SafetyCulture Staff

Smog Checklist

This smog checklist is used by smog technicians to record the measured vehicle emissions and indicate if they are within acceptable levels according to regulations. Indicate measured Hydrocarbons (HC), Carbon Monoxide (CO), and Oxides of Nitrogen (NOx) to see if the vehicle passed or failed the smog check.

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Title Page

Vehicle Owner
Location
Prepared by
Conducted on

Smog Check

General Information

Enter VIN #
Enter License Plate No.
Enter Mileage
Exhaust Configuration, when prompted (Single or Dual)
Vehicle Make
Body Type
Vehicle Model Name
Number of Cylinders
Engine Size
Transmission Type
Certification Type; (CA, FED, Referee)
BAR Referee Label Number
Fuel Type
Engine Make (Motor Homes, Referee)
Engine Year (Motor Homes, Referee)
Take photo of vehicle (optional)

Exhaust Emission Test Result

Hydrocarbons ppm (HC)
Carbon Monoxide % (CO)
Oxides of Nitrogen ppm (NOx)

COMPLETION

Comments/Recommendations
Full Name and Signature of Technician

SafetyCulture Staff

Smog Checklist

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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.