Melanchthon Daily Vehicle Check

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Sample Vehicle Inspection - General Details

• License plate number

• Registration expiry date

  Date

• Occupant Doors Open

  Safe

  At Risk

  N/A

• Occupant Doors Close

  Safe

  At Risk

  N/A

• Cargo Securement

  Safe

  At Risk

  N/A

• Coupling Device

  Safe

  At Risk

  N/A

• Dangerous Goods Compliance

  Safe

  At Risk

  N/A

• Instrument Cluster Gauges Functional

  Safe

  At Risk

  N/A

• Brake Pedal Operates

  Safe

  At Risk

  N/A

• Accelerator Pedal Operates

  Safe

  At Risk

  N/A

• Clutch Pedal Operates

  Safe

  At Risk

  N/A

• Driver Seat Remains in Position

  Safe

  At Risk

  N/A

• Seat Belts Functional

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• 1st Aid Kit

  Safe

  At Risk

  N/A

• Eyewash Bottle

  Safe

  At Risk

  N/A

• Spill Kit

  Safe

  At Risk

  N/A

• Exhaust (Leak)

  Safe

  At Risk

  N/A

• Body General Condition

  Safe

  At Risk

  N/A

• Frame General Condition

  Safe

  At Risk

  N/A

• Fuel Tank (Leak)

  Safe

  At Risk

  N/A

• Fuel Cap

  Safe

  At Risk

  N/A

• Windshield Condition

  Safe

  At Risk

  N/A

• Window Condition

  Safe

  At Risk

  N/A

• Rear-view Mirror

  Safe

  At Risk

  N/A

• Side Mirrors

  Safe

  At Risk

  N/A

• Defrost Capability

  Safe

  At Risk

  N/A

• Horn

  Safe

  At Risk

  N/A

• Brake Fluid Level

  Safe

  At Risk

  N/A

• Parking Brake Functional

  Safe

  At Risk

  N/A

• General Vehicle Condition

  Safe

  At Risk

  N/A

Sample Summary and Signoff

• Did the vehicle pass the inspection overall?

  Yes

  No

  N/A

• Quick summary of major issues

• Name and signature of inspector

  Sign