Main Site

Assessment Route and Guidelines for ADI

Please enable JavaScript in your browser to complete this form.

Client Details

Client Name *

First

Last

Assessment Date and Time

Date

Time

Assessment Route & Mileage

Distance in Miles of Assessment

Route of Assessment

Mileage Start

Mileage End

Vehicle Details

Controls Used

Manual
Automatic

MAKE of Vehicle

MODEL of Vehicle

Vehicle Adaptations Used

Driving Conditions

Weather

Sunny and Clear
Cloudy and Overcast
Light Rain
Heavy rain
Snow
High wind
Fog / Mist

Familiarisation

Time START familiarisation

Time FINISH familiarisation

On the Road

Time START on road

Time FINISH on road

Consent

Consent gained from client to go on road?

Time Consent Was Given

Accessibility and Safety

Dual Controls Used?

Emergency Stop Exercise

Stationary Transfer

Passenger's Seat - Independent
Passenger's Seat - Assisted
Driver's Seat - Independent
Driver's Seat - Assisted

Problems noted during familiarisation

Vision

Were corrective lenses or glasses required?

Has the candidate met the vision requirements?

Pass
Fail

Additional Notes

Use this area to include details of the Assessment.

Save and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternately, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

Copy Link

Email *

Herts Ability

Suite 4, Wentworth Lodge
Great North Road
Welwyn Garden City
Hertfordshire
AL8 7SR

Registered charity No. 1059015

Contact

01707 324581
01707 371297

Social Media

Facebook
Instagram
X (Twitter)
LinkedIn