Monthly Vehicle Inspection Report

• Audit Title

• Prepared by

• Driver Name

• Location

• Chaparral Vehicle #

• Vehicle License Plate #

• Supervisor Name

Safety Equipment

• H2S Monitor Serial #

• LOTO Kit fully stocked and not missing any equipment?

  Yes

  No

  N/A

• Vehicle Accident kit available?

  Yes

  No

  N/A

• Fire Extinguisher available on vehicle and inspected monthly?

  Yes

  No

  N/A

• Proof of Insurance in vehicle?

  Yes

  No

  N/A

• Respiratory Equipment in good condition and inspected monthly (if applicable)?

  Yes

  No

  N/A

• First Aid kit available and fully stocked on vehicle?

  Yes

  No

  N/A

• All PPE (safety glasses, gloves, hard hat, etc.) available and in good condition?

  Yes

  No

  N/A

Vehicle

• Has the oil been changed per manufacturer's recommendation?

  Yes

  No

  N/A

• Parking Lights & Head Lights

  Safe

  At Risk

  N/A

• Brake Lights

  Safe

  At Risk

  N/A

• Left Turn Signal

  Safe

  At Risk

  N/A

• Right Turn Signal

  Safe

  At Risk

  N/A

• Mirrors

  Safe

  At Risk

  N/A

• Windshield Condition

  Safe

  At Risk

  N/A

• Windshield Wipers

  Safe

  At Risk

  N/A

• Any damage to exterior of the vehicle? (If yes, please report to your supervisor immediately)

  Yes

  No

  N/A

• Is the vehicle running well, free of any issues with the motor, transmission, etc.?

  Yes

  No

  N/A

Tires

• Left Front

  Safe

  At Risk

  N/A

• Right Front

  Safe

  At Risk

  N/A

• Left Rear

  Safe

  At Risk

  N/A

• Right Rear

  Safe

  At Risk

  N/A

• Spare (if applicable)

  Safe

  At Risk

  N/A

Comments or Notes

• Signature of Person Conducting Inspection

  Sign

• Date and Time Inspected

  Date