GEARS FORWARD DRIVER TRAINING LTD

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Pre-Lesson Health Questionnaire

* Required

Please answer all questions truthfully to protect your instructor and others.

In the last 7 days have you experienced any COVID-19 symptoms (fever, new and old persistent cough, loss of taste or smell) ? *

Yes

In the last 14 days has anyone in your household experienced any COVID-19 symptoms or have you been in close contact with anyone who has ? *

Yes

If the answer to Q1 or Q2 is 'Yes', are you able to provide proof of a negative COVID-19 test within that period ? *

Yes

Have you been contacted by NHS Test & Trace and asked to self-isolate for a period that covers your next lesson ? *

Yes

I understand that the following safety procedures will be in place before I enter the car *

I will wear a face covering

I will be asked to use hand sanitiser

Required

I understand that I shall inform my instructor if myself or anyone I could have been in contact with has been required to carry out an NHS Test & Trace COVID-19 test *

Yes

Signed (type your name) *

Dated *

YYYY

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