Information

  • Company (Mopani / Contractor - specify):

  • Plate Number:

  • Model:

  • Date and Time of Inspection:

  • Location of Inspection (Nkana / Mufulira)
  • Supervisor Conducting Inspection Name:

  • Supervisor Conducting Inspection Mine Number / NRC:

  • Driver Name:

  • Driver Mine Number / NRC:

Mileage

  • Current Mileage (km):

  • Next service due (km):

Interior

  • Windows and windshield in good condition

  • Seatbelts

  • Mirrors in place

Exterior

  • Windshield wiper working

  • Headlights functional

  • Tail Lights & Brake Lights functional

  • Emergency brake in good condition

  • Passes brake test ramp

  • Tyres in good condition

  • Horn working

  • Exhaust system in good condition

  • Wheels fitted securely

  • Turn signals working

  • Additional comments/observation

  • Observation
  • Add observations/comments here.

Signatures

  • I hereby certify that all information is accurate and that an actual inspection was conducted.

  • Supervisor's Printed Name & Signature

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