Information
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East Wimmera Health Service
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Vehicle Damage Report
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Campus
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Make:
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Model
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Registration
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Kilometers
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Location
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Conducted on
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Vehicle Identification Photo
Exterior
Body
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Bonnet
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Left front guard
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Right front guard
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Left front door
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Right front door
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Left rear door
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Right rear door
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Left sill
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Right sill
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Left quarter panel
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Right quarter panel
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Boot / lift gate / tail gate
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Roof
Bumper Bars
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Front bar
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Rear bar
Lights
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Left head light
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Right head light
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Left guard flasher
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Right guard flasher
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Left tail light
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Right tail light
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Centre brake light
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Number plate lights
Glass
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Windscreen
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Left front door glass
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Right front door glass
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Left rear door glass
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Right rear door glass
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Back window / tail gate glass
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Station wagon left side glass
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Station wagon right side glass
Mirrors
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Left exterior mirror
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Right exterior mirror
Interior
Seats
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Left front seat
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Right front seat
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Rear seat
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7 Seater rear seat
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Trim
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Interior mirror
Wheels & Tyre's
Wheels
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Left front wheel
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Right front wheel
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Left rear wheel
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Right rear wheel
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Spare wheel
Tyre's
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Left front tyre
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Right front tyre
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Left rear tyre
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Right rear tyre
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Spare tyre
Sundries
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Bonnet protector
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Left headlight protector
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Right headlight protector
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Tow bar
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Add signature
