Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Customer Information and responsibilities
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Time & Date Vehicle signed out
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In signing this form, I accept responsibility for the safe and prudent operation of this vehicle in accordance with all applicable local, provincial and federal statues regulating the operation of a motor vehicle. I further certify that I currently hold a valid operators license permitting me to operate this vehicle in the province Alberta. Further that I am the full age of 25 years and have no graduated licensing restriction in force on my operators license. <br><br>In the event that a photo radar, parking or any other violation be committed with this vehicle during the time that it is in my care, I will be responsible for any fines or encumbrances that may be levied.
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Photo of Customer Credit Card & Operators license
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Customer Signature
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Repair Order Number
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Time & Date Vehicle signed out
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In signing this form, I accept responsibility for the safe and prudent operation of this vehicle in accordance with all applicable local, provincial and federal statues regulating the operation of a motor vehicle. I further certify that I currently hold a valid operators license permitting me to operate this vehicle in the province Alberta. Further that I am the full age of 25 years and have no graduated licensing restriction in force on my operators license. <br><br>In the event that a photo radar, parking or any other violation be committed with this vehicle during the time that it is in my care, I will be responsible for any fines or encumbrances that may be levied.
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Photo of Customer Credit Card & Operators license
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Customer Signature
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Repair Order Number
Vehicle return information
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Time & Date Vehicle Returned
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Customer Signature
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Budget Auto Centre Representative Signature
VEHICLE DESCRIPTION
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Photograph of Vehicle Being Inspected
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Year
- 2000
- 2001
- 2002
- 2003
- 2004
- 2005
- 2006
- 2007
- 2008
- 2009
- 2010
- 2011
- 2012
- 2013
- 2014
- 2015
- 2016
- 2017
- 2018
- 2019
- 2020
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Make
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Model
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VIN (Vehicle Inspection Number)
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License Number
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License State
EXTERIOR LIGHTING
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High and Low Beams Operational
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Clearance, Marker Lights Operational
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Left and Right Tail Lights Operational
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Left and Right Front Turn Signals Operational
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Left and Right Rear Turn Signals Operational
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Left and Right Break Lights Operational
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Left and Right Back-Up Lights Operational
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License Plate Light Operational
EXTERIOR BODY AND GLASS (Take Photos of any noted damage)
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Windshield Free of Cracks and Chips
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Front Hood, Grill and Bumper free of Damage
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Left Mirrors adjustable and Free of Damage
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Left Fender Free of Damage
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Left Door Free of Damage
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Left Side Free of Damage
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Left Side Windows Free of Cracks and Chips
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Rear WIndow Free of Cracks and Chips
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Rear of Vehicle and Bumper Free of Damage (Tailgate if included)
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Right Side Free of Damage
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License Plate / Tag is current and not expired / Note expiration date and verify to registration
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Right Side Windows Free of Cracks and Chips
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Right Door Free of Damage
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Right Front Fender Free of Damage
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Right Mirror Adjustable and Free of Damage
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Vehicle is Clean and Free of Road Grime and Dirt
Tires
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Front Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Rear Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Rear Driver (INSIDE) Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)
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Rear Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Rear Passenger (INSIDE) Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)
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Front Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Adequate Spare Tire is Available if Necessary in Good Repair with No Visible Signs of Wear or Cracking in Sidewall
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Front Driver and Passenger Wheel/Tire Trim Rings in Place
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Rear Driver and Passenger Wheel/Tire Trim Rings in Place
INTERIOR
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Driver Seat in Good Repair
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Driver Seat Belt Operational with Shoulder Harness
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Windshield Wipers Functioning Appropriately
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Windshield Washer Fluid Functioning and Appropriately Wetting Windshield to Clean
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Heater and Defroster Operational
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Air Conditioning Operational
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Dashboard Lights Operational
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All Gauges are Operating and Show within Appropriate Ranges
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Interior Compartment Lights Operational
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Under Storage Lights Operational
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Entry Grab Bar/Rail Secure
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Interior is Clean and Free of Loose Objects
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Passenger Seat Belts Operational
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Passenger Seats in Good Repair
REQUIRED DOCUMENTATION
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Date of Last Service (List Details of Last Service, i.e. New Tires, Oil Change, ect...)
SIGNATURES
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Signature of Auditor
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Inspection complex by<br>
Tyres
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Front Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Rear Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Rear Driver (INSIDE) Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)
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Rear Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Rear Passenger (INSIDE) Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)
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Front Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall
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Adequate Spare Tire is Available if Necessary in Good Repair with No Visible Signs of Wear or Cracking in Sidewall
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Front Driver and Passenger Wheel/Tire Trim Rings in Place
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Rear Driver and Passenger Wheel/Tire Trim Rings in Place
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John Hanewich<br>Ralph Garnett<br>Adam Hanewich<br>Joel Hanewich
