Prior to each driving lesson, the Coach will ask the student to verbally complete the following questionnaire to ensure it’s safe to proceed with the driving lesson.
COVID-19 Pre-Lesson Safety Questionnaire
To reduce sharing of objects and documents, Driving Coaches verbally administer this questionnaire and record the student’s responses.
Student Name:_____________________________________ Date:_________________
Please circle the student’s answer to the following questions:
- Are you feeling well with no symptoms of illness (COVID or otherwise)? Y N
- Do you have a fever? Y N
- Have you been in close contact with anyone who may have contracted COVID-19? Y N
- Have you travelled outside Canada within the last 14 days? Y N
- Do you have a mask to wear during your lesson? Y N (if no, coach will provide)
- Do you understand that participating in a driving lesson will put you inside of the 2M social distancing recommendation? Y N
- Are you aware that you may choose to postpone your driving lesson if you have any concerns about participating today? Y N
- Do you understand the coach is authorized to end this lesson if questions about your health condition arise during this time? Y N
- The Coach will now ask the student if they agree with the following statement and record their response: “I have answered the questions truthfully and to the best of my knowledge there is no reason why I should not participate in a driving lesson today. I understand I am able to reschedule this lesson if I choose to do so.” “I Agree” “Other…” (lesson will be rescheduled)
This questionnaire will be held on file as record of the student’s participation in the lesson.
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