Medi4 Driving Assessment

Title Page

DRIVING ASSESSMENT
OPERATING BASE
Location
Conducted on
ASSESSOR NAME

DRIVER DETAILS

Driver Name
Drivers Assigned operating base
Photograph FRONT and REAR of Drivers Licence
Driving Licence categories (groups)
- M
- P
- Q
- A1
- A2
- A
- B
- B Auto
- BE
- C1
- C1E
- C
- CE
- D
- DE
- f
- G
- H
- k
- l
- M
- n
- B+E
Overall Expiry Date
Photo-card Expiry Date
ENDORSEMENTS
- BA10 Driving whicst Disqualified by order of the court
- BA30 Attempting to drive whist disqualified by order of the court
- CD10 Driving without due care and attention
- CD20 Driving without reasonable consideration for other road users
- CD30 Driving without due care and attention or without reasonable consideration for other road users
- CD40 Causing death through careless driving when unfit through drink
- CD50 Causing death by careless driving when unfit through drugs
- CD60 Causing death by careless driving with alcohol level above the limit
- CD70 Causing death by careless driving then failing to supply a specimen for alcohol analysis
- DD10 Causing serious injury by dangerous driving
- DD40 Dangerous driving
- DD60 Manslaughter or culpable homicide while driving a vehicle
- DD80 Causing death by dangerous driving
- DD90 Furious driving
- DR10 Driving or attempting to drive with alcohol level above limit
- DR20 Driving or attempting to drive while unfit through drink
- DR30 Driving or attempting to drive then failing to supply a specimen for analysis
- DR31 Driving or attempting to drive then refusing to give permission for analysis of a blood sample that was taken without consent due to incapacity
- DR61 Refusing to give permission for analysis of a blood sample that was taken without consent due to incapacity in circumstances other than driving or attempting to drive
- DR40 In charge of a vehicle while alcohol level above limit
- DR50 In charge of a vehicle while unfit through drink
- DR60 Failure to provide a specimen for analysis in circumstances other than driving or attempting to drive
- DR60 Failure to provide a specimen for analysis in circumstances other than driving or attempting to drive
- DG10 Driving or attempting to drive with drug level above the specified limit
- DG60 Causing death by careless driving with drug level above the limit
- DR80 Driving or attempting to drive when unfit through drugs
- DG40 In charge of a vehicle while drug level above specified limit
- DR90 In charge of a vehicle when unfit through drugs
- LC20 Driving otherwise than in accordance with a licence
- UT50 Aggravated taking of a vehicle
- Any MR Code
- Any Code Where the 0 has been changed for a number
- Any offence not covered above
- No offense(s) recorded
Number of penalty points

VEHICLE DETAILS

VEHICLE INDEX
VEHICLE MAKE
VEHICLE TYPE
Gearbox Type
ODOMETER START
START TIME
Weather at Start of Assessment
Road Conditions

DRIVER ASSESSMENT

Vehicle Check
Cockpit Drill
Vehicle Sympathy
Use of Gears & Gear Selection
Brakes - Use of Handbrake
Steering
Use of mirrors
INFORMATION - Observation, Forward and Links, Planning, Hazard Perception
Position
Safety Margins / Space Management
Speed
Gear Selection
Appropriate use of acceleration
Manoeuvering
Reversing - Control and techniques \ Banksman

DRIVER KNOWLEDGE

Highway Code Knowledge
Traffic Signs
Parking - Suitable \ Lawful

ASSESSORS COMMENTS

FINISH ASSESSMENT
Finish Odometer Reading
Assessors Comments

RESULTS

Ambulance Response Assessment
Ambulance PTS Assessment
Car Assessment
Highway Code Test
Traffic Signs
Driver Signature (Name and PIN Number) :- I have been shown a copy of the driving policy. I will read it and comply with it.
ASSESSOR Signature