Before you start..

This questionnaire must be completed for all driving positions. You will need your GP, medication and any sickness absence details to hand.

1. Personal Details

2. General Practitioner's Details

Equality Act 2010

4. Medical Conditions

5. Past Medical History

6. Sickness Absence

Please list how many days you have been absent from work, school, college etc in the last three years due to sickness. For each absence please also indicate the dates and the reason.

7. Alcohol History

How much alcohol on average do you consume over a seven day period? Units per week 1 unit = 1/2 pint beer = 1 glass of wine = 1 measure of spirits

8. DECLARATION