SNRC Vehicle Inspection Form v2015-07

• Conducted on

  Date

• Prepared by

• Location
  Address

• Vehicle Number (or ID)

• Odometer Reading

• Next Service?

• Date

  Date

• Name of Inspector

General Vehicle Operating Equipment Checklist

• Spare tire - Correct Size? If stored under the vehicle does the lowering mechanism work?<br>

  Yes

  No

• Jack and Tire Iron - must be in correct storage location

  Yes

  No

• Jumper Cables - Available and in usable condition?

  Good

  Fair

  Poor

• Flashlight w/ working batteries

  Yes

  No

• Level 1 First Aid Kit (Stocked)<br>

  Yes

  No

• (24) 14 cm x 19 cm wound cleaning towelettes
  (60) hand cleansing towelettes
  (100) sterile adhesive dressings (BandAids)
  (12) 10 cm x 10 cm sterile gauze dressings
  (4) 10 cm x 16.5 cm sterile pressure dressings with crepe ties
  (2) 7.5 cm x 4.5 m crepe roller bandages
  (1) 2.5 cm x 4.5 m adhesive tape
  (4) 20 cm x 25 cm sterile abdominal dressings
  (6) cotton triangular bandages, minimum length of base 1.25 m
  (16) safety pins
  (1) 14 cm stainless steel bandage scissors or universal scissors
  (1) 11.5 cm stainless steel sliver forceps
  (12) cotton tip applicators
  (1) pocket mask with oxygen inlet + secondary face shield
  (6) pairs of medical gloves (preferably non-latex)
  first aid records, pen & pencil
  

• Emergency Blankets (3)

  Yes

  No

• Tow Strap and/or Logger's Chain - Appropriate Rigging to attach 2 vehicles

  Yes

  No

• Fire Extinguisher (if required) - Charged

  Yes

  No

  N/A

• Vehicle Log Book - complete and up to date?

  Yes

  No

• Per-Trip Inspection Card

  Yes

  No

• Radio Frequency List

  Yes

  No

• Radio - Radio Test

  Good

  Fair

  Poor

• Spill Kit (stocked)

  Yes

  No

• (12) White Spill pads
  (1) Yellow Hazardous materials bag
  (1) pair oil resistant gloves

• Spare fluids (optional)

  Yes

  No

  NA

• Tool Kit (optional)

  Yes

  No

  NA

Seasonal Safety Equipment & Tools Checklist

Summer

• Backpack Water Can - full?

  Yes

  No

  NA

• Pulaski

  Yes

  No

  NA

• Shovel - Condition

  Yes

  No

  NA

Winter

• Tire Chains

  Yes

  No

  NA

• Window Scraper?

  Yes

  No

  NA

• Sandbags

  Yes

  No

  NA

• Shovel?

  Yes

  No

Assessment of Vehicle Condition

• Tire Tread - Summer =>5/32 Winter =>8/32

  Good

  Fair

  Poor

• Wheel & Lug Nuts Secure - visual and kick the tire

  Yes

  No

• Brake Pedal & Pressure

  Good

  Fair

  Poor

• Emergency Brake Working - test engage pedal and put truck in gear (does it move?)

  Good

  Fair

  Poor

• Head & Tail Lights

  Yes

  No

• Turn Signal & Brake Lights

  Yes

  No

• Battery & Electrical - Connections/Corrosion

  Good

  Fair

  Poor

• Windshield Condition - Cracks in the Drivers vision (Estimate 4" from top/bottom - vehicles may vary)

  Good

  Fair

  Poor

• Horn

  Yes

  No

• Driver's Floor Mat in place and secure (ie. gas pedal cannot get stuck)

  Yes

  No

• Seat Belts - Fraying, good movement in and out or retraction box

  Good

  Fair

  Poor

• Windshield Wipers

  Good

  Fair

  Poor

• Mirrors

  Good

  Fair

  Poor

• Washer Fluid - topped up

  Yes

  No

• Oil Level

  Good

  Fair

  Poor

• Radiator/Coolant Level

  Good

  Fair

  Poor

• Brake Fluid

  Good

  Fair

  Poor

• Automatic Transmission Fluid (if applicable)

  Yes

  No

  NA

• Any Fluid Leaks Observed?

  No

  Yes

General Comments

• Additional Comments

Summary Declaration of Vehicle Condition

• This vehicle is

  Safe to Drive

  Requires Attention

  UNSAFE

• Signature

  Sign