Information
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Company (Mopani / Contractor - specify):
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Plate Number:
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Model:
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Date and Time of Inspection:
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Location of Inspection (Nkana / Mufulira)
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Supervisor Conducting Inspection Name:
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Supervisor Conducting Inspection Mine Number / NRC:
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Driver Name:
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Driver Mine Number / NRC:
Mileage
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Current Mileage (km):
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Next service due (km):
Interior
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Windows and windshield in good condition
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Seatbelts
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Mirrors in place
Exterior
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Windshield wiper working
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Headlights functional
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Tail Lights & Brake Lights functional
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Emergency brake in good condition
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Passes brake test ramp
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Tyres in good condition
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Horn working
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Exhaust system in good condition
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Wheels fitted securely
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Turn signals working
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Additional comments/observation
Observation
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Add observations/comments here.
Signatures
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I hereby certify that all information is accurate and that an actual inspection was conducted.
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Supervisor's Printed Name & Signature