Johansen Vehicle Safety Inspection Checklist

• Conducted on:

  Date

• Auditor:

Identification

• Equipment Number:11-001

• Odometer reading:

Documentation in vehicle

• Vehicle Registration, Insurance, Do Not Operate Tag

  Yes

  No

  N/A

• Accident Report Form and Instructions

  Yes

  No

  N/A

Interior

• Window Operation

  Meets Standard

  Needs Improvement

  not applicable

• Door Locks

  Meets Standard

  Needs Improvement

  not applicable

• Seatbelts

  Meets Standard

  Needs Improvement

  not applicable

• Mirrors properly adjusted

  Meets Standard

  Needs Improvement

  not applicable

• No Warning Lights turned on

  Yes

  No

  N/A

• Roadside Emergency Kit, Triangles, First-Aid Kit

  Yes

  No

  N/A

Engine Compartment

• Windshield washer fluid

  Meets Standard

  Needs Improvement

  not applicable

• Engine oil level

  Meets Standard

  Needs Improvement

  not applicable

• Coolant level

  Meets Standard

  Needs Improvement

  not applicable

• Brake Fluid level

  Meets Standard

  Needs Improvement

  not applicable

• Transmission Fluid Level

  Meets Standard

  Needs Improvement

  not applicable

Exterior

• Windows and windshield in good condition

  Meets Standard

  Needs Improvement

  not applicable

• Windshield wipers working

  Meets Standard

  Needs Improvement

  not applicable

• Headlights functional

  Meets Standard

  Needs Improvement

  not applicable

• Tail Lights, Brake Lights & Turn Signals

  Meets Standard

  Needs Improvement

  not applicable

• Emergency brake in good condition

  Meets Standard

  Needs Improvement

  not applicable

• Power brakes in good condition

  Meets Standard

  Needs Improvement

  not applicable

• Tires in good condition

  Meets Standard

  Needs Improvement

  not applicable

• Bald tires

• Not inflated properly

• Damaged tires

• Horn working

  Meets Standard

  Needs Improvement

  not applicable

• Back-Up Alarm

  Yes

  No

  N/A

• No grease or oil leaks

  Meets Standard

  Needs Improvement

  not applicable

• No fuel leaks

  Meets Standard

  Needs Improvement

  not applicable

• Fire Extinguisher in good condition and inspected in the last year?

  Yes

  No

  N/A

• Additional comments/observation

Observation

• Add observations/comments here.

• Add media

  Media

• I hereby certify that all information is accurate, and that after an actual inspection was conducted this vehicle is safe for use.

  Yes

  No

  N/A

• Auditor's Printed Name & Signature

  Sign