Small Vehicle Monthly Safety Inspection

Information

Site conducted
Vehicle #:
Vehicle Type:
Conducted on
Drivers License Expiration Date:
Current Mileage:
Franchise (e.g., ELL)
Network /Grid (e.g. Central Telecom)
Business Unit (e.g., L0000)
Document Number:

Vehicle Conditions:

Headlights Bright Beam?
Headlights Dim Beam?
Parking Lights?
Stop Lights?
Tail Lights?
Right Front Directional Light?
Right Rear Directional Light?
Left Front Directional Light?
Left Rear Directional Light?
Emergency Flashers?
Cab Lights?
Clearance Lights?
Spot Lights?
Emer. Lights - Portable?
Compartment Lights?
Warning Lights / Gauges?
Horn?
Brakes (Foot)?
Brakes (Emergency)?
Brakes (Parking)?
Brakes (Trailer)?
Windshield?
Windshield Wipers?
Windshield Washers?
Rear Glass?
Door Glasses?
Mirrors?
Tires - Gen. Condition?
Body Condition?
Seat Belts?
Winch?
Backup Sensor/Camera?
Is vehicle equipped with auxiliary battery?
Inspect battery for swelling/damage/corrosion. Inspect battery vent for blockage

Tools & Equipment Inspection / Storage:

Hand tools in good condition and stored with sharp edges properly covered.
Ladders in good condition and stored properly.
Does the ladder show signs of UV damage?
Are there any cracks or splits?
Does the ladder have the proper safety feet?
Are all the proper stickers, identification label, on the ladder in good condition?
Are there any missing rivets?
Are the hinges in good condition? (free of misalignment and bends).
Are the rungs in good order? (free of dents or cracks)
Is this ladder acceptable for use? If no, tag-out and remove from service.
Hot Stick in date. (Expires 2 years after test date.)
Expiration Date:
Rubber Gloves (air test daily) in date and properly stored.
Expiration Date:
PP&E (hard hat, safety glasses, face shields, work gloves, traffic vest, etc) in good condition.
Animal Deterrent (Dog Dazer, Halt Spray, Bully Ray Stick).
PVD - test before using (replace batteries every January & July).
Fire Extinguisher (annual maintenance tag good and monthly visual documented. Decal designating where stored).
First Aid Kit filled & in date (decal designating where kit is stored).
Water Jel Blanket in date and properly stored (decal designating where kit is stored).
Expiration date:
Automatic External Defibrillator. (decal designating where stored)
Battery Expiration Date:
Pad Expiration Date:
Chemicals stored properly with lids/covers on and MSDS/SDS for all chemicals carried on vehicle. (decal designating where SDS stored)
Volt Meters, Amp Meters, etc. (inspect prior to use, replace batteries as needed)
Safety Cones, Barricading Equipment/Material, Traffic Flags.
Tire Chains for use during winter seasons on suspected iced roadways.
Any comments not addressed above: