EMCOR Betlem Monthly Vehicle Inspection Checklist

Monthly Vehicle Inspection Checklist

• Today's Date

  Date

• This checklist is being prepared by (name):

• Vehicle Number

• Vehicle Mileage

• Next oil change due

• Brakes (Including Parking Break)

  Breaks are Functioning Normally

  Breaks are Not Functioning Normally

• Comments

• Was Engine Oil Checked?

  Yes

  No

• Comments

• Are all vehicle gauges/instruments functioning properly?

  Yes

  No- See Comments for Details

• Comments

• Does the horn work?

  Yes

  No

• Comments

• Are Ladder Racks secure and functioning?

  Secure & Functioning

  Secure Only

  Not Secure or Functioning

  Showing Signs of Wear

• Comments

• Are there any leaks or general problems with this vehicle?

  Yes

  No

• Comments

• Do lights and turn signals function properly?

  Yes

  No

• Comments

• Is radiator reservoir empty?

  Yes

  No

• Comments

• Please Select Which Equipment is Present from the List:

  Select Fire Extinguisher Present Fire Extinguisher Missing First Aid Kit Present and Stocked First Aid Kit Missing or Missing Supplies Accident Kit Present and Stocked Accident Kit Missing or Missing Supplies

  • Fire Extinguisher Present
  • Fire Extinguisher Missing
  • First Aid Kit Present and Stocked
  • First Aid Kit Missing or Missing Supplies
  • Accident Kit Present and Stocked
  • Accident Kit Missing or Missing Supplies

• Are seat belts working properly?

  Yes

  No

• Comments

• Please enter the month that inspection is due

  Select January February March April May June July August September October November December

  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December

• Please record expiration date of vehicle registration

  Date

• Are storage racks/cage secure?

  Yes

  Yes - But need some repairs

  No - Need repairs

• Comments

• Windshield: have you checked for cracks?

  Yes- there are cracks

  No- there are no cracks

• Comments

• Windshield Wipers

  Select Windshield Wiper Motor -Good Windshield Wiper Motor -Bad Windshield Wiper Arms -Good Windshield Wiper Arms -Bad Windshield Wiper Blades -Good Windshield Wiper Blades -Bad Windshield Wiper Controls -Good Windshield Wiper Controls -Bad

  • Windshield Wiper Motor -Good
  • Windshield Wiper Motor -Bad
  • Windshield Wiper Arms -Good
  • Windshield Wiper Arms -Bad
  • Windshield Wiper Blades -Good
  • Windshield Wiper Blades -Bad
  • Windshield Wiper Controls -Good
  • Windshield Wiper Controls -Bad

• Missing Children Poster Information: (Select all which apply.)

  Select Poster is for the current month Poster is not torn/damaged Poster is missing Poster is from a previous month Poster is torn/damaged

  • Poster is for the current month
  • Poster is not torn/damaged
  • Poster is missing
  • Poster is from a previous month
  • Poster is torn/damaged

• Vehicle PPE: (Please select items from the list.)

  Select Hard Hat Present Hard Hat Missing Safety Glasses Present Safety Glasses Missing Hearing Protection Present Hearing Protection Missing Hi-Vis Vest Present Hi-Vis Vest Missing

  • Hard Hat Present
  • Hard Hat Missing
  • Safety Glasses Present
  • Safety Glasses Missing
  • Hearing Protection Present
  • Hearing Protection Missing
  • Hi-Vis Vest Present
  • Hi-Vis Vest Missing

• Comments

• Add media

  Media

• Have you received any vehicle violations in the last 30 days?

  Yes

  No

• Comments

• Driver Signature

  Sign