RCSCW, Vehicle Safety Check

• Document No.

• Vehicle Safety Check

• Client / Site

• Conducted on

  Date

• Prepared by

• Supervisor:

VEHICLE INFORMATION:

• Assigned Facility:

• Managing Supervisor:

• Vehicle ID #:

• Year / Make / Model:

• License Plate #:

• Plate Expiration Date:

  Date

SAFETY INSPECTION:

• Inspection Date:

  Date

• Inspected By:

• Windshield Condition:

  Okay

  Needs Attention

  Replace

  Not Applicable

• Windshield Wipers:

  Okay

  Replace

  Not Applicable

• Tires:

  Okay

  Needs Attention

  Replace

  Not Applicable

• Lights: Head Lights, Tail Lights, Brake Lights, Hazard Flashers, Turn Signals, Back-up Lights, Work/Spot Lights

• Horn:

  Okay

  Not Working

  Not Applicable

• Comments / Unsafe Condition: