HSQE - FOR - 037 Van Check Sheet

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Vehicle Registration Number

• Date & Time

  Date

• am/pm

• Speedometer Reading

• Driver of vehicle

• Inspectors name

Please ask the driver of the vehicle if the following is in full working order

• Foot brake

  Good

  Fair

  Poor

  N/A

• Hand brake

  Good

  Fair

  Poor

  N/A

• Steering

  Good

  Fair

  Poor

  N/A

Please check the following are in full working order and undamaged

• Seat Belts

  Good

  Fair

  Poor

  N/A

• Horn

  Good

  Fair

  Poor

  N/A

• Rear View Mirror

  Good

  Fair

  Poor

  N/A

• Wing Mirrors

  Good

  Fair

  Poor

  N/A

• Windscreen

  Good

  Fair

  Poor

  N/A

• Windscreen Washers

  Good

  Fair

  Poor

  N/A

• Windscreen Wipers

  Good

  Fair

  Poor

  N/A

• Roof

  Good

  Fair

  Poor

  N/A

Please check all lights are in full working order

• Front near side

  Yes

  No

  N/A

• Front off side

  Yes

  No

  N/A

• Rear near side

  Yes

  No

  N/A

• Rear off side

  Yes

  No

  N/A

• Fog light

  Yes

  No

  N/A

• Main beam

  Yes

  No

  N/A

• Full beam

  Yes

  No

  N/A

• Indicators left & right

  Yes

  No

  N/A

• Hazard warning lights

  Yes

  No

  N/A

• Brake lights

  Yes

  No

  N/A

• Reverse light/s

  Yes

  No

  N/A

Tyre Pressure Check

• Rear off side

  Good

  Fair

  Poor

  N/A

• Rear near side

  Good

  Fair

  Poor

  N/A

• Front near side

  Good

  Fair

  Poor

  N/A

• Front off side

  Good

  Fair

  Poor

  N/A

• Spare wheel

  Good

  Fair

  Poor

  N/A

First Aid Kit

• Are all first aid kit contents in date and in full

  Yes

  No

  N/A

Vehicle

• Jack and Repair Tool Kit

  Yes

  No

  N/A

• Triangle

  Yes

  No

  N/A

• No Smoking Stickers

  Yes

  No

  N/A

• Clean Inside

  Yes

  No

  N/A

• Clean Outside

  Yes

  No

  N/A

• Drivers Pack

  Yes

  No

  N/A

• Hands Free Phone Kit

  Yes

  No

  N/A

• Oil level

  Good

  Fair

  Poor

  N/A

• Water (Radiator)

  Good

  Fair

  Poor

  N/A

• Brake fluid

  Good

  Fair

  Poor

  N/A

• Steering fluid

  Good

  Fair

  Poor

  N/A

• Windscreen wash

  Good

  Fair

  Poor

  N/A

Damage Report

• Is there any damage to the vehicle

  Yes

  NO