Light Vehicle Weekly Safety Record

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time audit began

  Date

Required information

• Date of completion required

  Date

VEHICLE DESCRIPTION

• Registration Number

• Make

• Model

• Odometer Reading at Inspection

EXTERIOR LIGHTING

• High and Low Beams Operational

  Yes

  No

  N/A

• Left and Right Tail Lights Operational

  Yes

  No

  N/A

• Left and Right Front Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Rear Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Break Lights Operational

  Yes

  No

  N/A

• License Plate Light Operational

  Yes

  No

  N/A

Maintenance

• Oil Level

  Yes

  No

  N/A

• Brake Fluid

  Yes

  No

  N/A

• Windscreen Washer Level

  Yes

  No

  N/A
• Add location
  Address

• Radiator Coolant Level

  Yes

  No

  N/A

EXTERIOR BODY AND GLASS (Take Photos of any noted damage)

• Windshield Free of Cracks and Chips

  Yes

  No

  N/A

• Front Hood, Grill and Bumper free of Damage

  Yes

  No

  N/A

• Left & Right Mirrors adjustable and Free of Damage

  Yes

  No

  N/A

• Left / Right Fender Free of Damage

  Yes

  No

  N/A

• Left / Right Door Free of Damage

  Yes

  No

  N/A

• Left /Right Side Free of Damage

  Yes

  No

  N/A

• Left / Right Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Rear WIndow Free of Cracks and Chips

  Yes

  No

  N/A

• Rear of Vehicle and Bumper Free of Damage (Tailgate if included)

  Yes

  No

  N/A

• License Plate / Tag is current and not expired / Note expiration date and verify to registration

  Yes

  No

  N/A

• Vehicle is Clean and Free of Road Grime and Dirt

  Yes

  No

  N/A

Tyres

• Front Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Front Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Adequate Spare Tire is Available if Necessary in Good Repair with No Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

INTERIOR

• Driver Seat in Good Repair

  Safe

  At Risk

  N/A

• Driver Seat Belt Operational

  Safe

  At Risk

  N/A

• Windshield Wipers Functioning Appropriately

  Yes

  No

  N/A

• Windshield Washer Fluid Functioning and Appropriately Wetting Windshield to Clean

  Yes

  No

  N/A

• Horn Operational

  Yes

  No

  N/A

• Air Conditioning Operational

  Yes

  No

  N/A

• Dashboard Lights Operational

  Yes

  No

  N/A

• All Gauges are Operating and Show within Appropriate Ranges

  Yes

  No

  N/A

• Interior Compartment Lights Operational

  Yes

  No

  N/A

• Interior is Clean and Free of Loose Objects

  Yes

  No

  N/A

• Passenger Seat Belts Operational

  Safe

  At Risk

  N/A

• Passenger Seats in Good Repair

  Safe

  At Risk

  N/A

SAFETY EQUIPMENT

• Beacon fitted and operational

  Yes

  No

  N/A

• Hi viz mining tape fitted?

  Yes

  No

  N/A

• First aid kit supplied?

  Yes

  No

  N/A

• Fire extinguisher pressure correct and inspection tag in date?

  Yes

  No

  N/A

• All jack and tools required for wheel change supplied ?

  Yes

  No

  N/A

REQUIRED DOCUMENTATION

• Next service due (Klm's)

• Kim's for next service due?

  Yes

  No

  N/A

• Date of Last Service (List Details of Last Service, i.e. New Tires, Oil Change, ect...)

  Date

SIGNATURES

• Signature of Driver

  Sign