New Vehicle Data Collection

• Document No.

• Car Number

• licence Plate Number

• Name

• Contractor<br>

  Modo Co-operative

  Commit Autobody

  Ok Tire

  Fountain Tire

  Keeners Carwash

• Select date

  Date

• Odometer reading

• 360 Photograph of Vehicle

  Media

VEHICLE DESCRIPTION

• Barcode

  Media

• Vehicle number

• Make

  Select Chevrolet Chrysler Dodge Ford Nissan Toyota Suzuki Mazda Scion Kia Lexus Hyundai GMC Fiat

  • Chevrolet
  • Chrysler
  • Dodge
  • Ford
  • Nissan
  • Toyota
  • Suzuki
  • Mazda
  • Scion
  • Kia
  • Lexus
  • Hyundai
  • GMC
  • Fiat

• Model

• Trim Level

• Year

Fluids

• Oil Type

• Fuel type

  Select Regular Gasoline Premium Gasoline Gasoline-Electric Electric Diesel Hydrogen

  • Regular Gasoline
  • Premium Gasoline
  • Gasoline-Electric
  • Electric
  • Diesel
  • Hydrogen

• Washer fluid location

EXTERIOR LIGHTING

• Front High beam Bulb

• Front Low Beam Bulb

• Front Turn signal bulb

• Rear Turn signal bulb

EXTERIOR BODY AND GLASS (Take photos of any damage)

• The windshield is free of cracks and chips larger than a dime and there are no chips/cracks in drivers view area

  Yes

  No

  N/A

• The front hood, grill and bumper are free of damage.

  Yes

  No

  N/A

• The left mirrors are adjustable and free of damage.

  Yes

  No

  N/A

• The left fender is free of damage.

  Yes

  No

  N/A

• The left door is free of damage.

  Yes

  No

  N/A

• The left side is free of damage.

  Yes

  No

  N/A

• The left side windows are free of cracks and chips.

  Yes

  No

  N/A

• The rear window is free of cracks and chips.

  Yes

  No

  N/A

• The rear of the vehicle and bumper are free of damage.

  Yes

  No

  N/A

• The right side is free of damage.

  Yes

  No

  N/A

• The license plates on the front and rear are secure and the rear has a valid insurance decal

  Yes

  No

  N/A

• The right side windows are free of cracks and chips.

  Yes

  No

  N/A

• The right door is free of damage.

  Yes

  No

  N/A

• The right front fender is free of damage.

  Yes

  No

  N/A

• The right mirror is adjustable and free of damage.

  Yes

  No

  N/A

• The vehicle is clean and free of road grime and dirt.

  Yes

  No

  N/A

TIRES

• The front driver tire is in a good condition with no visible signs of damage.

  Yes

  No

  N/A

• Front driver tire tread depth

  Select 3/32nd Not Compliant 4/32nd 5/32nd 6/32nd 7/32nd 8/32nd 9/32nd 10/32nd

  • 3/32nd Not Compliant
  • 4/32nd
  • 5/32nd
  • 6/32nd
  • 7/32nd
  • 8/32nd
  • 9/32nd
  • 10/32nd

• The rear driver tire is in a good condition with no visible signs of damage.

  Yes

  No

  N/A

• Rear driver tire tread depth

  Select 3/32nd Not Compliant 4/32nd 5/32nd 6/32nd 7/32nd 8/32nd 9/32nd 10/32nd

  • 3/32nd Not Compliant
  • 4/32nd
  • 5/32nd
  • 6/32nd
  • 7/32nd
  • 8/32nd
  • 9/32nd
  • 10/32nd

• The rear passenger tire is in a good condition with no visible signs of damage.

  Yes

  No

  N/A

• Rear passenger tire tread depth

  Select 3/32nd Not Compliant 4/32nd 5/32nd 6/32nd 7/32nd 8/32nd 9/32nd 10/32nd

  • 3/32nd Not Compliant
  • 4/32nd
  • 5/32nd
  • 6/32nd
  • 7/32nd
  • 8/32nd
  • 9/32nd
  • 10/32nd

• The front passenger tire is in a good condition with no visible signs of damage.

  Yes

  No

  N/A

• Front passenger tire tread depth

  Select 3/32nd Not Compliant 4/32nd 5/32nd 6/32nd 7/32nd 8/32nd 9/32nd 10/32nd

  • 3/32nd Not Compliant
  • 4/32nd
  • 5/32nd
  • 6/32nd
  • 7/32nd
  • 8/32nd
  • 9/32nd
  • 10/32nd

• The spare tire is in a good condition with no visible signs of damage.

  Yes

  No

  N/A

• All the wheels/mags are free of damage.

  Yes

  No

  N/A

INTERIOR

• The windshield wipers are functioning and in a good condition.

  Yes

  No

  N/A

• The windshield washer fluid level is acceptable and the washer is operational.

  Yes

  No

  N/A

• The heater and defroster are operational.

  Yes

  No

  N/A

• The airconditioning is operational.

  Yes

  No

  N/A

• The dashboard lights are operational.

  Yes

  No

  N/A

• All the gages are operational and show within the acceptable ranges.

  Yes

  No

  N/A

• The interior compartment lights are operational.

  Yes

  No

  N/A

• The interior is clean and free of loose objects.

  Yes

  No

  N/A

• All seat belts are free of damage and operational.

  Yes

  No

  N/A

• All seats are in a good and clean condition.

  Yes

  No

  N/A

SIGNATURES

• Signature of inspector

  Sign

SUMMARY

• Final comments / conclusion

• Negative responses

• Positive responses

• Total responses

• Inspection rating