Summit Natural Gas Fleet Vehicle Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Fleet Vehicle Inspection Form:

• Select date

  Date

Summit Utilities, Inc:

• Summit Natural Gas of Maine, Inc

• Summit Natural Gas of Missouri, Inc

• Colorado Natural Gas, Inc

Vehicle Information:

Driver:

Vehicle / Equipment #

Vin #

Location:

Vehicle / Equipment Make:

Odometer / Hour Reading:

Vehicle Inspection Report:

• Body Dented

  Yes

  No

  N/A

• Body Scratched

  Yes

  No

  N/A

• Is there any damage to the headlights

  Yes

  No

  N/A

• Is there any damage to the tail lights

  Yes

  No

  N/A

• Is there any damage to the windshield

  Yes

  No

  N/A

• Is there any damage to the front grill

  Yes

  No

  N/A

• Is there any damage to the hood

  Yes

  No

  N/A

• Is there any damage to the front passenger door

  Yes

  No

  N/A

• Is there any damage to the front drivers door

  Yes

  No

  N/A

• Is there any damage to the rear passenger door

  Yes

  No

  N/A

• Is there any damage to the rear drivers door

  Yes

  No

  N/A

• Is there any damage to the mirrors

  Yes

  No

  N/A

• Is there any damage to the windows

  Yes

  No

  N/A

• Is there any damage to the front fenders

  Yes

  No

  N/A

• Is there any damage to the rear fenders

  Yes

  No

  N/A

• Is there any damage to the rear window

  Yes

  No

  N/A

• Is there any damage to rear bumper

  Yes

  No

  N/A

• Is there any damage to the truck bed

  Yes

  No

  N/A

• Is there any damage to the tailgate

  Yes

  No

  N/A

• Is there any damage to the roof

  Yes

  No

  N/A

Condition of tires:

• Remaining tread depth of right front tire

  Yes

  No

  N/A

• Remaining tread depth of left front tire

  Yes

  No

  N/A

• Remaining tread depth of right rear tire

  Yes

  No

  N/A

• Remaining tread depth if left rear tire

  Yes

  No

  N/A

Interior:

• Is the dash worn or need repair

  Yes

  No

  N/A

• Is the drivers seat worn or need repair

  Yes

  No

  N/A

• Is the passenger seat worn or need repair

  Yes

  No

  N/A

• Is the back seat worn or need repair

  Yes

  No

  N/A

• Are the floor covering worn or need repair

  Yes

  No

  N/A

• Are any of the interior panels worn or need repair

  Yes

  No

  N/A

Mechanics:

• Is the steering system in good condition

  Yes

  No

  N/A

• Is the battery in good condition

  Yes

  No

  N/A

• Is the motor in good condition

  Yes

  No

  N/A

• Is the suspension in good condition

  Yes

  No

  N/A

• Is the differential in good condition

  Yes

  No

  N/A

• Are the brakes in good condition

  Yes

  No

  N/A

• Is the transmission / clutch in good condition

  Yes

  No

  N/A

• Is the starter in good condition

  Yes

  No

  N/A

• Is the cooling system in good condition

  Yes

  No

  N/A

• Is the exhaust system in good condition

  Yes

  No

  N/A

• Is the fuel system in good condition

  Yes

  No

  N/A

• Are the hydraulic hoses in good condition

  Yes

  No

  N/A

• Are the windshield wipers in good condition

  Yes

  No

  N/A

• Is the horn working properly

  Yes

  No

  N/A

• Is the heater working properly

  Yes

  No

  N/A

• Are all of the lights working properly

  Yes

  No

  N/A

Fire extinguisher:

• What month is the annual inspection due

  Yes

  No

  N/A

• Have the monthly inspections been completed

  Yes

  No

  N/A

First aid kit:

• Is it available and stocked

  Yes

  No

  N/A

Maintenance: What date was the last oil change

• Select date

  Date

What date is the next scheduled oil change

• Select date

  Date

Tire rotation:

• Have the tires been rotated every 5,000 miles

  Yes

  No

  N/A

Are there any repairs scheduled:

• Is the condition of the above vehicle satisfactory

  Yes

  No

  N/A

• Above defects corrected and paperwork attached

  Yes

  No

  N/A

• Above defects need not be fixed for safe operation of vehicle equipment

  Yes

  No

  N/A

Please attach any maintenance paperwork receipts to this report:

Drivers signature:

• Add signature

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Managers or Safety Department signature:

• Add signature

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