DERBYSHIRE COUNTY COUNCIL
Checklist for Driver Details
DRIVING LICENCE
Any query concerning Driving Licences should be raised with the Head of Transport
Fleet Services on 01629 532110 (VOIP ext 32110)
Employees Name
………………………………..
Licence Type (i.e. UK1) ………………………………..
Licence No
………………………………..
Issue No
……………………………….
Issue Date
……………………………….
Last Check Date
……………………………….
Entitlements
……………………………….
If the licence holder has entitlements C or C+E record details below from their DQC
(Driver Certificate of Professional Competence)
DQC No
Expiry Date
Please
Confirm
Tick
 I have seen the original documentation for the licence and paper counterpart
to photocard Licence
 Take a photocopy of both sides of licences and counterparts and append to
this form
Check
 Does the Licence contain the security markings
 Personal details are correct – name, date of birth and address
 Age Restrictions – Use Guide to Driving Licences
 Restriction codes - Use Guide to Driving Licence Information and Restriction
Codes
 Photocard expiry date
 Any new endorsements/disqualifications since last licence check if so list
below – Use Guide to Driving Offences & Penalty Points
Code
Date of Conviction
Code
Date of Conviction
 Whether any medicals/renewals are due in the future – if so advise driver
 Advise driver of reportable medical conditions see section of this form
 Bring to the attention of the driver the policy on the use of Mobile Telephones
and Substance Misuse.
D:\116099482.doc
EN068
Revised 01/10/11
DERBYSHIRE COUNTY COUNCIL
Checklist for Driver Details
MEDICAL CONDITIONS
 Bring the following to the attention of the employee:
It is an offence for a person to drive on a road any vehicle otherwise than in accordance with
a licence authorising them to drive it. It is also an offence for a person to cause or permit to
cause another person to drive it.
I am aware that any changes to the medical conditions or my health which affect my ability to
drive or drive safely must be reported to the Drivers Medical unit, DVLA, Swansea SA99 1TU
and my line manager:
The following conditions are reportable to the DVLA:
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Epilepsy, fits or blackouts
Severe and recurrent disabling giddiness
Parkinson’s disease
Any chronic neurological condition, eg multiple sclerosis, motor neurone disease
Major or minor strokes
Brain surgery, brain tumour, severe head injury
Memory problems
Any mental ill health condition (including depression)
Any psychiatric illness requiring hospital admission
Dependence on or misuse of alcohol or drugs in the past 3 years
Sight in one eye only or visual problem affecting either eye
Diabetes controlled by diet/tablets/insulin
Any heart condition other than innocent heart murmurs
Peripherals arterial disease causing symptoms
Abdominal aortic aneurysm
Sleep apnoea syndrome/narcolepsy/cataplexy
Any other condition which causes excessive daytime or awake time sleepiness
Severe spinal injuries
Treatment for the following types of cancer or tumours in the last 5 years, lung, melanoma,
non hodgkin’s lymphoma
Aids
Behavioural problems, eg aspergers syndrome
Chronic renal failure
Deafness (profound)
Any other medical condition likely to affect ability to safely control a vehicle, eg amputation,
impairment secondary to medication, chronic debilitating illness
D:\116099482.doc
EN068
Revised 01/10/11
DERBYSHIRE COUNTY COUNCIL
Checklist for Driver Details
VEHICLE INSURANCE
This section is to be used when checking the licence details of Grey Fleet Drivers
(Casual or Essential Users)
Confirm
Please
Tick
 I have seen the original documentation for the Vehicle Insurance
 Take a photocopy of the vehicle insurance certificate and append to this form
Any query concerning Insurance should be raised with the Insurance and
Risk Manager at County Hall on extension 39988
Yes
or
No
Do you recognise the insurance provider
Does the certificate say that the insurer is authorised and regulated by the
Financial Services Authority
The description and registration of the vehicle insured is the same as the one the
employee is claiming mileage allowance for
Is the policy holder the employee
If No who is the policy holder and is the employee a named driver.
Is the employee covered for business purposes
Is the policy in force and has not expired
List the classes of persons entitled to drive
Any limits on use applied by the insurer
If YES what are they
Bring the following statement to be attention of the employee:
You are advised that failure to pay the premium in full will render the policy null and
void and preclude you from using the vehicle on Council business.
If the Policy has one month or less before expiry ask the employee to present the new
policy on issue.
D:\116099482.doc
EN068
Revised 01/10/11
DERBYSHIRE COUNTY COUNCIL
Checklist for Driver Details
VEHICLE MOT CERTIFICATE
This section is to be used when checking the licence details of Grey Fleet Drivers
(Casual or Essential Users)
Please
Tick
Confirm
 I have seen the original documentation for the Vehicle MOT Certificate
 Take a photocopy of the vehicle MOT Certificate and append to this form
Yes
or
No
Any query concerning MOT Certificates should be raised with the Head of
Transport Fleet Services on 01629 532110 (VOIP ext 32110)
The description and registration of the vehicle described on the Test Certificate is
the same as the one the employee is claiming mileage allowance for
Was an Advisory Notice Issued (if yes ask for a copy of the advisory notice and
append to this form).
Expiry Date of Certificate
Have the advisory items been rectified or replaced
If NO list the items still outstanding, if necessary seek advice from County Transport.
If the MOT Certificate has one month or less before expiry ask the employee to present
the new certificate on issue.
I declare that I have produced my latest licence, insurance and MOT Certificate.
(Delete items not appropriate)
Signature of Employee
Signed …………………………………………………. Date ……………………………..
Signature of Person Conducting Check
Signed …………………………………………………. Date ……………………………..
Position………………………………………………………………………….
D:\116099482.doc
EN068
Revised 01/10/11