KNS Vehicle Safety Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

INSPECTION INFORMATION

• Inspectors Name

• Date/Time:

  Date

VEHICLE INFORMATION

• VIN/LP

  Media

TIRES

• Are tire properly inflated?

  Yes

  No

  N/A

• Tread in acceptable condition?

  Yes

  No

  N/A

• Any bulges, cuts, or unusual wear.

  Yes

  No

  N/A

LIGHTING

Headlights:

• Do the brights work (both lamps)?

  Yes

  No

  N/A

• Do the dims work (both lamps)?

  Yes

  No

  N/A

• Do the fogs lamps work (if applicable)?

  Yes

  No

  N/A

• Do the rear tail lights work (both lamps)?

  Yes

  No

  N/A

Parking/Turn Signals:

• Are Hazard/Flashers operational (front & back)?

  Yes

  No

  N/A

• Does right turn signal work (front & back)?

  Yes

  No

  N/A

• Does left turn signal work (front & back)?

  Yes

  No

  N/A

Break Lights:

• Are both brakek lights operational?

  Yes

  No

  N/A

• Are all lenses intact?

  Yes

  No

  N/A

Visibility

Windshield:

• Is the windshield is good condition (no cracks)?

  Yes

  No

  N/A

• Is the windshield clean (inside & outside)?

  Yes

  No

  N/A

• Are the windshield wipers operational & in good condition?

  Yes

  No

  N/A

• Does the windshield washer fluid work properly?

  Yes

  No

  N/A

External/Sideview Mirrors:

• Are the external/sideview mirrors clean?

  Yes

  No

  N/A

• Are the external/sideview adjustable?

  Yes

  No

  N/A

• Is the rear view mirror clean and free of cracks?

  Yes

  No

  N/A

INTERNAL CONTROLS & GAUGES

Vehicle Gauges:

• Is there a clear line of sight to the dashboard gauges?

  Yes

  No

  N/A

• Does the speedometer work correctly?

  Yes

  No

  N/A

• Does the temperature gauge work correctly?

  Yes

  No

  N/A

• Does the fuel gauge work correctly?

  Yes

  No

  N/A

Seat Belts:

• Are all seat belts fully operational (latch, unlatch, and lock on hard break)?

  Yes

  No

  N/A

• Are all seat belts in good condition (no tears)?

  Yes

  No

  N/A

Horn:

• Does the horn work?

  Yes

  No

  N/A

• Is the horn sound at a reasonable volume?

  Yes

  No

  N/A

MAINTENANCE

Fluids:

• Are all fluids at acceptable levels?

  Yes

  No

  N/A

OTHER ISSUES

• Please described any major issues in detail below:

• I hereby affirm that I have completed this vehicle inspection, and it is to the best of my knowledge accurate and truthful.

• Signature

  Sign