Title Page

  • Document No.

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Basic Details

  • Enter basic information about the driver and vehicle. Take picture of front of car.

  • Add media

  • Drivers Name

  • Type of vehicle

  • Vehicle Make

  • Registration

  • Current Mileage

  • Date of Last Service

  • Mileage at last service

Vehicle Check

  • Is evidence of Car Tax available and kept with vehicle?

  • Is a No Smoking sign displayed inside vehicle?

  • Is a High Visibility jacket / vest kept in vehicle?

  • Is a Warning Triangle Sign kit kept in the Vehicle?

  • Is a travelling first aid kit kept in the Vehicle?

Front of Vehicle

  • Check the front of the vehicle. Use the check boxes to indicate correct operation.

Side Lights

  • Near Side

  • Off Side

Dip Lights

  • Near Side

  • Off Side

Full Beam

  • Near Side

  • Off Side

Indicators

  • Near Side

  • Off Side

Hazard Warning Lights

  • Near Side

  • Off Side

Fog Lights

  • Near Side

  • Off Side

Rear of Vehicle

  • Check the tear of the vehicle. Use the check boxes to indicate correct operation. If an item is not fitted then. ........

Side Lights

  • Near Side

  • Off Side

Brake Lights

  • Near Side

  • Off Side

Reversing Lights

  • Near Side

  • Off Side

Indicators

  • Near Side

  • Off Side

Hazard Warning Lights

  • Near Side

  • Off Side

Fog Lights

  • Near Side

  • Off Side

General

  • Check the following general items.

  • Windscreen free from crack or other significant damage?

  • Wing mirrors free from cracks or other significant damage? If electrically operated do they function correctly?

  • Windscreen Wipers in good condition, not split or damaged?

  • Windscreen wash available and working?

  • Rear mirror OK?

  • Rear Window free from crack or other significant damage?

  • Horn operational?

Tyres

  • Make a visual check of tyres. Indicate if visually they look;
    In Good Condition
    In Reasonable Condition
    In Poor Condition

  • Near Side Front

  • Near Side Rear

  • Off Side Front

  • Off Side Rear

  • Spare or Space Saver

  • Tyre Repair Kit / Pump / Jack

Vehicle Damage

  • Make a note of any vehicle damage. Take a photo to show damage.

  • Vehicle Damage
  • Description

  • Photo

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.