COVID-19 CLIENT RISK ASSESSMENT CLIENT NAME:
The purpose of this Assessment form is to ensure that both you as my client, and I 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. You can complete the form digitally or print & complete whichever is your preference.
Once you have completed the form return to me electronically by email.
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.
FOR ADVICE ON COVID-19 SYMPTOMS VISIT
https://www.Gov.uk : coronavirus-guidance and support.
YOU MUST NOT ATTEND ANY DRIVING LESSONS OR DRIVING TESTS IF YOU HAVE ANY COVID-19 SYMPTOMS.
YOU WILL NOT BE CHARGED A SHORT NOTICE CANCELLATION FEE IF THE CANCELLATION IS DUE TO COVID-19.Please highlight or circle ‘YES’ or ‘NO’ in each of the sections below. If you answer ‘YES’, please provide details in the line below each question to provide further information where necessary.
Have you had any symptoms or suffered from COVID- 19 since your last driving lesson?
Does any member of your immediate household currently have any COVID- 19 symptoms or reason to feel they need to self-isolate?
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?
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.
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?
If ‘YES’, you must bring your own products to cleanse your hands and keep you safe before touching the vehicle or controls in the car.
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?
If ‘YES’, please advise details so we can discuss options to work round this issue.
You will need to wear a face covering during lessons?
If ‘YES’ will you be able to provide your own covering?
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.
You will have to wear protective gloves during lessons?
If ‘YES’, will you be able to provide your own gloves?
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’ we need to discuss a plan prior to your lesson.
CLOTHING AND FOOTWEAR
At time of writing, it is a requirement that we wear suitable clothing and footwear that minimises the exposure of bare skin (arms, legs, feet) whilst in car. This means wearing long sleeved tops and shirts (no T-shirts or 3⁄4 sleeved shirts or tops), 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 and Standard Operating Procedure, but this is the current guidance regarding clothing and footwear. You will be updated, as and when this guidance changes.
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 return this completed form to:
My email address is:
My mobile number is:
Data Protection Statement: All data is held securely by your Driving Instructor. Data will be treated in strictest confidence and will never be disclosed to external third parties or organisations, other than those – such as an NHS Medical or Track & Trace professional – who may require evidence in respect of your responses relating to your health, symptoms and that of your Driving Instructor in relation to Covid-19.