Audit

Date and time

I/we understand the car seat donated and installed today is done in the interest of community safety. The sponsoring organizations/Technicians cannot and will not guarantee any child seat donated today is constructed without defects.
I/we understand that for the child seat to work In it's correct manner the child must be secured in the seat and the seat installed in accordance with the manufacturers and vehicles instructions.
I/we agree to hold harmless the sponsoring organizations, workers, and technicians from any present and future liability and/or damages or injuries including death, arising from or growing out of the assistance received today.

Location the seat was collected/installed

Technician Information

Name

Technicians signature
Vehicle information

Year

Make

Model

Caregiver information

Name

Address

Phone

Email

Child/ren information

Age

Height

Weight

Is the child present?

Child restraint information

Brand

Model

Model number

Date of manufacture

Select date

Expiry Date

Select date

Has instruction manual

Is the harness routed correctly and free from tears and frays

Is the buckle working correctly

Are the tether and isofix attachments is good working order

Installation

Is the seat installed

Installation method

Top Tether Used

Angle of rear facing seat

Photo of restraint installed on departure
Technician discussed

Projectiles ( Including pets)

Bulky clothing

Adjusting car seat

Next steps

Air bags

Any other discussion or concerns

Caregiver

Did the caregiver harness the child today?

Did the caregiver participate in the fitting today

Caregivers signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.