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"
*
" indicates required fields
Forklift Medical Form
Business Name
*
Applicant Full Name
*
Job Title
*
Date of Birth
*
Attendance
*
Attended
Did Not Attend
Has the applicant given consent?
*
This should have been sent to the driver by the employer/training provider.
Yes
No
DO NOT PROCEED UNTIL THE CANDIDATE HAS PROVIDED CONSENT
Consent Form Here
Did the applicant meet the DVLA group 2 standard?
*
Yes
No
Please give further details
Isharaha Colour Vision Test
*
Normal
Abnormal
Not Completed
Upper Limb Test
*
Pass
Fail
Not Completed
Was any advice given to the applicant or any referral made (to GP, Optician, etc.)
*
Yes
No
Please share further details
I give permission to D4Drivers to issue a fitness certificate for this candidate
*
Yes
No
(For Doctor) I consent to my signature used on any certification issued to this candidate for this medical
*
Doctor to consent to use of signature
Yes
No
