Other Work Driver Questionnaire

TO BE COMPLETED BY DRIVER (PLEASE PRINT)

1. DRIVER NAME……………………………………………………………………

2. Other company / agency NAME…………………………………………………………………..

3. DO YOU WORK FOR OTHER COMPANIES? YES / NO

4. IF YES, PLEASE GIVE NAME…………………………………………………

5. END OF PREVIOUS DUTY (including non-driving)

DATE……………………………………. TIME………………………………

6. HAVE YOU TAKEN A DAILY REST OF 11 HOURS (reducible to 9 hours) SINCE LAST DUTY? YES / NO

7. END OF PREVIOUS WEEKLY REST.

DATE……………………………………… TIME ………………………………

8. DETAIL OTHER COMPANIES WORKED FOR SINCE LAST WEEKLY REST (please detail on rear of sheet –
detail all work and state companies worked for since last weekly rest, including non-driving)

9. IS THIS YOUR PRIMARY SOURCE OF EMPLOYMENT? YES / NO

10. ARE YOU PHYSICALLY ABLE TO CARRY OUT THE TYPE OF WORK REQUIRED? YES / NO

11. DO YOU FULLY UNDERSTAND THE DRIVER’S HOURS REGULATIONS, USE OF TACHO-CARDS AND SPEED
LIMITS? YES / NO

12. DO YOU FULLY UNDERSTAND THOSE ASPECTS OF THE WORKING TIME DIRECTIVE REGULATIONS
APPLICABLE TO DRIVER’S? YES / NO (please circle0

13. DRIVER DECLARATION

 CONFIRM THAT ALL OF THE ABOVE IS TRUE AND I AM LEGALLY ABLE TO DRIVE
 I CONFIRM THAT I AM CARRYING WITH ME AT ALL TIMES ALL LEGALLY REQUIRED TACHO
INFORMATION FROM THE PREVIOUS 28 CALENDER DAYS
 I CONFIRM THAT I WILL CARRY ALL LICENCES/TACHO/DCPC/ADR/PDP CARDS AT ALL TIMES
 I CONFIRM THAT I CARRY A SPARE DIGITAL PRINTER ROLL

I CONFIRM THAT I WILL INFORM YOU OF ANY CHANGES TO THE ABOVE IMMEDIATELY WHILST
WORKING FOR YOUAND PRIOR TO MY NEXT DUTY WITH YOURSELVES

DRIVER SIGNATURE ……………………………………………………………..DATE …………………………………………