Banlaw Vehicle Safety Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time

  Date

VEHICLE DESCRIPTION

• Photograph of Vehicle Being Inspected

  Media

• License Number

• Odometer Reading at Inspection

EXTERIOR LIGHTING

• High and Low Beams Operational

  Yes

  No

  N/A

• Left and Right Tail Lights Operational

  Yes

  No

  N/A

• Turn Signals Operational

  Yes

  No

  N/A

• Audible Back-up Alarm Operational

  Yes

  No

  N/A

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

• Windshield Free of Cracks and Chips

  Yes

  No

  N/A

• Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Rear WIndow Free of Cracks and Chips

  Yes

  No

  N/A

• Vehicle is Clean and Free of Road Grime and Dirt

  Yes

  No

  N/A

TIRES

• Tyres in good condition

  Yes

  No

  N/A

INTERIOR

• Driver Seat Belt Operational

  Safe

  At Risk

  N/A

• Windshield Wipers Functioning Appropriately

  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 is Clean and Free of Loose Objects

  Yes

  No

  N/A

SAFETY EQUIPMENT

• Vehicle is Equipped with Two Way Radio System or Driver Has Cell Phone when Vehicle is in Operation

  Yes

  No

  N/A

• Securely mounted First Aid Kit (Ensure Completely Stocked)

  Safe

  At Risk

  N/A

• Highway safety triangles available

  Yes

  No

  N/A

• Fire Extinguisher Charged and Inspected Monthly?

  Safe

  At Risk

  N/A

SIGNATURES

• Signature

  Sign