Page 35 - Safe Mobility for Life E-book

Question A F O N

I have trouble moving my foot from
the gas pedal to the brake pedal or
turning the steering wheel.

I get lost on roads that are familiar
to me.

I feel nervous, agitated, or irritated CHAPTER 2
while driving.

I have had several “fender benders”
in the last three years.

TOTAL

Always=3 Frequently=2 Occasionally=1 Never=0

A:______ F: ______ O: ______ N: ______

(Multiply the total number of checkmarks in each column
by the matching number above for your grand score.)

Grand Score You Should

0 to 5 Not be concerned at this time

6 to 15 Take additional self-assessments

16 or Above Consider a more formal assessment
by a driver rehabilitation specialist

For more information on other available driver fitness
screening tools, go to the Statewide Resources in
Chapter 5.

Chapter 2: Be Proactive 31