Information
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Select date
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Prepared by
Particulars
Vehicle Identification
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Name of Custodian
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Vehicle Make
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Vehicle Type
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Registration Number
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Speedo reading
Driver history
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Attach image of licence
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Does the licence expire within 12mth annual review period?
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Set up reminder to ensure new licence is provided when renewed.
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Has the Custodian received any traffic infringements in the last 12 months?
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If yes, provide details
Traffic Infringement
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Add details here
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When was last Driver Observation?
Internal
Cabin clean and tidy / no loose items in cabin
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All loose items stowed and secured in rear of vehicle (cabin, tray, boot). <br>Items stored in cabin stored at floor level
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Rubbish is removed from vehicle (footwells/seats)
Seats and Seatbelts
Seatbelt (check no knicks or frayed edges)
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Good
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Bad
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Seatbelts in good condition (eg retraction / fraying)
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Seats in good condition (eg slide forward & back, lock in place, back rest can be adjusted and locks in place)
Electronics and accessories
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Dashboard / in cab gauges functioning and no indication of faults
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Horn working
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Mirrors / windows, clean and undamaged
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Doors open/close and lock
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Jack and components (in vehicle and accessible)
Emergency Equipment carried
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Safety equipment available and correctly stowed (eg: fire extinguishers in test, complete first aid and items in date)
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In-cab documentation (eg: Fleet information, emerg guides, placards)
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PPE in accessible and in good condition (eg gloves, glasses, boots, uniform)
External
Tyres & Wheels
Tyres (check tread and no damage to sidewall)
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Good
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Bad
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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.
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Bald tyres
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Not inflated properly
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Damaged tyres
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Spare tyre - in vehicle, easily accessible, no damage and inflated .
Windows & Mirrors
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Windows and windshield in good condition
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Windshield wipers working
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Mirrors properly adjusted
Lights
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Headlights functional
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Tail Lights & Brake Lights working
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Hazard lights working
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Blinkers working
External
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Check for damage to lights or unreported work body damage
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External Body Clean (look at condition of branding as well)
Load Restraints
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Load restraints (eg cages secure, lockable and un-damaged , webbed strapping – check for frays, cuts )
Signatures
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Additional comments/observation
Observation
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Add observations/comments here.
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Reviewers Signature
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Custodians Signature if different to Reviewers