Driver Competency Check List

Please answer the following questions. Your answers may require us to seek advice concerning your safety to drive a company vehicle
from your GP or another medically qualified person. We will only do this after requesting your permission.

Employee Name: Department:

Please tick the appropriate answer Y N

1. Do you hold a current UK/EEC driving license?

2. Does your license have penalty points on it? If so how many? No of points:-

3. Do have any pending prosecutions for motoring offences?

4. Do you suffer from any of the following medical conditions?

a) High blood pressure or hyper tension

b) Diabetes

c) Epilepsy

d) Heart disease or angina

e) Any other medical condition that would render you unfit to drive

5. Have you been prescribed or are you taking any medicines or drugs that may make you unfit to drive?

6. Have you been advised by a doctor or Ophthalmic Optician not to drive because of defective eye sight?

7. Are you registered disabled such that a motor vehicle needs to be specially adapted for your safe use?

If you knowingly give incorrect answers or false information you may be subject to disciplinary action and the company’s motor insurance
may be void if you are involved in an accident whilst driving.
Details relating to medical conditions/prosecutions will be kept strictly confidential as per the Data Protection Act.

Signed (Employee): Date:

Signed (HR Department): Date:

Comments:

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