Title Page
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
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. <br>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. <br>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?<br><br>
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
