FIELD STUDIES COUNCIL: HEALTH AND SAFETY COMMITTEE

FSC has imposed on its own staff a requirement that they should not carry passengers in FSC vehicles unless they
have been given a driving assessment and received a satisfactory report from a qualified person. As far as
possible FSC would like to be assured that visitors who drive FSC vehicles are also suitably competent. (FSC
vehicles include both those which are owned and those which are hired).

This form has been devised to elicit from potential drivers information to enable an assessment to be made. The
Health and Safety Committee hopes you will not mind answering the questions and will understand the reason for
asking them.
C J Bayliss, Secretary/Treasurer

DRIVER’S QUESTIONNAIRE
TO BE COMPLETED BY ALL PERSONS BEFORE DRIVING AN FSC VEHICLE

A clear copy of your full Driving Licence (including the paper Counterpart, if a Photo-Card licence) must be
submitted with this form which should be returned to the Head of Centre, who will decide whether permission to
drive the Centre vehicle will be granted or if further evidence of competence is required e.g. an ‘FSC Internal
Driving Test’. Please bring your full original Driving Licence with you when visiting the Centre, as failure to do so
may mean that you will not be permitted to drive a Centre vehicle.

1 Name ………………………………………………… 2 Address ……………………………………………

3 Occupation ………………………………………… ………………………………………………………………

4 Age (must be 21 or over) ………………….……… Postcode …………………………………………………

5 Have you taken a local authority or institution minibus test? ……..…………… Did you pass? ……………….

6 Have you had any accidents in the last 5 years? ……………

If so, please give brief facts: ………….……………………………………………………………………………………
…………………………………………………………………………………………………………………………………

7 Do you have, or have you had, any illness, disease, medical condition, or other disability which could impair
your driving ability? ……………
If so, please give brief facts and dates: ….…………………….…………………………………………………………
…………………………………………………………………………………………………………………………………

8 Do you have your own car insurance? ……………

If so, which is your present insurance co.? …………………………………………..…………………………………..

9 Has any insurance company ever refused you cover? ……………

If so, please give brief facts: ………….……………………………………………………………………………………
…………………………………………………………………………………………………………………………………

I wish to drive an FSC vehicle and agree to read the FSC Driver’s Handbook prior to driving. I undertake to abide
by any statutory regulations or Centre rules governing its use and in particular to carry no more than the maximum
number of passengers stipulated for the vehicle.

The above answers are complete and correct.

SIGNED …………………………………………………............. DATED ..............................................................

08/08

FSC use only: Confirmed as suitable to drive FSC vehicles:

Head of Centre …………………………………………………… Date ………………………………………………..
Driving Licence No: ……………………………………………… Driving Categories: ……………………………….
Licence Expiry Date: ………...................... Endorsements - Dates & Codes: ……………………………………….
…………………………………………….………………………………………………………………………………………...