Information
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Document No.
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Document Title
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Conducted By
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Conducted on
Vehicle Information
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Fleet ID
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Community
- Angurugu
- Darwin
- Gapuwiyak
- Galiwinku
- Gunyangara
- Milingimbi
- Milyakburra
- Nhulunbuy
- Ramingining
- Umbakumba
- Yirrkala
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Odometer Reading
VEHICLE IDENTIFICATION
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Photo Examples
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Front of Vehicle (Showing Rego Plate)
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Right Side Vehicle (Showing Rego Plate & Fleet ID)
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Rear of Vehicle (Showing Registration Number)
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Close up of Badge - Identifying Model Code
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Left Side Vehicle (Showing Rego Plate & Fleet ID)
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Photo of Identification Plate (VIN)
VEHICLE SPECIFICATION
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Transmission
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Drive
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Fuel
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Colour
- White
- Green
- Blue
- Black
- Beige
- Brown
- Grey
- Orange
- Gold
- Red
- Yellow
- Silver
- Pearl
- Purple
- Pink
VEHICLE ACCESSORIES
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Bull Bar
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Cargo Barriers
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Floor Mats
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Reversing Camera
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Roof Rack
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Roll Over Bar (Ute)
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Seat Covers
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Tow Package
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Tow Capacity
NOTES/COMMENTS
Exterior
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Vehicle Diagram
Hood
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Headlights, Indicator & High Beam
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- Headlights Not Working
- High Beam Not Working
- Indicators Not Working
- Cover Damaged
- Cover Missing
- Other
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Please Describe Other Damage
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Add Photo
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Action
Front Bumper
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Grill
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Front Windshield
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Right Fender
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Right Mirror
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Right Front Tyre
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Condition
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Damage
- Crack
- Cut
- Puncture
- Tread Wear
- Other
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Please Describe Other Damage
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Add Photo
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Action
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Tyre Size & Make
Right Front Door Panel
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Right Front Window
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Right Rear Door Panel
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Right Rear Window
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Right Rear Tyre
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Condition
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Damage
- Crack
- Cut
- Puncture
- Tread Wear
- Other
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Please Describe Other Damage
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Add Photo
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Action
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Tyre Size & Make same as the Front?
Right Quarter
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Taillights, Indicators and Break Lights
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Condition
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Damage
- Break Lights Not Working
- Indicator Lights Not Working
- Tail Lights Not Working
- Cover/Glass Damage
- Other
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Please Describe Other Damage
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Add Photo
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Add Photo
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Action
Right Rear Bumper
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
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Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Boot
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Tray
-
Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Rear Windscreen
-
Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
-
Add Photo
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Action
Left Quarter
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Left Rear Tyre
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Condition
-
Damage
- Crack
- Cut
- Puncture
- Tread Wear
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Left Rear Window
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Left Rear Door Panel
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Left Front Window
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Left Front Door Panel
-
Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Left Front Tyre
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Condition
-
Damage
- Crack
- Cut
- Puncture
- Tread Wear
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Left Fender
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- None
- Bent
- Creased
- Cracked
- Dent
- Hole
- Loose
- Paint Discolouration
- Rust
- Scratch
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Left Mirror
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Condition
- Clean
- Dirty
- Damage
- Undamaged
- N/A
-
Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Under Body
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Any Leaks Visible?
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Action
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Any Loose Wires Visible?
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Action
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Any Bent or Hanging Parts?
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Action
NOTES/COMMENTS
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Additional Comments
Interior
General Photo
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Add General Photo of Interior
Dash Panel
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Condition
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Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Dash Gauges,Lights and Electrics
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Condition
-
Damage
- Burn
- Crack
- Holes
- Loose Parts
- Missing
- Non Operational
- Other
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Add Photo
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Action
Rear Review Mirror
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Condition
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Damage
- Chip
- Crack
- Loose
- Missing
- Smash
- Other
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Add Photo
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Action
Driver Side Seat
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Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Driver Seat Belt
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Condition
-
Damage
- Cut
- Frayed
- Missing
- Not Locking
- Not Releasing
- Unsecured
- Other
-
Please Describe Other Damage
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Add Photo
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Action
Driver Side Door Panel
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Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Driver Side Carpet & Mats
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Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Front Passenger Side Seat
-
Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Front Passenger Seat Belt
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Condition
-
Damage
- Cut
- Frayed
- Missing
- Not Locking
- Not Releasing
- Unsecured
- Other
-
Please Describe Other Damage
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Add Photo
-
Action
Front Passenger Side Door Panel
-
Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Front Passenger Side Carpet & Mat
-
Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Rear Seats
-
Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Rear Seat Belts
-
Condition
-
Damage
- Cut
- Frayed
- Missing
- Not Locking
- Not Releasing
- Unsecured
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Rear Door Panels
-
Condition
-
Damage
- Burn
- Dent
- Hole
- Loose Part
- Missing
- Mold
- Scratch
- Stain
- Torn
- Worn
- Other
-
Please Describe Other Damage
-
Add Photo
-
Action
Miscallenous
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Interior Free from Loose Objects and Rubbish?
Notes/Comments
-
Additional Comments
Miscallenous
NOTES
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Add Further Notes if Required
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Add Photos if Required
Safety and Other
WHEELCHAIR RESTRAINT AND LIFT
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Add Photo of Wheelchair Lift
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Is the Vehicle Fitted with Wheelchair Lift Kit?
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Adequate Restrain - Tie Downs Available for all Wheelchair Positions
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Action
-
Wheelchair Safety Straps are Free of Frays,Nicks and Cuts?
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Action
-
Seat Belt Web Cutter for Emergency Use Available?
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Action
-
Lift Manufacturer
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Lift Model Number
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Lift Serial Number
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Manufacture Date
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Lift Anti Skid is In Serviceable Condition (Not Worn or Missing)
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Action
-
Vehicle Movement is Prevented Unless the Lift door is Closed, Ensuring the Lift is Stowed
-
Action
-
Lift Operation is Prevented Unless the Vehicle is Stopped and vehicle Movement is Preveneted
-
Action
-
Platform will not Fold/Stow if Occupied
-
Action
-
Date of Last Inspection
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Name and Number of Authorised Service Centre Performing Lift Inspection Available?
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Name of Company
-
Phone Number
SAFETY
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Date of Last Service
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Details of Last Serviced Performed (Km/Months)
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First Aid Kit Present & Fully Stocked?
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Action
-
Fire Extinguisher Located in the Vehicle?
-
Action
-
Spare Tyre in Good Condition & Present?
-
Action
-
Motor Vehicle Check Book Located in the Vehicle and Being Completed
-
Action
Notes/Comments
-
Additional Comments
