Drivers Health Declaration
It is an offence for a person to drive on a road, any vehicle otherwise than in accordance with a licence authorising him to drive it. It is also an offence for a person to cause or permit another person to drive it.
As a Employee I declare that I have produced my latest licence, and that I have no pending convictions, endorsements of disqualifications.
I have had no change in my health, which could affect my entitlement to drive. In particular, for ALL licences:
- An Epileptic event (seizure or fit)
- Sudden attacks of disabling giddiness, fainting or blackouts
- Severe mental handicap
- A pacemaker, defibrillator or anti-ventricular tachycardia device fitted.
- Diabetes controlled by insulin or tablets
- Angina (heart pain) while driving
- Parkinson’s disease
- Any other chronic neurological condition
- A serious problem with memory
- A Major or minor stroke
- Any type of brain surgery or tumour
- Severe head injury involving in-patient treatment at hospital
- Any severe psychiatric illness or mental disorder
- Continuing/permanent difficulty in the use of arms or legs
- Dependence on a misuse of alcohol, illicit drugs or chemical substances in the past three years (do not include drink/driving offences)
- Any visual disability that affects both eyes (do not declare short/long sight or colour blindness)
Also, for vocational licences:
- Any heart condition or heart operation
- Any visual problem affecting either eye.
If any of the above affects me I will inform my employer as soon as possible. I understand that I must also inform DVLA by writing to: Drivers Medical Unit, DVLA, Swansea SA99 1TU. Failure to do so is a criminal offence punishable by a fine of up to £100.00. I will inform my employer of any road traffic incidents, convictions, endorsements or disqualifications that occur, which could affect my entitlement to drive, as soon as possible.
Driver declaration: I have read and fully understand the above and will comply with what is requested of me.