Title Page

  • Year

  • Make

  • Model

  • Plate Number

  • Prepared by

  • Please submit a photo showing the condition of the vehicle.

General Condtion

  • Mileage/Hours

  • Oil Change Due Date

  • DOT Inspection Date (For DOT Vehicles)

  • Cab/Doors/Windows

  • Body/Doors

  • Oil Leaks

  • Grease Leaks

  • Coolant Leak

  • Fuel Leak

Interior

  • Gauges/Warning Indicators

  • Windshield Wipers/Washers

  • Windshield Glass

  • Horn

  • Heater/Defroster

  • Mirrors

  • Steering

  • Clutch

  • Emergency Brakes

  • Seat Belts

  • Spare Fuses

Exterior

  • Headlights

  • High Beams

  • Hazard Lights

  • Turn Signals

  • Brake Lights

  • Suspension

  • Tire Condition and inflation

  • Wheels

  • Rims

  • Lug Nuts

  • Battery

  • Service Brakes

  • Air Filter

  • Spare Tire

  • Reflectors

  • Coupling Devices

  • Dents

Engine Compartment

  • Oil Level

  • Coolant Level

  • Belts

Emergency Equipment

  • Fire Extinguisher (Insect and initial)

  • First Aid Kit

  • Caution Triangle/Flares (For DOT Trucks)

  • Yellow Strobe Light (For Lift Trucks)

Paperwork

  • Insurance Card

  • Registration

  • Accident Report Sheets

  • MSDS Booklet

  • Safety Manual

Remarks and Signature

  • Comments

  • Reporting Driver (Inspector)

Maintenance Actions

  • Repairs Needed?

  • Work Order Number

  • Repaired By

  • Location

  • Shop Remarks

  • Repair Mechanic Signature

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