Information

  • Select date

  • Prepared by

Particulars

Vehicle Identification

  • Name of Custodian

  • Vehicle Make

  • Vehicle Type

  • Registration Number

  • Speedo reading

Driver history

  • Attach image of licence

  • Does the licence expire within 12mth annual review period?

  • Set up reminder to ensure new licence is provided when renewed.

  • Has the Custodian received any traffic infringements in the last 12 months?

  • If yes, provide details

  • Traffic Infringement
  • Add details here

  • When was last Driver Observation?

Internal

Cabin clean and tidy / no loose items in cabin

  • All loose items stowed and secured in rear of vehicle (cabin, tray, boot). <br>Items stored in cabin stored at floor level

  • Rubbish is removed from vehicle (footwells/seats)

Seats and Seatbelts

Seatbelt (check no knicks or frayed edges)

  • Good

    Good Seatbelt.png
  • Bad

    Bad Seatbelt.png
  • Seatbelts in good condition (eg retraction / fraying)

  • Seats in good condition (eg slide forward & back, lock in place, back rest can be adjusted and locks in place)

Electronics and accessories

  • Dashboard / in cab gauges functioning and no indication of faults

  • Horn working

  • Mirrors / windows, clean and undamaged

  • Doors open/close and lock

  • Jack and components (in vehicle and accessible)

Emergency Equipment carried

  • Safety equipment available and correctly stowed (eg: fire extinguishers in test, complete first aid and items in date)

  • In-cab documentation (eg: Fleet information, emerg guides, placards)

  • PPE in accessible and in good condition (eg gloves, glasses, boots, uniform)

External

Tyres & Wheels

Tyres (check tread and no damage to sidewall)

  • Good

    Good Tyre1.png
  • Bad

    Bad tyres.png
  • Check for tread wear and damage, include sidwall damage particularly kerb side. Check for at least 1.6mm depth on tread across all tyres including any spares.

  • Bald tyres

  • Not inflated properly

  • Damaged tyres

  • Spare tyre - in vehicle, easily accessible, no damage and inflated .

Windows & Mirrors

  • Windows and windshield in good condition

  • Windshield wipers working

  • Mirrors properly adjusted

Lights

  • Headlights functional

  • Tail Lights & Brake Lights working

  • Hazard lights working

  • Blinkers working

External

  • Check for damage to lights or unreported work body damage

  • External Body Clean (look at condition of branding as well)

Load Restraints

  • Load restraints (eg cages secure, lockable and un-damaged , webbed strapping – check for frays, cuts )

Signatures

  • Additional comments/observation

  • Observation
  • Add observations/comments here.

  • Reviewers Signature

  • Custodians Signature if different to Reviewers

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.