Continental Pipelines Vehicle Inspection Audit - MTC

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time audit began

  Date

VEHICLE DESCRIPTION

• Photograph of Vehicle Being Inspected

  Media

• Year

  Select 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

  • 2000
  • 2001
  • 2002
  • 2003
  • 2004
  • 2005
  • 2006
  • 2007
  • 2008
  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014
  • 2015
  • 2016
  • 2017
  • 2018
  • 2019
  • 2020

• Vehicle Make

  Select Ford Chev/GM Dodge Sterling Toyota Nissan

  • Ford
  • Chev/GM
  • Dodge
  • Sterling
  • Toyota
  • Nissan

• Model

• License Number

• Licensed in.....

  BC

  AB

• Mileage

EXTERIOR LIGHTING

• High and Low Beams Operational

  Yes

  No

  N/A

• Clearance, Marker Lights Operational

  Yes

  No

  N/A

• Left and Right Tail Lights Operational

  Yes

  No

  N/A

• Left and Right Front Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Rear Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Break Lights Operational

  Yes

  No

  N/A

• Left and Right Back-Up Lights Operational

  Yes

  No

  N/A

• License Plate Light Operational

  Yes

  No

  N/A

• Audible Back-up Alarm Operational

  Yes

  No

  N/A

EXTERIOR BODY AND GLASS (Take Photos of any noted damage)

• Windshield Free of Cracks and Chips

  Yes

  No

  N/A

• Front Hood, Grill and Bumper free of Damage

  Yes

  No

  N/A

• Left Mirrors adjustable and Free of Damage

  Yes

  No

  N/A

• Left Fender Free of Damage

  Yes

  No

  N/A

• Left Door Free of Damage

  Yes

  No

  N/A

• Left Side Free of Damage

  Yes

  No

  N/A

• Left Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Rear WIndow Free of Cracks and Chips

  Yes

  No

  N/A

• Rear of Vehicle and Bumper Free of Damage (Tailgate if included)

  Yes

  No

  N/A

• Right Side Free of Damage

  Yes

  No

  N/A

• License Plate / Tag is current and not expired / Note expiration date and verify to registration

  Yes

  No

  N/A

• Right Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Right Door Free of Damage

  Yes

  No

  N/A

• Right Front Fender Free of Damage

  Yes

  No

  N/A

• Right Mirror Adjustable and Free of Damage

  Yes

  No

  N/A

• Vehicle is Clean and Free of Road Grime and Dirt

  Yes

  No

  N/A

• MTC Marker Lights All WorkingInterior

  Yes

  No

  N/A

TIRES

• Front Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Driver (INSIDE) Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)

  Safe

  At Risk

  N/A

• Rear Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Passenger (INSIDE) Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)

  Safe

  At Risk

  N/A

• Front Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Adequate Spare Tire is Available?

  Yes

  No

  N/A

INTERIOR

• Driver Seat in Good Repair

  Safe

  At Risk

  N/A

• Driver Seat Belt Operational with Shoulder Harness

  Safe

  At Risk

  N/A

• Windshield Wipers Functioning Appropriately

  Yes

  No

  N/A

• Windshield Washer Fluid Functioning and Appropriately Wetting Windshield to Clean

  Yes

  No

  N/A

• Heater and Defroster Operational

  Yes

  No

  N/A

• Air Conditioning Operational

  Yes

  No

  N/A

• Dashboard Lights Operational

  Yes

  No

  N/A

• All Gauges are Operating and Show within Appropriate Ranges

  Yes

  No

  N/A

• Interior Compartment Lights Operational

  Yes

  No

  N/A

• Entry Grab Bar/Rail Secure

  Safe

  At Risk

  N/A

• Interior is Clean and Free of Loose Objects

  Yes

  No

  N/A

• Passenger Seats in Good Repair

  Safe

  At Risk

  N/A

• Passenger Seat Belts Operational

  Safe

  At Risk

  N/A

SAFETY EQUIPMENT

• Vehicle is Equipped with Two Way Radio System with updated road frequencies.

  Yes

  No

  N/A

• Are Safety Triangle With The Vehicle In Case Of Emergency?

  Yes

  No

  N/A

• Fire Extinguisher Charged and Inspected Monthly?

  Safe

  At Risk

  N/A

• Is There A Cargo Net Inside The Cab?

  Yes

  No

  N/A

REQUIRED DOCUMENTATION

• Valid Vehicle Registration is located in Vehicle?

  Yes

  No

  N/A

• Valid Vehicle Insurance Certificate is Located in Vehicle (Note where kept)

  Yes

  No

  N/A

Interior Of MTC

• Are There Proper Stairs Located At The Back Of The MTC.

  Yes

  No

  N/A

• IsThe Door Unlocked While Onsite?

  Yes

  No

  N/A

• Is The Certificate For The Roll Cage Available By The Back Door?

  Yes

  No

  N/A

• Do All Interior Lights Work?

  Yes

  No

  N/A

• Is There A Stocked Jump Kit In The MTC.

  Yes

  No

  N/A

• Is There A Stretcher Inside the MTC.

  Yes

  No

  N/A

• Is There A Large Oxygen Cylinder Inside?

  Yes

  No

  N/A

• Is There A Sufficient Amount Of Oxygen For The Job-site Onboard?

  Yes

  No

  N/A

• Is There A Proper Working Medic Seat Onboard The MTC.

  Yes

  No

  N/A

• Is The Required Paperwork Completed?

  Yes

  No

  N/A

• Is The Door Seal In Good Shape?

  Yes

  No

  N/A

• Do Both Heaters Produce Heat?

  Yes

  No

  N/A

Compliance Date

• To be in compliance before;

  Date

SIGNATURES

• Signature of Auditor

  Sign

• Signature of Medical Attendants

  Sign