BHG VAN CONDITION REPORT AND SAFETY CHECK - V 1.1

• Document No.

• Broadland Housing Association
  NCFC
  Jarrold Stand
  Carrow Road
  Norowich
  NR1 1HU

• Vehicle Inspection Form

• Site Inspection Details:

• Conducted on:

  Date

• Prepared by:

Driver and Van Details

• Driver Name:

• Inspecting Person (If applicable):

• Vehicle Registration:

• Vehicle Mileage:

TYRE CONDITION:

• N/S FRONT:

  GOOD (8 - 6 mm)

  AVERAGE (6 - 4 mm)

  POOR (4 - 2 mm)

  FLAT (2 -0 mm)

• N/S REAR:

  GOOD (8 - 6 mm)

  AVERAGE (6 - 4 mm)

  POOR (4 - 2 mm)

  FLAT (2 -0 mm)

• O/S FRONT:

  GOOD (8 - 6 mm)

  AVERAGE (6 - 4 mm)

  POOR (4 - 2 mm)

  FLAT (2 -0 mm)

• O/S REAR:

  GOOD (8 - 6 mm)

  AVERAGE (6 - 4 mm)

  POOR (4 - 2 mm)

  FLAT (2 -0 mm)

• SPARE:

  GOOD (8 - 6 mm)

  AVERAGE (6 - 4 mm)

  POOR (4 - 2 mm)

  FLAT (2 -0 mm)

VEHICLE INDICATORS & LIGHTS INSPECTION CHECKS:

• HEAD LIGHTS:

  OK

  U/S

• TAIL LIGHTS:

  OK

  U/S

• SIDE LIGHTS:

  OK

  U/S

• INDICATORS:

  OK

  U/S

• HORN:

  OK

  U/S

VEHICLE FLUID LEVELS:

• WATER:

• OIL:

• SCREEN WASH:

• ADBLUE (Container on van):

• POWER STEERING FLUID:

VEHICLE INSPECTION CHECKS CONT:

• INTERNAL RACKING:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• FIRST AID KIT (check contents and expiry date):

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• EYE WASH (Expiry date):

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• FIRE EXTINGUISHER:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• NON - SMOKING SIGN:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• INTERNAL LIGHTING:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• CHEMICALS PRESENT:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• INTERNAL REAR CLEANLINESS:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• INTERNAL CAB CLEANLINESS:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• CLEANLINESS OUTSIDE OF VAN:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• VAN STOCK (as required for job role):

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• PPE EQUIPMENT:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

DROP DOWN LADDER & RACK INSPECTION:

• DROP DOWN LADDER RACK & LADDER:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• PIPE-RACK/S:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• ROOF RACK:

  ACCEPTABLE

  NOT ACCEPTABLE

  N/A

• NUMBER OF PIPE-RACKS:

VEHICLE DAMAGE CHECKS:

• Windscreen / Mirrors damaged - i.e. chips or cracks etc.

  Yes

  NO

• Add media

  Media

• Vehicle Damaged - i.e. Dents, Scratches etc.

  Yes

  No

  N/A

• Take Photos of any defects / Damage:

  Media

OTHER ITEMS TO BE INSPECTED AND CHECKED:

• Identification Card (ID)

• Sky Guard (Charged and functioning correctly)

• Needle kit (If applicable to job role)

Additional Notes: Example: Excellent van stock, very clean and tidy

• Add Notes:

• Add media

  Media

• Are their any reasons why I am not fit to drive a works vehicle i.e. health condition, taking medication etc.

• Driver Signature:

  Sign

• Inspecting Supervisor Signature:

  Sign