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




YES NO


YES NO


YES NO



PERSONAL PROTECTIVE EQUIPMENT (PPE)



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

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

Face coverings will be mandatory.

YES NO


YES NO

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

YES NO

We do not expect you to wear gloves but if you wish to, please provide your own.

YES NO


YES NO

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.



YES NO

CLOTHING AND FOOTWEAR

SHORT SLEEVES ARE NOW OK. At time of writing, it is a requirement that we wear suitable clothing and footwear that minimises the exposure of bare skin (legs, feet) whilst in car. This means wearing long trousers (no shorts, dresses or skirts) and footwear such as comfortable shoes or trainers (no open toed sandals). There may be a change to this policy, but this is the current guidance regarding clothing and footwear. May I please request that you ensure you comply with these requirements during your lesson and/or whilst out on your driving test? Do you have any further questions? Do not hesitate to ask.


Please state which instructor you are with, Angie, Gemma, Nick or Dan









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


v 2.0

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Quality tuition

Flexible pick up / drop off

Learn at YOUR pace
£30.00


Belt Up Driving School
 01752 783386
 07904 611081


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