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