Template

Medi4 Driving Assessment Form

by Carl Penny, from the Community

30+

Use this Medi4 Driving Assessment form to evaluate the competence of ambulance, PTS, and car drivers. The checklist covers licence categories and endorsements, vehicle details and pre-drive checks, cockpit drill, gear selection, braking and steering, mirror use, observation and hazard perception, positioning and safety margins, speed and acceleration, manoeuvring and reversing with a banksman, and knowledge of the Highway Code, traffic signs, and lawful parking. It includes results sections for Ambulance Response, Ambulance PTS, and Car assessments, plus a Highway Code and traffic signs test and declarations for driver and assessor.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Chauffeur Driving Assessment Checklist
This Chauffeur Driving Assessment checklist helps evaluate professional drivers across key competencies. It covers licence and eyesight checks, driving position, observation and anticipation, and correct use of vehicle controls. Assess responses to signs and signals, mirror use, signalling, speed management, and lane discipline. Review judgement in overtaking and meeting traffic, junction approach, and required manoeuvres such as reversing and parking. The template also checks Highway Code knowledge, passenger comfort and consideration, human factors like temperament and concentration, and ancillary controls. Use it to document results, identify development requirements, and capture driver and assessor signatures.
by Gary Dodd, from the Community
Downloads: 0
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Template
Medi4 Patient Satisfaction Survey PTS
This Medi4 Patient Satisfaction Survey PTS template helps health and patient transport teams capture actionable feedback from patients and carers. The form records demographics and service-user type, then assesses key experience areas including crew promptness, professionalism, communication and reassurance, treatment of companions, and likelihood to use the service again. It also provides space for comments to identify improvements. Use it to standardize surveys across ambulance and non-emergency transport services, customize fields to your needs, and monitor trends over time.
by Carl Penny, from the Community
Downloads: 30+
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Template
Driver Assessment Report Template
Use this Driver Assessment Report template to evaluate volunteer and professional drivers across key safety criteria. Capture licence details, vehicle class, and expiry; review use of controls, steering, acceleration, braking, and gear selection; assess turns, lane position, roundabouts, city and highway driving; verify compliance with speed, signals, signs, and give way; check observation, gap selection, safety cushion, and emergency stop. Record assessor notes, competency outcome, and volunteer acknowledgments to guide training and continuous improvement.
by Kerin Knuckey, from the Community
Downloads: 0
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Template
Medi4 Vehicle Defect Form
Use this Medi4 Vehicle Defect Form to report and track issues affecting ambulance and fleet vehicles. Record vehicle base and location, driver details and signature, vehicle off road status, and whether an accident or breakdown occurred. Document each defect with clear descriptions and photos, note recovery details, and indicate cleaning and decontamination status. A dedicated fleet section captures job numbers, responsible technicians, purchase orders, repair schedules, vehicle movement, and notifications to operations, helping teams prioritize repairs and maintain compliance.
by Carl Penny, from the Community
Downloads: 20+
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Medi4 Driving Assessment Form

About author

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Chauffeur Driving Assessment Checklist

Medi4 Patient Satisfaction Survey PTS

Driver Assessment Report Template

Medi4 Vehicle Defect Form

You might also like

Chauffeur Driving Assessment Checklist

Medi4 Patient Satisfaction Survey PTS

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Medi4 Vehicle Defect Form