Atmos Energy - Vehicle & Equipment Inspection Report

• Unit No.

• Year/Make/Model

• Vehicle License Plate No.

• Vehicle Inspection Date & Time

  Date

• Inspected by

• Location
  Address

GENERAL INFORMATION

• Custodian

• Driver's License Class

• Driver's License Expiration Date

  Date

• Medical Expiration Date (CDL Only)

• Odometer Reading

• Mileage This Month

• Supervisor

VEHICLE CONDITION

• Vehicle Registration

  OK

  NOT OK

  N/A

• Registration Date

  Date

• Current Vehicle State Inspection (Brake Tag)

  OK

  NOT OK

  N/A

• State Inspection Due Date

  OK

  NOT OK

  N/A

• Accident Form

  OK

  NOT OK

  N/A

• Proof of Insurance

  OK

  NOT OK

  N/A

• GE Fleet Services & Maintenance Card

  OK

  NOT OK

  N/A

• Service MAnual

  OK

  NOT OK

  N/A

• Insude Appearance

  OK

  NOT OK

  N/A

• Horn

  OK

  NOT OK

  N/A

• Seat Belts

  OK

  NOT OK

  N/A

• Outside Appearance

  OK

  NOT OK

  N/A

• Windshield (Cracks/Wiper/Blades,etc.)

  OK

  NOT OK

  N/A

• Headlights

  OK

  NOT OK

  N/A

• Turn Signals

  OK

  NOT OK

  N/A

• Brakes

  OK

  NOT OK

  N/A

• Brake Lightss

  OK

  NOT OK

  N/A

• Parking Brake

  OK

  NOT OK

  N/A

• Tires

  OK

  NOT OK

  N/A

• Wheels & Rims

  OK

  NOT OK

  N/A

• Mirrors

  OK

  NOT OK

  N/A

• Hoses & Belts

  OK

  NOT OK

  N/A

• Fluid Levels

  OK

  NOT OK

  N/A

• Battery & Cables

  OK

  NOT OK

  N/A

TRAILER

• Lights

  OK

  NOT OK

  N/A

• Reflectors

  OK

  NOT OK

  N/A

• Tires

  OK

  NOT OK

  N/A

• Brakes

  OK

  NOT OK

  N/A

• Safety Chains

  OK

  NOT OK

  N/A

• Tie Downs

  OK

  NOT OK

  N/A

• DOT Inspection Sticker

  OK

  NOT OK

  N/A

SAFETY EQUIPMENT

• First Aid Kit

  OK

  NOT OK

  N/A

• Fire Extinguisher / Inspection Due Date

  OK

  NOT OK

  N/A

• Hardhats

  OK

  NOT OK

  N/A

• Eye Protection

  OK

  NOT OK

  N/A

• Ear Protection

  OK

  NOT OK

  N/A

• Traffic Cones

  OK

  NOT OK

  N/A

• Ladder

  OK

  NOT OK

  N/A

• Proper Storage for Sensitive Equipment?

  OK

  NOT OK

  N/A

• Hazardous Materials Signs (If required)

  OK

  NOT OK

  N/A

• Disposable Camera

  OK

  NOT OK

  N/A

• Proper Decals for Type of Vehicle (see application guide)

  OK

  NOT OK

  N/A

SIGN OFF

• Inspector's Name & Signature

  Sign