07904 611081
Belt Up Driving School

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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



You MUST take a lateral flow test the evening before your lesson and confirm your result by sending a photo of the result to your instructor in order for your lesson to go ahead



YES NO


YES NO


YES NO

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

Colds, flue, sickness bugs

YES NO

Face coverings will be mandatory.

YES NO


YES NO


YES NO

Please state which instructor, Angie, Gemma, Nick or Dan









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


v 3.2

Rates from
Secure your place in our diary by Block Booking

Quality tuition

Flexible pick up / drop off

Learn at YOUR pace
£40.00


Belt Up Driving School
 01752 783386
 07904 611081


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