Title Page
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Document No.
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Conducted on
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Prepared by
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Location
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Personnel
Basic Details
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Enter basic information about the driver and vehicle. Take picture of front of car.
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Add media
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Drivers Name
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Type of vehicle
- Company Car
- Cash for Car
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Vehicle Make
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Registration
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Current Mileage
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Date of Last Service
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Mileage at last service
Vehicle Check
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Is evidence of Car Tax available and kept with vehicle?
- Yes
- No
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Is a No Smoking sign displayed inside vehicle?
- Yes
- No
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Is a High Visibility jacket / vest kept in vehicle?
- Yes
- No
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Is a Warning Triangle Sign kit kept in the Vehicle?
- Yes
- No
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Is a travelling first aid kit kept in the Vehicle?
- Yes
- No
Front of Vehicle
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Check the front of the vehicle. Use the check boxes to indicate correct operation.
Side Lights
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Near Side
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Off Side
Dip Lights
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Near Side
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Off Side
Full Beam
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Near Side
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Off Side
Indicators
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Near Side
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Off Side
Hazard Warning Lights
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Near Side
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Off Side
Fog Lights
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Near Side
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Off Side
Rear of Vehicle
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Check the tear of the vehicle. Use the check boxes to indicate correct operation. If an item is not fitted then. ........
Side Lights
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Near Side
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Off Side
Brake Lights
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Near Side
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Off Side
Reversing Lights
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Near Side
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Off Side
Indicators
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Near Side
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Off Side
Hazard Warning Lights
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Near Side
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Off Side
Fog Lights
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Near Side
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Off Side
General
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Check the following general items.
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Windscreen free from crack or other significant damage?
- Yes
- No
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Wing mirrors free from cracks or other significant damage? If electrically operated do they function correctly?
- Yes
- No
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Windscreen Wipers in good condition, not split or damaged?
- Yes
- No
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Windscreen wash available and working?
- Yes
- No
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Rear mirror OK?
- Yes
- No
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Rear Window free from crack or other significant damage?
- Yes
- No
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Horn operational?
- Yes
- No
Tyres
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Make a visual check of tyres. Indicate if visually they look;
In Good Condition
In Reasonable Condition
In Poor Condition -
Near Side Front
- Good
- Reasonable
- Poor
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Near Side Rear
- Good
- Reasonable
- Poor
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Off Side Front
- Good
- Reasonable
- Poor
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Off Side Rear
- Good
- Reasonable
- Poor
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Spare or Space Saver
- Good
- Reasonable
- Poor
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Tyre Repair Kit / Pump / Jack
- Yes
- No
- N/A
Vehicle Damage
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Make a note of any vehicle damage. Take a photo to show damage.
Vehicle Damage
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Description
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Photo