Kansanshi Daily Vehicle Inspection Report

• Date

  Date

• Shift: Day or Night Shift:

• Registration Number:

• Make Of Vehicle:

• Km Reading

• Fuel Level:

• Inspector Name & Surname:

• Signature:

  Sign

• Valid Insurance, Road Tax & Fitness Certificates:

  Yes

  No

  N/A

• First Aid Kit

• First Aid Kit Seal Numbers:

• Jack & Wheel Spanner

  Yes

  No

  N/A

• Tri-Angles:

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• Head Lights Working:

  Yes

  No

  N/A

• Park Lights Working:

  Yes

  No

  N/A

• Indicator Lights Working:

  Yes

  No

  N/A

• Front Seat Belts:

  Yes

  No

  N/A

• Passenger Seat Belts Back:

  Yes

  No

  N/A

• Spare Tyre:

  Yes

  No

  N/A

• Tyre Conditions:

  Yes

  No

  N/A

• Windscreen:

  Yes

  No

  N/A

• Wipers Working:

  Yes

  No

  N/A

• Trailer Female Plug Intact:

  Yes

  No

  N/A

Engine

• Oil Level Checked:

  Yes

  No

  N/A

• Radiator Water Level Checked:

  Yes

  No

  N/A

• Brake Fluid Level Checked:

  Yes

  No

  N/A

• Transmission Fluid Checked:

  Yes

  No

  N/A

• Wiper Water Checked:

  Yes

  No

  N/A

• Battery Intact:

  Yes

  No

  N/A

• Battery Terminals Fastened:

  Yes

  No

  N/A

Vehicle Body:

• Visible Damages:

• Description:

• Visible Scratches:

• Description:

• Drivers Name & Surname:

• Drivers Company Number:

• Does the Driver have a valid Drivers License?

  Yes

  No

  N/A

• Driver Tested for Alcohol:

  Yes

  No

  N/A

• Alcohol Test Result:

  Pass

  Fail

  N/A

• Drivers Safety Talk Attended:

  Yes

  No

  N/A

• Date & Time:

  Date

Driver`s Declaration: Driver informed to:

• Driving to Road conditions:

  Yes

  No

  N/A

• Do not over speed.

  Yes

  No

  N/A

• Do not overlaod.

  Yes

  No

  N/A

• Driver is responsible for passengers to wear seatbelts.

  Yes

  No

  N/A

• Date & Time:

  Date

• Name & Surname:

• Signature:

  Sign