• Conducted on:

  • Officer's present:

  • Address / location

  • Registration:

  • State Registration:

  • Is the vehicle currently registered? [Check on your Service NSW App]

  • Is the vehicle more than 15 days out of registration?

  • Penalty to be issued:

  • Reason for UV report:

  • ECM Refrence:

Inspection / investigation

  • Make:

  • Model:

  • Type:

  • Colour:

  • Vin/chassis:

  • Condition of vehicle:

  • Is the vehicle in a dangerous position?

  • Is the vehicle locked and secure?

  • Is there damage?

  • Photograph of damage:

  • Are there valuables or personal belongings visible?

  • Photograph of valuables:

  • Discription:

  • Photograph front:

  • Photograph right hand side: (Drivers)

  • Photograph Rear:

  • Photograph left hand side: (Passenger)

  • Photograph of date chalk marks [Preferable - rear left hand tyre]

  • Tyre chalked

Outcome / notification

  • Comments and/or follow up actions:

  • Report forwarded to

  • Completed by (Name & signature)

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.