Belmont Vehicle Inspection

• Document No.

• Client

• Conducted on

  Date

• Branch inspected

  Select Stockton Modesto Concord Yuba City Vacaville Sonora Sacramento Rancho Cordova Livermore Milpitas Santa Rosa Belmont Merced Salinas Chico Redding Santa Maria Ventura Auburn San Diego Reno

  • Stockton
  • Modesto
  • Concord
  • Yuba City
  • Vacaville
  • Sonora
  • Sacramento
  • Rancho Cordova
  • Livermore
  • Milpitas
  • Santa Rosa
  • Belmont
  • Merced
  • Salinas
  • Chico
  • Redding
  • Santa Maria
  • Ventura
  • Auburn
  • San Diego
  • Reno

• Inspection conducted by:

  Jason Barnhart

• Inspection Score (100 points possible)

Vehicle Information

• Vehicle license plate number or last 5 of VIN number

• Vehicle model

  Select Ranger F-150 F-250 or larger Fusion Escape Other

  • Ranger
  • F-150
  • F-250 or larger
  • Fusion
  • Escape
  • Other

• Make and model

Driver information

• Was the driver present during the inspection? <br>Up to -5 points<br>

  Yes

  No

  N/A

• Driver's name

• Was the driver dress appropriately?<br>Up to -10 points

  Yes

  No

  N/A

• What is not correct?

  Select missing Clark belt not wearing black shoes shoes not shined clothing ripped or dis colored name badge missing

  • missing Clark belt
  • not wearing black shoes
  • shoes not shined
  • clothing ripped or dis colored
  • name badge missing

Exterior of vehicle

• Is the vehicle clean?<br>Up to -10 points

  Yes

  No

  N/A

• Is the vehicle waxed?<br>Up to -5 points

  Yes

  No

  N/A

• Body free of dents?<br>Up to -10 points

  Yes

  No

  N/A

• Damage severity?

  Heavy Damage

  Moderate Damage

  Light Damage

  N/A

• Are the bumpers and grille free of damage?<br>Up to -5 points

  Yes

  No

  N/A

• Is paint in good condition?<br>Up to -10 points

  Yes

  No

  N/A

• Have all scratches been filled?<br>Up to -5 points

  Yes

  No

  N/A

• Are the decals in correct and in good condition?

  Yes

  No

  N/A

• Are the wheels painted?<br>Up to -5 points

  Yes

  No

  N/A

• Are the license plate frames Clark-branded?<br>Up to -4 points

  Yes

  No

  N/A

• Is the windshield free of cracks or chips that are not filled?<br>Up to -5 points

  Yes

  No

  N/A

Interior of vehicle

• Is the interior clean and orderly?<br>Up to -5 points

  Yes

  No

  N/A

• Is the proof of insurance and vehicle registration in the important papers envelope?<br>Up to -5 points

  Yes

  No

  N/A

• What is missing?

  Vehicle registration

  Proof of insurance

• Is Idrive installed and working?<br>Up to -10 points

  Yes

  No

  N/A

• Why is Idrive not working or missing?

  RMA

  Broken needs to be RMA

  Wiring problem

• Is an eye wash on board the vehicle?<br>Up to -2 points

  Yes

  No

  N/A

• Is there a first aid kit on board?<br>Up to -3 points

  Yes

  No

  N/A

• Is there soak-up on board?<br>Up to -5 points

  Yes

  No

  N/A

• Is there a fire extinguisher on board?<br>Up to -5 points

  Yes

  No

  N/A

• Is the brake pedal pad present?<br>Up to -5 points

  Yes

  No

  N/A

• Is the brake pedal pad in good condition?

  Yes

  No

  N/A

Mechanical operation of vehicle

• Are all of the engine lights off when the engine is running?<br>Up to -5 points

  Yes

  No

  N/A

• Is the drivetrain free of oil leaks?<br>Up to -3 points

  Yes

  No

  N/A

• Is the paperwork organized and in good condition?<br>Up to -5 points

  Yes

  No

  N/A

• Is the engine free of coolant leaks?<br>Up to -3 points

  Yes

  No

  N/A

• Is the water pump free of leaks?<br>Up to -3 points

  Yes

  No

  N/A

• Is the thermostat housing free of leaks?<br>Up to -3 points

  Yes

  No

  N/A

• Is the battery secure?<br>Up to -3 points

  Yes

  No

  N/A

• Are the battery terminals free of corrosion?<br>Up to -3 points

  Yes

  No

  N/A

• Are the fluids full?<br>Up to -3 points

  Yes

  No

  N/A

• Is the air filter in operational condition?<br>Up to -3 points

  Yes

  No

  N/A

• Are the tire air pressures correct?<br>Up to -4 points

  Yes

  No

  N/A

• Do any of the tires need replacing?<br>Up to -5 points

  Yes

  No

  N/A

• Which tire?

  Select Front left tire Front right tire Rear right tire Rear left tire

  • Front left tire
  • Front right tire
  • Rear right tire
  • Rear left tire

• Why does the tire need replacing?

  Select Tread is worn unusual wear, needs front end alignment defect in tire

  • Tread is worn
  • unusual wear, needs front end alignment
  • defect in tire

• Are all lights functioning properly?<br>Up to -5 points

  Yes

  No

  N/A

• Which light?

  Select RF head light LF head light RF turn signal LF turn signal Cab lights RR tail light LR tail light Third Tail Light License plate light

  • RF head light
  • LF head light
  • RF turn signal
  • LF turn signal
  • Cab lights
  • RR tail light
  • LR tail light
  • Third Tail Light
  • License plate light

• Any other Mechanical defect?<br><br><br>-

  Yes

  No

  N/A

Power sprayer, B&G and other equipment

• Is the power sprayer free of leaks? (Including hoses, reel and attachments)<br>Up to -30 points

  Yes

  No

  N/A

• Is the power sprayer clean and painted?<br>Up to -10 points

  Yes

  No

  N/A

• Are grade 8 bolts and cables used to hold down the rig?<br>Up to -10 points

  Yes

  No

  N/A

• Is the reel clean and painted?<br>Up to -5 points

  Yes

  No

  N/A

• Is the material storage box clean and organized?<br>Up to -5 points

  Yes

  No

  N/A

• Is the storage container lockable and locks?<br>Up to -5 points

  Yes

  No

  N/A

• Is there an air gap device?<br>Up to -5 points

  Yes

  No

  N/A

• Are the B&G's polished and shine?<br>Up to -5 points

  Yes

  No

  N/A

• If No, what is the condition?

  Dirty

  Clean

  Some shine

CPC and Regulatory compliance

• Are all service containers and equipment labeled?<br>Up to -30 points

  Yes

  No

  N/A

• There is no use of food container for pesticide service containers?<br>Up to -10 points

  Yes

  No

  N/A

• Is there soap and water on board? (Instant soap and water or a bar of soap)<br>Up to -5 points

  Yes

  No

  N/A

• Is there a Label book in the truck? (WDO trucks only)<br>Up to -5 points

  Yes

  No

  N/A

• Is the emergency medical care information displayed?<br>Up to -3 points

  Yes

  No

  N/A

• Is all required PPE on board?<br>Up to -10 points

  Yes

  No

  N/A

• Are the respirators in a container?<br>-5 points

  Yes

  No

  N/A

• Is the safety spill kit complete with break-away zip-tie and name tag?<br>Up to -3 points

  Yes

  No

  N/A

• Are inside shoe cover on board?<br>Up to -3 points

  Yes

  No

  N/A

• Is there a orange safety cone on board?<br>-5points

  Yes

  No

  N/A

Supervision

• Was there a Supervisor available at all time during the inspection?<br>Up to -3 points

  Yes

  No

  N/A

• Does the Employee need retraining?<br><br><br>-

  Yes

  No

  N/A

Final Score

• Final Score?