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Older Drivers' Self-Assessment Questionnaire

DISCLAIMER: This questionnaire has been designed to help you identify areas related to your safety that may need to be addressed. Being honest in your answers will achieve the best results. Ratings/Scores that you achieve after answering the questions set out below are a guide only and are not intended to be professional advice about your driving ability. For a full evaluation of your driving ability, medical, driving theory and practical assessments would need to be performed. To assess your medical and physical condition, a full medical assessment would need to be performed by an appropriately qualified medical practitioner. However, your answers give a subjective indication about your ability to continue to drive safely. If you or others who observe your driving have any concerns about your continued ability to drive, further professional advice should be sought. Your answers to this questionnaire are in no way being captured, recorded or stored by RACQ.

<Health>

Question 1

Has your mobility and flexibility decreased? e.g., are you having more difficulty performing shoulder checks (checking blind spots by looking over your shoulders) and/or do you need assistive devices to walk?

 Yes
 No

Question 2

Do your joints ache or become stiff on long trips?

 Yes
 No

Question 3

Are your reactions to unexpected situations slower than they used to be?

 Yes
 No

Question 4

Do you often get tired or feel sleepy while driving during the day?

 Yes
 No

Question 5

Do you get tired or feel sleepy on long trips?

 Yes
 No

Question 6

Do you suffer from any chronic medical conditions e.g., heart disease, epilepsy, diabetes, or vision/hearing impairment?

 Yes
 No

Question 7

If you are 75 or over, do you require a medical certificate to continue driving?

 Yes
 No

Question 8

Do you always read the labels on medications that you take?

 Yes
 No

Question 9

Have you asked your doctor or pharmacist if your medication can affect your driving?

 Yes
 No

Question 10

Do you ever forget to take a dose of your medication?

 Yes
 No

Question 11

Do you have trouble judging the distance of other vehicles, or changing focus from your instrument panel to the road?

 Yes
 No

Question 12

Are you having more trouble adjusting to glare and/or night driving than you did previously?

 Yes
 No

Question 13

Do you ever get surprised by pedestrians or other vehicles coming from your left or right while you are focussing straight ahead?

 Yes
 No
<Driving>

Question 14

Do you ever drive without wearing a seatbelt?

 Yes
 No

Question 15

When you sit in the driver's seat, is your chest less than 25cm (around 10 inches) from the steering wheel, and/or is your eye level less than 10cm (around 4 inches) above the top of the steering wheel and/or do you have trouble completely depressing the clutch, accelerator and brake pedals without discomfort?

 Yes
 No

Question 16

Are you able to reach and operate your turn indicators, horn, hazard light switch, headlight switch (including high and low beam) handbrake, and turn the steering wheel from full lock from left to right and back again without pain or discomfort?

 Yes
 No

Question 17

Are you able to get in and out of your vehicle without discomfort?

 Yes
 No

Question 18

Do you regularly lose your sense of direction, become lost or have trouble deciding on an appropriate route to your destination?

 Yes
 No

Question 19

Do some traffic situations or other drivers upset you?

 Yes
 No

Question 20

Do you have trouble driving through, or turning at busy intersections or roundabouts?

 Yes
 No

Question 21

Do you keep up to date with changes to the road rules?

 Yes
 No

Question 22

Do you ever have trouble deciding who to give way to at an intersection?

 Yes
 No

Question 23

Does driving in heavy traffic make you feel uncomfortable?

 Yes
 No

Question 24

Do you feel more comfortable driving well below the speed limit?

 Yes
 No

Question 25

Do you feel uncomfortable driving in unfamiliar territory?

 Yes
 No

Question 26

Do you predominantly drive in one type of traffic environment, i.e., either predominantly in city environments, or predominantly in country environments?

 Yes
 No

Question 27

Do you have trouble merging with, or entering fast moving traffic e.g., an entry ramp to a freeway?

 Yes
 No

Question 28

Do you find that you are easily distracted or that your thoughts wander while you are driving?

 Yes
 No
<Other Factors>

Question 29

Have you caused any minor crashes or experienced any near misses in the last 12 months?

 Yes
 No

Question 30

Have you received a warning or a ticket from a police officer in the last 12 months?

 Yes
 No

Question 31

Have your children, family members, friends or passengers expressed concerns about your ability to drive safely?

 Yes
 No

Question 32

Do you find that other drivers react negatively to your driving e.g., blowing horn, flashing lights, driving aggressively around you?

 Yes
 No

Question 33

Have your children, family members, friends or passengers expressed concerns about your vehicle?

 Yes
 No

Question 34

Do you have regular health and vision checks?

 Yes
 No