PSE Incidental Field Repair

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time audit began

  Date

VEHICLE DESCRIPTION

• Photograph of Vehicle Being Inspected

  Media

• Check for Drivers Alert Sticker on Rear of Unit

• PSE vehicle ID number

• USDOT Identification Number is visible

• check for current DOT inspection Sticker

  Yes

  No

  N/A

• Odometer reading at Inspection

Vital Vehicle Fluid Levels and Condition

• Engine Oil Level

  Yes

  No

  N/A

• Transmission Fluid Condition

  Yes

  No

  N/A

• Power Steering Fluid

  Yes

  No

  N/A

• Engine Coolant

  Yes

  No

  N/A

• Window Washer Fluid

  Yes

  No

  N/A

Repair Description

• Yes

  No

  N/A

• Yes

  No

  N/A

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