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Lee Farrar - Risk Assessment

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* 1. Full Name and Date

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* 2. 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. 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.
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.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid-19/coronavirus-covid-19-general-advice
•       YOU MUST NOT ATTEND ANY DRIVING LESSONS OR DRIVING TESTS IF YOU HAVE ANY COVID-19 SYMPTOMS.

At time the 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 ¾ 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.

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.

Do you consent to the above?

YES/NO

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* 3. Have you had any symptoms or suffered from COVID- 19 since your last driving lesson?         YES/NO

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* 4. Does any member of your immediate household currently have any COVID- 19 symptoms or reason to feel they need to self-isolate?                                                                                                          YES/NO

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* 5. 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.
YES/NO

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* 6. Do you have any allergies or health conditions that means you would not be able to use Hand Sanitiser? 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.                                                                                                          YES/NO

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* 7. I may 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.
. YES/NO

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* 8. Do you plan to wear a face covering / protective gloves during lessons?           
                  YES/NO

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* 9. I may 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.                                                                           YES/NO

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* 10. 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’, I will need to discuss a plan with you prior to lessons to work around this issue.                            YES/NO

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