Information

  • Location

  • Vehicle Number

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Office

  • Department

  • Driver details

REQUIRED DOCUMENTATION

  • Accident packet, insurance card, and registration are available and current?

  • Statement of Practical Treatment is available and current?

  • Note the date of the last service.

  • Note the odometer reading at the last service.

VEHICLE DESCRIPTION

  • Vehicle Make

  • Vehicle number

  • Odometer reading

PPE

  • Are safety glasses/goggles available and in good condition?

  • Is bump cap or hard hat available and in good condition?

  • If respirator is available, cartridges removed, is it clean and in good condition, and stored properly?

  • Are coveralls available and clean?

  • Are Nitrile or leather gloves available and in good condition?

OTHER SAFETY ITEMS

  • Is first aid kit stocked, accessible, and up-to-date?

  • Is eye wash available, easily accessible, and up-to-date?

  • Is spill kit complete and easily accessible?

  • Are electrical cords in good condition and ground prong intact?

  • Is safety cone available, in good condition and easily accessible?

  • If available, is ladder in good condition and adequately secured for travel?

EXTERIOR LIGHTING

  • Brake lights (DS, PS, trunk lid, rear window etc.) are operational?

  • The left and right tail lights are operational?

  • The left and right back-up lights are operational?

  • The left and right rear turn signals are operational?

  • Front and rear emergency flashers are operational?

  • The left and right front turn signals are operational?

  • The high and low beams are operational?

  • The left and right side marker lights are operational?

  • The back license plate lights are operational?

GLASS AND MIRRORS

  • The windshield is free of cracks, chips, breaks or scratches?

  • Mirrors (DS, PS, and rearview) are adjustable and free of damage?

  • Door windows are free of cracks and chips?

  • The rear window is free of cracks and chips?

  • Truck topper windows are free of cracks and chips?

EXTERIOR BODY AND GLASS (Take photo's of any noted damage)

  • The front hood, grill and bumper are free of damage?

  • The DS front fender is free of damage?

  • The DS door(s) is/are free of damage?

  • The DS rear fender is free of damage?

  • The rear of the vehicle and bumper are free of damage?

  • The PS side rear fender is free of damage?

  • The PS door(s) is/are free of damage?

  • The PS front fender is free of damage?

  • The truck topper is free of damage and doors are operational?

  • All wheel hubs are free of damage?

  • Decals are free of damage and not faded?

  • The vehicle is clean and free of road grime and dirt?

TIRES

  • The front DS tire is in a good condition with no visible signs of damage?

  • The rear DS tire is in a good condition with no visible signs of damage?

  • The rear PS tire is in a good condition with no visible signs of damage?

  • The front PS tire is in a good condition with no visible signs of damage?

  • The spare tire is in a good condition with no visible signs of damage?

INTERIOR

  • The seat belts are in good condition and operational?

  • Seats are in a good and clean condition?

  • Floor mat/rug are in a good and clean condition?

  • The interior cabin is clean and free of loose objects?

  • All the gauges are operational and show within the acceptable ranges?

  • The interior compartment lights are operational?

  • The dashboard lights are operational?

  • Dashboard warning lights illuminate for per-check then go off?

  • Interior doors are in good condition?

  • The interior of truck bed is clean, organized, products labeled and secured for stop?

MECHANICAL

  • The windshield wipers are functioning and in a good condition? (check to see that washer is operational)

  • The horn is oprerational?

  • Steering is good and does not pull to side?

  • Are the AC, defroster and heater operational?

List any other items that need to be addressed or corrected

  • Enter/list items here

SIGNATURES

  • Driver

  • Inspector

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