COVID-19 CANDIDATE ASSESSMENT

Salvin's Pass School

call Cindy today: 07748946743

or email Cindy on: cindy.salvin@yahoo.co.uk

call Cindy today: 07748946743

or email Cindy on: cindy.salvin@yahoo.co.uk

COVID-19 CANDIDATE ASSESSMENT FORM

Fields marked with an * are required

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.

Please take the time to discuss this form with your family before completing this form to ensure everyone in your home understands the questions and that your answers are accurate.

Once you have completed the form please click Submit to send and tick the verify box for security

* Name

* Date

Telephone

* Email

Please choose ‘YES’ or ‘NO’ to give your answer. If you answer YES: please provide details in the area below to provide further information where necessary.

HEALTH

Do you or any member of your immediate household currently have any COVID- 19 symptoms or reason to feel you need to self-isolate? * YES
NO

Have you had any symptoms or suffered from COVID- 19 since your last driving lesson? * 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 COVID-19 Government guidelines? * YES
NO

If yes to the above, I will need to call you to have a chat about your personal situation regarding your lesson plan and agree timescales. * YES
NO

* Additional Information needed if answering 'Yes'

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Do you have any allergies or health conditions that means you would not be able to use Hand Sanitiser provided by me? * YES
NO

If yes, you must bring your own products to cleanse your hands before touching the vehicle or controls in the car. * YES
NO

I may 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? * YES
NO

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

Would you plan to wear a face covering during lessons? * YES
NO

If ‘YES’, will you be able to provide your own covering? * YES
NO

I may be wearing protective gloves during lessons to minimise 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

Would you plan to wear protective gloves during lessons * YES
NO

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

CLOTHING & FOOTWEAR

It is a requirement that we wear suitable clothing and footwear that minimises the exposure of bare skin whilst in car. This means wearing long sleeved tops and shirts (no T-shirts or ¾ sleeved shirts or tops), long trousers (no shorts, dresses or skirts) and footwear such as shoes or trainers (no open toed sandals) where our whole foot is covered.

May I please request that you ensure you comply with this requirement during your lesson and/or whilst out on your driving test?

* Do you have any further questions? If YES please add below

Click Here To Verify