Lutheran Homes Motor Vehicle Inspection

• Registration Number

• Prepared by

• Conducted on

  Date
• Location
  Address

1.0 Vehicle

• 1.1- Is the vehicle registered?

  Yes

  No

  N/A

• 1.2- Are both number plates secured and in good order? (Add a photo to media)

  Yes

  No

  N/A

• 1.3- Is the Log Book present?

  Yes

  No

  N/A

• 1.4- Have you entered all details in the Log Book prior to commencing your journey?

  Yes

  No

  N/A

2.0- Driver-

• 2.1- Has the driver a current licence to meet State legislation? (Add a photo to media)

  Yes

  No

  N/A

3.0- Vehicle

• 3.2- Does the vehicles Brake lights, indicators , park, head and high beam lights work?

  Yes

  No

  N/A

• 3.3- Are the vehicles lights damaged or cracked?

  Yes

  No

  N/A

• 3.4- Does the horn work?

  Yes

  No

  N/A

• 3.5- Is the vehicles windscreen cracked or damaged?

  Yes

  No

  N/A

• 3.6- Does the air conditioning work?

  Yes

  No

  N/A

• 3.7- Are tyre pressures to standard?

  Yes

  No

  N/A

• 3.8- Is the tyre tread not below the tread wear marks on all tyres?

  Yes

  No

  N/A

4.0- Vehicle Cleanliness

• 4.1- Is the vehicles outside clean and undamaged?

  Yes

  No

  N/A

• 4.2- Is the vehicles inside clean and undamaged?

  Yes

  No

  N/A

• 4.3- Are there unsecured or loose items in the vehicle that may cause harm?

  Yes

  No

  N/A

• 4.4- If a cargo barrier fitted. Is it secured and utilised properly?

  Yes

  No

  N/A

5.0- First Aid

• 5.1- Is there a first aid kit fitted and in good condition?

  Yes

  No

  N/A

• 5.2- Is a copy of the First Aid Treatment Guidance Procedure available with each First Aid Kit?

  Yes

  No

  N/A

• 5.3- Is the First Aid Kit stocked in accordance with enclosed contents list?

  Yes

  No

  N/A

6.0 Acknowledgement

• I understand that any expiation notices or fines issued for breaching road rules will be the sole responsibility of the employee driving the vehicle at the time.

  Yes

  No

  N/A

• I understand that in the event of an accident whilst driving, I will exchange contact details with the other driver, notify Police where required by law, and complete an Incident Report form using the LHG system Solv Safety.

  Yes

  No

  N/A