PSE Vehicle Simplified Repair Estimate -

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time audit began

  Date

VEHICLE DESCRIPTION

• 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

Repair Estimate Description

• Description of the problem

  Safe

  At Risk

  N/A

• Cost of repair, please list the Cost of labor & parts individually

  Yes

  No

  N/A

• Photo of the problem

  Media

• Description of the problem

  Safe

  At Risk

  N/A

• Cost of repair, please list the Cost of labor & parts individually

  Yes

  No

  N/A

• Photo of the problem

  Media

• Description of the problem

  Safe

  At Risk

  N/A

• Cost of repair, please list the Cost of labor & parts individually

  Yes

  No

  N/A

• Photo of the problem

  Media

SIGNATURES

• Comments?

  Yes

  No

  N/A

• Repairs Completed?

  Yes

  No

  N/A

• All repairs not completed (please list)

  Yes

  No

  N/A

• Business name & contact number

  Yes

  No

  N/A

• Signature of Mechanic Performing Repairs

  Sign