The purpose of this study was to provide an outline of the process of developing an on-road driving test route and rating form. Comprehensive evaluation of medical fitness to drive should comprise of an off-road and an on-road assessment. Much research attention has focussed on the off-road phase of assessment, while there is less standardisation evident in the completion and measurement of the on-road phase of fitness-to-drive assessment. Design/methodology/approach A scholarship of practice approach was used to inform the development of an on-road test route and an associated generic on-road assessment tool that was guided by research evidence and best practice recommendations. Findings A step-by-step guide, outlining seven recommended phases in the development of an on-road route for the assessment of fitness to drive that aligns with best practice recommendations, was developed. A preliminary generic on-road assessment tool (the Maynooth–Trinity Driving Test) that includes higher-order cognition alongside element of strategic, tactical and operational driving ability was developed and piloted alongside the newly developed on-road test route. Originality/value This paper offers an overview of an approach to developing evidence-based on-road test routes and an associated generic assessment tool that may assist occupational therapists and on-road driving assessors establish a standard practice for testing on-road behaviour as part of a comprehensive approach to evaluate fitness to drive.