SFMI Vehicle Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Vehicle Number

• Odometer Reeading

• Date

  Date

• Name of Inspector

General Vehicle Operating Equipment Checklist

• Spare tire

  Yes

  No

  N/A

• Jack and Tire Iron

  Yes

  No

  N/A

• Jumper Cables

  Yes

  No

  N/A

• Flashlight w/ working batteries

  Yes

  No

  N/A

• Level 1 First Aid Kit (Stocked)

  Yes

  No

  N/A

• Emergency Blankets (3)

  Yes

  No

  N/A

• Tow Strap and/or Logger's Chain

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• Vehicle Log Book

  Yes

  No

  N/A

• Per-Trip Inspection Card

  Yes

  No

  N/A

• Radio Frequency List

  Yes

  No

  N/A

• Radio

  Yes

  No

  N/A

• Spill Kit (stocked)

  Yes

  No

  N/A

• Spare fluids (optional)

  Yes

  No

  N/A

• Tool Kit (optional)

  Yes

  No

  N/A

Seasonal Safety Equipment & Tools Checklist

Summer

• Backpack Water Can

  Yes

  No

  N/A

• Shovel

  Yes

  No

  N/A

• Pulaski

  Yes

  No

  N/A

Winter

• Tire Chains

  Yes

  No

  N/A

• Sandbags

  Yes

  No

  N/A

Assessment of Vehicle Condition

• Tire Tread

  Good

  Fair

  Poor

• Wheel & Lug Nuts Secure

  Good

  Fair

  Poor

• Brake Pedal & Pressure

  Good

  Fair

  Poor

• Emergency Brake

  Good

  Fair

  Poor

• Head & Tail Lights

  Good

  Fair

  Poor

• Turn Signal & Brake Lights

  Good

  Fair

  Poor

• Battery & Electrical

  Good

  Fair

  Poor

• Windshield Condition

  Good

  Fair

  Poor

• Horn

  Good

  Fair

  Poor

• Driver's Floor Mat in place

  Yes

  No

  N/A

• Seat Belts

  Good

  Fair

  Poor

• Windshield Wipers

  Good

  Fair

  Poor

• Mirrors

  Good

  Fair

  Poor

• Washer Fluid

  Yes

  No

  N/A

• Oil Level

  Good

  Fair

  Poor

• Radiator/Coolant Level

  Good

  Fair

  Poor

• Brake Fluid

  Good

  Fair

  Poor

• Automatic Transmission Fluid

  Good

  Fair

  Poor

• Any Fluid Leaks Observed?

  Off

  On

General Comments

• Additional Comments

Summary Declaration of Vehicle Condition

• This vehicle is

  Safe to Drive

  Safe to Drive but requires attention

  UNSAFE TO DRIVE and must be repaired immediately

• Signature

  Sign