Information

  • I/We understand the car seat check up provided today is done in the interest of community safety. The sponsoring organizations/technicians will not and cannot guarantee any child seat checked today is constructed without defects. I/We understand to have full protective benefits of a child car seat the child must be properly secured in the seat and the seat must be attached to the vehicle in accordance with the manufacturer's and vehicle's instructions. I/We agree to hold harmless the sponsoring organizations, workers, and technicians from any present and future liability and/or damages for injuries including death, arising from or growing out of the assistance/information received today.

  • Date and time

  • Location

Carseat check

Personal information on caregiver

  • Name:

  • Address:

  • Phone number:

  • Email address:

Vehicle information

  • Year:

  • Make:

  • Model:

  • Additional vehicles

  • Vehicle

Vehicle information

  • Year:

  • Make:

  • Model:

Child's information

  • Child present?

  • Name:

  • Birthday:

  • Weight:

  • Height:

Car seat info on arrival:

  • Photo on arrival if installed.

  • Car seat is

  • Car seat received

  • Is the seat free of crashes?

  • Is the seat free of frontal airbags?

  • Vehicle seat faces forward?

  • Seating position has side airbag? If so, discuss with caregiver.

  • Location in vehicle on arrival

Child arrives in:

  • Rear facing seat?

  • Child's age and/or weight appropriate?

  • Shell at least 1" above head, or required amount?

  • Shoulder straps in correct slots?

  • Seat appropriately reclined?

  • Handle position correct?

  • Harness adjusted snugly?

  • Chest clip present?

  • Chest clip threaded properly?

  • Chest clip at the armpit level?

  • Maximum weight limit rear facing?

  • Converted seat to forward facing?

  • Forward facing seat?

  • Child's age and/or weight appropriate?

  • Ears at or below top of shell?

  • Shoulder straps in correct slots?

  • Seat appropriately reclined, if necessary?

  • Harness adjusted snugly?

  • Chest clip present?

  • Chest clip threaded properly?

  • Chest clip at the armpit level?

  • Tethered?

  • Tether can be retrofitted?

  • Tether part and information

  • Properly adjusted?

  • Attached to tether anchor?

  • Maximum weight limit forward facing?

  • Moved child to rear facing?

  • Moved child to booster?

  • Belt positioning booster?

  • Child's age and/or weight appropriate?

  • Ears at or below top of whiplash protection?

  • Uses lap and shoulder belt?

  • Shoulder portion fits appropriately?

  • Lap portion fits appropriately?

  • Maximum weight limit?

  • Moved child to harnessed seat?

  • Moved child to seat belt?

  • Seat belt?

  • Uses lap and shoulder belt?

  • Child's bottom is against seat back?

  • Child's knees bend at the edge of the seat and their feet reach the floor?

  • Lap portion fits appropriately?

  • Shoulder portion fits appropriately?

  • Ears at or below top of whiplash protection?

  • Moved child to booster?

  • Moved child to harnessed seat?

Installation on arrival:

  • Uninstalled

  • Lower Anchors

  • Seat belt

  • Tether

  • Seat belt or lower connectors properly routed?

  • Seat secured with less than 1" of movement at the belt path?

  • Locking clip/lock off mechanism used if needed?

  • Locking clip/lock off mechanism used correctly?

  • Seatbelt free of inappropriate locking clip?

  • Seatbelt

  • Retractor

  • Latch plate?

  • Lower anchors

  • Used correctly?

  • In LATCH position?

Installation on departure:

  • Same location on departure?

  • Location in vehicle on departure

  • Same as on arrival?

  • Lower Anchors

  • Seat belt

  • Tether

  • Seat belt or lower connectors properly routed?

  • Seat secured with less than 1" of movement at the belt path?

  • Locking clip/lock off mechanism used if needed?

  • Locking clip/lock off mechanism used correctly?

  • Seatbelt free of inappropriate locking clip?

  • Seatbelt

  • Retractor

  • Latch plate?

  • Lower anchors

  • Used correctly?

  • In LATCH position?

  • Photo on departure

Restraint information

  • Manufacturer

  • Model name

  • Model number

  • Date of manufacture

  • Has instructions?

  • Seat is within acceptable lifespan?

  • Free from recalls

  • Recalls corrected?

  • Recall fix/phone number:

  • Harness:

  • Harness is threaded properly?

  • Harness lies flat and is not torn or frayed?

  • Buckle mechanism appears to open and lock appropriately?

  • Add on products are acceptable?

  • Additional children

  • Child

Child's information

  • Child present?

  • Name:

  • Birthday:

  • Weight:

  • Height:

Car seat info on arrival:

  • Photo on arrival if installed.

  • Car seat is

  • Car seat received

  • Is the seat free of crashes?

  • Is the seat free of frontal airbags?

  • Vehicle seat faces forward?

  • Seating position has side airbag? If so, discuss with caregiver.

  • Location in vehicle on arrival

Child arrives in:

  • Rear facing seat?

  • Child's age and/or weight appropriate?

  • Shell at least 1" above head, or required amount?

  • Shoulder straps in correct slots?

  • Seat appropriately reclined?

  • Handle position correct?

  • Harness adjusted snugly?

  • Chest clip present?

  • Chest clip threaded properly?

  • Chest clip at the armpit level?

  • Maximum weight limit rear facing?

  • Converted seat to forward facing?

  • Forward facing seat?

  • Child's age and/or weight appropriate?

  • Ears at or below top of shell?

  • Shoulder straps in correct slots?

  • Seat appropriately reclined, if necessary?

  • Harness adjusted snugly?

  • Chest clip present?

  • Chest clip threaded properly?

  • Chest clip at the armpit level?

  • Tethered?

  • Tether can be retrofitted?

  • Tether part and information

  • Properly adjusted?

  • Attached to tether anchor?

  • Maximum weight limit forward facing?

  • Moved child to rear facing?

  • Moved child to booster?

  • Belt positioning booster?

  • Child's age and/or weight appropriate?

  • Ears at or below top of whiplash protection?

  • Uses lap and shoulder belt?

  • Shoulder portion fits appropriately?

  • Lap portion fits appropriately?

  • Maximum weight limit?

  • Moved child to harnessed seat?

  • Moved child to seat belt?

  • Seat belt?

  • Uses lap and shoulder belt?

  • Child's bottom is against seat back?

  • Child's knees bend at the edge of the seat and their feet reach the floor?

  • Lap portion fits appropriately?

  • Shoulder portion fits appropriately?

  • Ears at or below top of whiplash protection?

  • Moved child to booster?

  • Moved child to harnessed seat?

Installation on arrival:

  • Uninstalled

  • Lower Anchors

  • Seat belt

  • Tether

  • Seat belt or lower connectors properly routed?

  • Seat secured with less than 1" of movement at the belt path?

  • Locking clip/lock off mechanism used if needed?

  • Locking clip/lock off mechanism used correctly?

  • Seatbelt free of inappropriate locking clip?

  • Seatbelt

  • Retractor

  • Latch plate?

  • Lower anchors

  • Used correctly?

  • In LATCH position?

  • Photo of seat on departure

Installation on departure:

  • Same location on departure?

  • Location in vehicle on departure

  • Same as on arrival?

  • Lower Anchors

  • Seat belt

  • Tether

  • Seat belt or lower connectors properly routed?

  • Seat secured with less than 1" of movement at the belt path?

  • Locking clip/lock off mechanism used if needed?

  • Locking clip/lock off mechanism used correctly?

  • Seatbelt free of inappropriate locking clip?

  • Seatbelt

  • Retractor

  • Latch plate?

  • Lower anchors

  • Used correctly?

  • In LATCH position?

  • Photo on departure

Restraint information

  • Manufacturer

  • Model name

  • Model number

  • Date of manufacture

  • Has instructions?

  • Seat is within acceptable lifespan?

  • Free from recalls

  • Recalls corrected?

  • Recall fix/phone number:

  • Harness:

  • Harness is threaded properly?

  • Harness lies flat and is not torn or frayed?

  • Buckle mechanism appears to open and lock appropriately?

  • Add on products are acceptable?

  • Technician discussed

  • Airbags

  • Unused seatbelt

  • Projectiles (including pets)

  • Airplane travel

  • Unattended children in and around cars

  • Bulky clothing

  • Next steps

Caregiver

  • Caregiver harnessed child/doll?

  • Caregiver participated in check today?

  • Caregiver signature

Technician information

  • Name

  • Email

  • Tech ID

  • Technician signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.