Plumbing Annual Van Inspection

• Document Number

• Technician's Name

• Vehicle Number

• Current Odometer

• Conducted On

  Date

• Prepared by

• Location
  Address

Exterior Body and Glass

• License plate is current and not expired

  Yes

  No

  N/A

• Vehicle is clean and free of road grime and dirt

  Yes

  No

  N/A

• Windshield Free of Cracks and Chips

  Yes

  No

  N/A

• Front Bonnet, Grill and Bumper free of Damage

  Yes

  No

  N/A

• Left Mirrors adjustable and Free of Damage

  Yes

  No

  N/A

• Left Fender Free of Damage

  Yes

  No

  N/A

• Left Door Free of Damage

  Yes

  No

  N/A

• Left Side Free of Damage

  Yes

  No

  N/A

• Rear Window Free of Cracks and Chips

  Yes

  No

  N/A

• Rear of Vehicle and Bumper Free of Damage

  Yes

  No

  N/A

• Right Side Free of Damage

  Yes

  No

  N/A

• Right Door Free of Damage

  Yes

  No

  N/A

• Right Front Fender Free of Damage

  Yes

  No

  N/A

• Right Mirror Adjustable and Free of Damage

  Yes

  No

  N/A

• Ladders are strapped down and locked properly

  Yes

  No

  N/A

• Hockey puck locks are in place on exterior doors

  Yes

  No

  N/A

Tires

• FRONT LEFT TIRE - % of tread left

• Tire still roadworthy?

  Yes

  No

  N/A

• FRONT RIGHT TIRE - % of tread left

• Tire still roadworthy?

  Yes

  No

  N/A

• REAR LEFT TIRE - % of tread left

• Tire still roadworthy?

  Yes

  No

  N/A

• REAR RIGHT TIRE WEAR - % of tread left

• Tire still roadworthy?

  Yes

  No

  N/A

• SPARE TIRE WEAR - % of tread left

• Tire still roadworthy?

  Yes

  No

  N/A

Exterior Lighting

• Left and Right Rear Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Front Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Break Lights Operational

  Yes

  No

  N/A

• License Plate Light Operational

  Yes

  No

  N/A

• High and Low Beams Operational

  Yes

  No

  N/A

• Left and Right Reversing Lights Operational

  Yes

  No

  N/A

• Left and Right Tail Lights Operational

  Yes

  No

  N/A

Front Cab Area

• Valid vehicle registration is located in vehicle

  Yes

  No

  N/A

• Valid vehicle insurance is located in vehicle

  Yes

  No

  N/A

• Fluid levels are adequate (oil and windshield fluid)

  Yes

  No

  N/A

• Heater and defroster operational

  Yes

  No

  N/A

• Air conditioning operational<br>

  Yes

  No

  N/A

• Interior is clean and free of loose objects

  Yes

  No

  N/A

• Interior compartment lights operational

  Yes

  No

  N/A

• All gauges are operational and show within appropriate ranges

  Yes

  No

  N/A

• Driver seat belt is operational

  Yes

  No

  N/A

• Driver seat is in good repair

  Yes

  No

  N/A

• Passenger seat belt is operational

  Yes

  No

  N/A

• Passenger seat is in good repair

  Yes

  No

  N/A

• First aid kit is accessible

  Yes

  No

  N/A

• Vehicle is free of tobacco usage

  Yes

  No

  N/A

Rear Cargo Area

• Tools are properly stored, strapped and accessible

  Yes

  No

  N/A

• Material is properly stored and accessible

  Yes

  No

  N/A

• Fire extinguisher is accessible

  Yes

  No

  N/A

Tools

• Vehicle is equipped with 24' extension ladder and 8'/6' A ladder

  Yes

  No

  N/A

• Large snake

  Yes

  No

  N/A

• Medium snake

  Yes

  No

  N/A

• Small snake

  Yes

  No

  N/A

• Urinal auger

  Yes

  No

  N/A

• Pencil propress

  Yes

  No

  N/A

• Presto-lite tank present and secured

  Yes

  No

  N/A

• 100' of extension cords

  Yes

  No

  N/A

• Battery operated sawzall

  Yes

  No

  N/A

• Battery operated drill

  Yes

  No

  N/A

• Hammer-drill

  Yes

  No

  N/A

• COMMENTS

MATERIAL

SIGNATURES

• Name and Signature of Employee

  Sign

• Name and Signature of Auditor

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