For Participant

Participant Information

Name

Address (Street/City/State/Zip)

Phone number

Email address

Vehicle Information
Vehicle Make

Vehicle Model

Vehicle Year

Odometer

Children Information

Child 1 Name

Child 1 Age
Child 1 Weight (pounds)
Child 1 Height (inches)

Child 2?

Child 2 Name

Child 2 Age
Child 2 Weight (pounds)
Child 2 Height (inches)

Child 3?

Child 3 Name

Child 3 Age
Child 3 Weight (pounds)
Child 3 Height (inches)
Agreement

I understand that the sole purpose of this check up form is to help reduce the incidence of improper installation and use of child safety seats. This inspection is being provided as a free service to me. I understand that this program cannot fully evaluate the quality, safety, or condition of my child safety seat or any component of my vehicle. This includes the seats, safety belts, LATCH and airbags. This assessment cannot guarantee my child's safety in a vehicle collision. However, I understand that a properly used child safety seat can reduce fatal injury by 71% and that it is important to read both my vehicle and safety seat instruction manuals.

Signature

Child 1 On Arrival

Child 1 Name

CRS Type

Is the child the correct age/weight/height for this seat?

Is the child present?

Is the child sitting up, not slouching?

Is the lap belt snug and low on the hips?

Is the shoulder belt properly positioned?

Is the buckle latched securely?

Is it a high back or backless booster?

Is the seat attached with LATCH?

Is LATCH use acceptable for this booster?

Is the top tether strap used?

Is it used correctly?

Current Booster Information

Is booster information missing?

Booster manufacturer

Booster model name

Booster model number

Date of manufacture

Is the booster expired?

Is the participant the original owner of the booster?

Has the booster been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this booster?

Has the recall been repaired?

Is this a US certified (FMVSS 213) booster?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this seat?

Is the base installed on arrival?

Is the base attached with LATCH?

Is the LATCH system holding the base tightly (1" test)?

Is the LATCH used correctly?

Is the base attached with the safety belt?

Is the belt holding the base tightly (1" test)?

Is the belt routed through the base correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Is the seat belt used correctly?

Is the base attached with both LATCH and belt?

Current Seat Information

Is the seat information missing?

Base manufacturer

Base model name

Base model number

Date of manufacture

Is the base expired?

Is the participant the original owner of the base?

Has the base been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this base?

Has the recall been repaired?

Is this a US certified (FMVSS 213) base?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the seat installed on arrival?

Is the child present?

What type of seat is it?

Is the seat installed with a base?

Does the seat have a five-point harness?

Is the handle in the proper position?

Is the seat reclined properly for the age of the child?

Is the seat reclined properly for the age of the child?

Is the seat properly upright?

Is the child the correct age/weight/height for this seat?

Is this seat facing the appropriate direction for this child?

Is the harness snug?

Is the harness in the correct slots?

Has the harness retainer clip been used properly?

Is the seat attached with LATCH?

Is the LATCH system holding the seat tightly (1" test)?

Is the LATCH used correctly?

Is the seat attached with the safety belt?

Is the belt holding the seat tightly (1" test)?

Is the belt routed through the seat correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the seat attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

What type of seat is it?

Is the seat installed with a base?

Does the seat have a five-point harness?

Is the handle in the proper position?

Is the seat reclined properly for the age of the child?

Is the seat reclined properly for the age of the child?

Is the seat properly upright?

Is the child the correct age/weight/height for this seat?

Is this seat facing the appropriate direction for this child?

Is the seat attached with LATCH?

Is the LATCH system holding the seat tightly (1" test)?

Is the LATCH used correctly?

Is the seat attached with the safety belt?

Is the belt holding the seat tightly (1" test)?

Is the belt routed through the seat correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the seat attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

What type of seat is it?

Does the seat have a base?

Does the seat have a five-point harness?

Are any safety belt after-market products used?

Is the child the correct age/weight/height for this seat?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Step 1: Is the child sitting all the way back against the auto seat?

Step 2: Are the child’s knees bending comfortably at the edge of the auto seat?

Step 3: Does the belt cross the shoulder between the neck and arm?

Step 4: Is the lap belt as low as possible, touching the thighs?

Step 5: Does the child stay seated like this for the whole trip?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this seat?

Is the harness snug?

Is the harness in the correct slots?

Has the harness retainer clip been used properly?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this vest?

Is the vest attached with LATCH?

Is the LATCH system holding the vest tightly?

Is the LATCH used correctly?

Is the vest attached with the safety belt?

Is the belt holding the vest tightly?

Is the belt routed through the vest correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the vest attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the vest information missing?

Vest manufacturer

Vest model name

Vest model number

Date of manufacture

Is the vest expired?

Is the participant the original owner of the vest?

Has the vest been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this vest?

Has the recall been repaired?

Is this a US certified (FMVSS 213) vest?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Child 2 On Arrival

Child 2 Name

CRS Type

Is the child the correct age/weight/height for this seat?

Is the child present?

Is the child sitting up, not slouching?

Is the lap belt snug and low on the hips?

Is the shoulder belt properly positioned?

Is the buckle latched securely?

Is it a high back or backless booster?

Is the seat attached with LATCH?

Is LATCH use acceptable for this booster?

Is the top tether strap used?

Is it used correctly?

Current Booster Information

Is booster information missing?

Booster manufacturer

Booster model name

Booster model number

Date of manufacture

Is the booster expired?

Is the participant the original owner of the booster?

Has the booster been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this booster?

Has the recall been repaired?

Is this a US certified (FMVSS 213) booster?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this seat?

Is the base installed on arrival?

Is the base attached with LATCH?

Is the LATCH system holding the base tightly (1" test)?

Is the LATCH used correctly?

Is the base attached with the safety belt?

Is the belt holding the base tightly (1" test)?

Is the belt routed through the base correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Is the seat belt used correctly?

Is the base attached with both LATCH and belt?

Current Seat Information

Is the seat information missing?

Base manufacturer

Base model name

Base model number

Date of manufacture

Is the base expired?

Is the participant the original owner of the base?

Has the base been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this base?

Has the recall been repaired?

Is this a US certified (FMVSS 213) base?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the seat installed on arrival?

Is the child present?

What type of seat is it?

Is the seat installed with a base?

Does the seat have a five-point harness?

Is the handle in the proper position?

Is the seat reclined properly for the age of the child?

Is the seat reclined properly for the age of the child?

Is the seat properly upright?

Is the child the correct age/weight/height for this seat?

Is this seat facing the appropriate direction for this child?

Is the harness snug?

Is the harness in the correct slots?

Has the harness retainer clip been used properly?

Is the seat attached with LATCH?

Is the LATCH system holding the seat tightly (1" test)?

Is the LATCH used correctly?

Is the seat attached with the safety belt?

Is the belt holding the seat tightly (1" test)?

Is the belt routed through the seat correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the seat attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

What type of seat is it?

Is the seat installed with a base?

Does the seat have a five-point harness?

Is the handle in the proper position?

Is the seat reclined properly for the age of the child?

Is the seat reclined properly for the age of the child?

Is the seat properly upright?

Is the child the correct age/weight/height for this seat?

Is this seat facing the appropriate direction for this child?

Is the seat attached with LATCH?

Is the LATCH system holding the seat tightly (1" test)?

Is the LATCH used correctly?

Is the seat attached with the safety belt?

Is the belt holding the seat tightly (1" test)?

Is the belt routed through the seat correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the seat attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

What type of seat is it?

Does the seat have a base?

Does the seat have a five-point harness?

Are any safety belt after-market products used?

Is the child the correct age/weight/height for this seat?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Step 1: Is the child sitting all the way back against the auto seat?

Step 2: Are the child’s knees bending comfortably at the edge of the auto seat?

Step 3: Does the belt cross the shoulder between the neck and arm?

Step 4: Is the lap belt as low as possible, touching the thighs?

Step 5: Does the child stay seated like this for the whole trip?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this seat?

Is the harness snug?

Is the harness in the correct slots?

Has the harness retainer clip been used properly?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this vest?

Is the vest attached with LATCH?

Is the LATCH system holding the vest tightly?

Is the LATCH used correctly?

Is the vest attached with the safety belt?

Is the belt holding the vest tightly?

Is the belt routed through the vest correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the vest attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the vest information missing?

Vest manufacturer

Vest model name

Vest model number

Date of manufacture

Is the vest expired?

Is the participant the original owner of the vest?

Has the vest been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this vest?

Has the recall been repaired?

Is this a US certified (FMVSS 213) vest?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Child 3 On Arrival

Child 3 Name

CRS Type

Is the child the correct age/weight/height for this seat?

Is the child present?

Is the child sitting up, not slouching?

Is the lap belt snug and low on the hips?

Is the shoulder belt properly positioned?

Is the buckle latched securely?

Is it a high back or backless booster?

Is the seat attached with LATCH?

Is LATCH use acceptable for this booster?

Is the top tether strap used?

Is it used correctly?

Current Booster Information

Is booster information missing?

Booster manufacturer

Booster model name

Booster model number

Date of manufacture

Is the booster expired?

Is the participant the original owner of the booster?

Has the booster been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this booster?

Has the recall been repaired?

Is this a US certified (FMVSS 213) booster?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this seat?

Is the base installed on arrival?

Is the base attached with LATCH?

Is the LATCH system holding the base tightly (1" test)?

Is the LATCH used correctly?

Is the base attached with the safety belt?

Is the belt holding the base tightly (1" test)?

Is the belt routed through the base correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Is the seat belt used correctly?

Is the base attached with both LATCH and belt?

Current Seat Information

Is the seat information missing?

Base manufacturer

Base model name

Base model number

Date of manufacture

Is the base expired?

Is the participant the original owner of the base?

Has the base been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this base?

Has the recall been repaired?

Is this a US certified (FMVSS 213) base?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the seat installed on arrival?

Is the child present?

What type of seat is it?

Is the seat installed with a base?

Does the seat have a five-point harness?

Is the handle in the proper position?

Is the seat reclined properly for the age of the child?

Is the seat reclined properly for the age of the child?

Is the seat properly upright?

Is the child the correct age/weight/height for this seat?

Is this seat facing the appropriate direction for this child?

Is the harness snug?

Is the harness in the correct slots?

Has the harness retainer clip been used properly?

Is the seat attached with LATCH?

Is the LATCH system holding the seat tightly (1" test)?

Is the LATCH used correctly?

Is the seat attached with the safety belt?

Is the belt holding the seat tightly (1" test)?

Is the belt routed through the seat correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the seat attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

What type of seat is it?

Is the seat installed with a base?

Does the seat have a five-point harness?

Is the handle in the proper position?

Is the seat reclined properly for the age of the child?

Is the seat reclined properly for the age of the child?

Is the seat properly upright?

Is the child the correct age/weight/height for this seat?

Is this seat facing the appropriate direction for this child?

Is the seat attached with LATCH?

Is the LATCH system holding the seat tightly (1" test)?

Is the LATCH used correctly?

Is the seat attached with the safety belt?

Is the belt holding the seat tightly (1" test)?

Is the belt routed through the seat correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the seat attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

What type of seat is it?

Does the seat have a base?

Does the seat have a five-point harness?

Are any safety belt after-market products used?

Is the child the correct age/weight/height for this seat?

Current Seat Information

Is the seat information missing?

Seat manufacturer

Seat model name

Seat model number

Date of manufacture

Is the seat expired?

Is the participant the original owner of the seat?

Has the seat been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this seat?

Has the recall been repaired?

Is this a US certified (FMVSS 213) seat?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Step 1: Is the child sitting all the way back against the auto seat?

Step 2: Are the child’s knees bending comfortably at the edge of the auto seat?

Step 3: Does the belt cross the shoulder between the neck and arm?

Step 4: Is the lap belt as low as possible, touching the thighs?

Step 5: Does the child stay seated like this for the whole trip?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this seat?

Is the harness snug?

Is the harness in the correct slots?

Has the harness retainer clip been used properly?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Is the child the correct age/weight/height for this vest?

Is the vest attached with LATCH?

Is the LATCH system holding the vest tightly?

Is the LATCH used correctly?

Is the vest attached with the safety belt?

Is the belt holding the vest tightly?

Is the belt routed through the vest correctly?

What type of belt was used?

What type of retractor was used?

What type of latchplate was used?

Is a locking clip needed?

Is it used?

Is it used correctly?

Are any safety belt after-market products used?

Is the seat belt used correctly?

Is the vest attached with both LATCH and belt?

Is the top tether strap used?

Is it used correctly?

Current Seat Information

Is the vest information missing?

Vest manufacturer

Vest model name

Vest model number

Date of manufacture

Is the vest expired?

Is the participant the original owner of the vest?

Has the vest been in a crash?

Was the registration card sent in?

With the participant's current address?

NHTSA Recall List
http://www-odi.nhtsa.dot.gov/recalls/childseat.cfm?MfgID=All

Is there a recall on this vest?

Has the recall been repaired?

Is this a US certified (FMVSS 213) vest?

Did the child get a new seat at the event?

New seat manufacturer

New seat model name

New seat model number

New seat date of manufacture

Who provided the seat?

Who registered the seat?

Final Install with?

Used the top tether?

Draw the final location of the seat (X). Use a M if the seat was moved. D for the driver.
Photograph if desired.

Final comments on installation

Departure

Discussion Items. Did you discuss:

Next step education

Bulky clothing

Aftermarket products

Hazards in the vehicle

Did the participant install the seat and secure the child?

Describe why not.

Did you consult both the vehicle and the CRS owner's manual?

Explain why not.

Which items were given to the participant?
Photograph

Comments

Technician Name/Signature

Technician number

Will this information be used for recertification?

Senior Checker Name/Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.