ASI Van Pre-trip Inspection

• Document No.

• Team

• Area Office

• Conducted on

  Date

• Prepared by

• Location
  Address

• Driver

VEHICLE DESCRIPTION

• Make & Model

  Chevy

  other describe:

• License Plate Number

• Mileage

LIGHTS

• High and Low Beams Operational

  Yes

  No

  N/A

• Front Turn Signals Operational

  Yes

  No

  N/A

• Tail Lights Operational

  Yes

  No

  N/A

• Rear Turn Signals Operational

  Yes

  No

  N/A

• Right Break Lights Operational

  Yes

  No

  N/A

• Reversing Lights Operational

  Yes

  No

  N/A

• License Plate Light Operational

  Yes

  No

  N/A

ENGINE COMPARTMENT

• Engine oil level

  Satisfactory

  Unsatisfactory

• Coolant fluid

  Satisfactory

  Unsatisfactory

• Brake fluid level (get pads checked if level is low)

  Satisfactory

  Unsatisfactory

• Windshield washer fluid level

  Satisfactory

  Unsatisfactory

EXTERIOR BODY AND GLASS (Take Photos of any noted damage)

• Windshield Free of Cracks and Chips

  Yes

  No

  N/A

• Grill and Bumper free of Damage

  Yes

  No

  N/A

• Drivers Side Mirrors adjustable and Free of Damage

  Yes

  No

  N/A

• Sliding Doors Free of Damage

  Yes

  No

  N/A

• Drivers Door Free of Damage

  Yes

  No

  N/A

• Drivers Side Free of Damage

  Yes

  No

  N/A

• Drivers Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Rear Window Free of Cracks and Chips

  Yes

  No

  N/A

• Rear of Vehicle and Bumper Free of Damage (Doors if included)

  Yes

  No

  N/A

• Front and Rear License Plate Intact

  Yes

  No

  N/A

• Passenger Side Free of Damage

  Yes

  No

  N/A

• Passenger Door Free of Damage

  Yes

  No

  N/A

• Passenger Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Passenger Mirror Adjustable and Free of Damage

  Yes

  No

  N/A

• Vehicle is Clean and Free of Road Grime and Dirt

  Yes

  No

  N/A

TIRES

• Front Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

• Front Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

• Rear Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

• Rear Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

• Spare Tire is in Good Repair with No Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

• Tire Pressure Adequate per manufactures specs.

  Yes

  No

  N/A

INTERIOR

• Driver Seat in Good Repair

  Yes

  No

  N/A

• Driver Seat Belt Operational with Shoulder Harness

  Yes

  No

  N/A

• Windshield Wipers Functioning Appropriately

  Yes

  No

  N/A

• Windshield Washer Fluid Functioning and Appropriately Wetting Windshield to Clean

  Yes

  No

  N/A

• Heater and Defroster Operational

  Yes

  No

  N/A

• Dashboard Lights Operational

  Yes

  No

  N/A

• All Gauges are Operating and Show within Appropriate Ranges

  Yes

  No

  N/A

• Interior Compartment Lights Operational

  Yes

  No

  N/A

• Interior is Clean and Free of Loose Objects

  Yes

  No

  N/A

• Passenger Seat Belts Operational

  Yes

  No

  N/A

• Passenger Seats in Good Repair

  Yes

  No

  N/A

SAFETY EQUIPMENT

• Securely mounted First Aid Kit (Ensure Completely Stocked)

  Yes

  No

  N/A

• Fire Extinguisher Charged and Inspected Monthly?

  Yes

  No

  N/A

REQUIRED DOCUMENTATION

• Valid Vehicle Insurance Certificate is Located in Vehicle (Note where kept)

  Yes

  No

  N/A

• Is Vehicle Serviced According to the Manufacturers Schedule?

  Yes

  No

  N/A

• Date of Last Service (List Details of Last Service, i.e. New Tyres, Oil Change, ect...)

  Date

COMMENTS & SIGNATURES

• Additional comments

• Signature of Auditor

  Sign

• Signature of Driver

  Sign

• Ver 1.1 - 16 Jan 13