LIS 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

• Vehicle Fleet Number:

  Select LIS001 LIS002 LIS003 LIS004 LIS005 LIS006 LIS007 LIS008 LIS009 LIS010 LIS0011

  • LIS001
  • LIS002
  • LIS003
  • LIS004
  • LIS005
  • LIS006
  • LIS007
  • LIS008
  • LIS009
  • LIS010
  • LIS0011

• Make:

• Model:

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 break lights operational?

  Yes

  No

  N/A

• Is the third break light operational (if applicable)?

  Yes

  No

  N/A

• Are all covers intact?

  Yes

  No

  N/A

VISABILITY

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

Rearview Mirror:

• Is the rear view mirror clean?

  Yes

  No

  N/A

• Is the rear view mirror adjustable?

  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

• Does the battery indicator light 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:

• Engine fluids will be checked weekly unless dashboard gauges suggest a problem. Check with safety manager to see when fluids were last checked.

• Is the oil level in the acceptable range?

  Yes

  No

  N/A

• Is the break fluid in the acceptable range?

  Yes

  No

  N/A

• Is the anti-freeze/coolant topped off?

  Yes

  No

  N/A

• Is the transmission fluid in the acceptable range?

  Yes

  No

  N/A

• Is the windshield washer fluid topped off?

  Yes

  No

  N/A

Vehicle Operations:

• Does the vehicle break properly?

  Yes

  No

  N/A

• Is the turning/steering responsive and working properly?

  Yes

  No

  N/A

• Does the vehicle accelerate properly?

  Yes

  No

  N/A

• Does the vehicle idle within a an acceptable range (650-1,000 RPM)?

  Yes

  No

  N/A

Towing/Coupling:

• This section should only apply if you will be towing anything during use. If a trailer is being use please inspect the trailer for all applicable items on is checklist. Only mark "YES" if BOTH the vehicle and trailer are in compliance. If EITHER are not in compliance mark "NO" and note the issue in the details.

• Does the tow hitch work properly?

  Yes

  No

  N/A

• Are all of the lights on the trailer fully functioning (break lights, right/left turn signals, hazards/flashers)?

  Yes

  No

  N/A

EMERGENCY/WEATHER EQUIPMENT

• Are safety chains in good, working condition?

  Yes

  No

  N/A

• If the First-Aid kit fully stocked?

  Yes

  No

  N/A

• Is the Fire extinguisher fully charged?

  Yes

  No

  N/A

OTHER ISSUES

• Please described any major issues in detail below: