurate.

PLEASE NOTE:

YOU MUST NOTIFY ME IMMEDIATELY IF YOU OR ANY MEMBER OF YOUR IMMEDIATE HOUSEHOLD, SOCIAL CIRCLE OR WORK GROUP DEVELOP COVID-19 SYMPTOMS AND NEED TO SELF ISOLATE.

Visit here for advice on Covid 19 symptoms

You MUST NOT attend any driving lessons or tests if you have any Covid-19 symptoms

You WILL NOT BE CHARGED a short cancellation fee if the cancellation is due to Covid-19

HEALTH

Have you had symptoms or suffered COVID- 19 since your last lesson?*

YES NO

Does any member of your immediate household currently have any COVID- 19 symptoms or reason to feel they need to self-isolate?*

YES NO

Do you or anyone who you are in regular close contact with have any health issues which are classed as a vulnerable group in respect of Govt COVID-19 guidelines?*

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Do you have any allergies or health issues that means you would not be able to use Hand Sanitiser provided?*

NB If ‘YES’, you must bring your own products to clean your hands and keep you safe before touching the vehicle or controls in the car.

YES NO

I will be wearing a face covering during lessons in order to minimise risk from myself to you. This means my voice may not be as clear or loud. Do you have any difﬁculties with hearing?*

This means my voice may not be as clear or loud. Do you have any difﬁculties with hearing?

If ‘YES’, please advise details so we can discuss options to work round this issue.

YES NO

You must wear a face mask during lessons?*

YES NO

If ‘YES’, will you be able to provide your own covering?*

YES NO

I will be wearing protective gloves during lessons to minimise the risk of skin to skin contact. Do you have any allergies to latex or synthetic products?*

If ‘YES’, I will need to discuss a plan with you prior to lessons to work around this issue

YES NO

You can wear protective gloves during lessons if you wish*

YES NO

If ‘YES’, will you be able to provide your own gloves?*

CAR CLEANLINESS

I will be Sanitising the car between every lesson and before and after driving tests with anti-virus grade sanitiser. This means I will be wiping down all touchable surfaces with this sanitiser in spray and/or wipes form. Surfaces include, door frames, door handles inside and out, controls (signals, gear stick, parking brake, bonnet release), mirrors, seatbelts, seat adjusters and seats.

Do you have any allergies or breathing/respiratory conditions or other health problems for which this sanitisation process would cause you any problems or difﬁculties? If ‘YES’, I will need to discuss a plan with you prior to lessons to work around this issue.*

YES NO

Please type code shown into box below. NB. This is not case sensitive.

Note : Personal information you submit on this form is not shared
or permenantly stored.

Learn at a pace that suits YOU

Quality tuition to give YOU a great chance to pass 1ST TIME!

£32.00

Tim passed 17th of June 2013.

Tim Jordan

Sasha passed 13th of Feb 13.

Sasha McCashin

Collingwood Learner Driver Insurance

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