PSE Equipment Brake Inspection Document

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time audit began

  Date

VEHICLE DESCRIPTION

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• PSE vehicle ID number

• Adjust Front & Rear Brakes

  Safe

  At Risk

  N/A

• Front axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

• Rear axle brake percentage remaining

  100 percent

  75 percent

  50 percent

  25 percent

  Requires brakes immediately

SIGNATURES

• Comments?

  Yes

  No

  N/A

• Repairs Completed?

  Yes

  No

  N/A

• All repairs not completed (please list)

  Yes

  No

  N/A

• Signature of Mechanic Performing Service

  Sign