Title Page
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Vehicle Make
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License Plate #
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Conducted on
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Prepared by
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Before operating any company vehicle for business, the operator must perform a vehicle safety check to ensure the vehicle is operating properly and safely. Use the following checklist as a guide to determine if the vehicle you will be using is safe for operation. In the event you find any deviation from the standards below, immediately bring it to your supervisor's attention and do not us the vehicle until supervisory personnel says it is safe. ** By checking the boxes below you are indicating that each item is in a safe working condition.
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Safety Belts (All in Good Working Order)
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Rear Reflectors (2 Red Reflectors on Side and Rear Fenders, Either part of Taillights or Separate)
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Windshield Wipers (Good Working Wipers Required)
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Brakes (In Good Working Order)
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Exhaust System (Good Working Order Operation; Noise and Smoke Restrictions Apply)
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Tires (No Body Ply or Belt Material Exposed, No Tread or Sidewall Separation, Should Have Minimum 2/32 Inch of Tread; Check Tire Pressure
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Rear View Mirror (Drivers Must be Able to See at Least 200 Feet Behind Them at All Times)
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Headlights (2 white headlights (both working))
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License Plate Lights (White Rear License Plate Light (Working))
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License Plates (Front and Rear Plates are Required Except for Trailers)
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Brake Lights (2 Brake Lights with Red Lenses (Both Working))
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Horns (Working Horn is Required)
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Windows / Windshield (Clean & Free From Obstruction, Cracks or Decals)
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Turn Signals (Right and Left Turn Signal on Front and Rear of Vehicle; Front Signals May be White or Amber, Rear Signals May be Red, Yellow or Amber)
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Inspector Signature
