VAN Pre-trip Inspection Checklist

• Van ID

• Conducted on (Date and Time)

  Date

• Inspected by (Full Name)

• Location
  Address

EXTERIOR GENERAL CHECK

• Leaks underneath, Leaning

  OK

  At Risk

  N/A

• Mirrors, Body, Doors, Windows (Check for damage and operational)

  OK

  At Risk

  N/A

• Tires and Wheels- 2/32" min tread wear, proper inflation, Any damage or loose- valve stem, side walls, Lug nuts

  OK

  At Risk

  N/A

UNDER HOOD

• Fluid Levels- Oil, Coolant, Washer Fluid, Power Steering, Transmission Fluid

  OK

  At Risk

  N/A

• Battery- Terminals, Cables (Loose, Corrosion)

  OK

  At Risk

  N/A

• Hoses, belts, wiring, loose items, leaks

  OK

  At Risk

  N/A

INTERIOR

• Emergency equipment- fire extinguisher, first aid kit, body fluid cleanup kit, reflectors.

  OK

  At Risk

  N/A

• Windshield, Windows- cracks

  OK

  At Risk

  N/A

• Seats, Seat belts, Interior dome lights, general interior condition

  OK

  At Risk

  N/A

• Driver's seat, seat belts, mirrors and adjust

  OK

  At Risk

  N/A

• Gauges operational and within proper range, dash panel lights, any warning lights/buzzers

  OK

  At Risk

  N/A

• Horn, Heaters, Defroster, A/C, Fans

  OK

  At Risk

  N/A

• Windshield wipers and washers - operation, blade condition

  OK

  At Risk

  N/A

• Headlights high and low beam, turn signals, hazards, brake, tail, parking lights, license plate light

  OK

  At Risk

  N/A

• Steering wheel play, shifter, brake pedal, parking brake

  OK

  At Risk

  N/A

• Person doing pretrip (Sign Initials )

  Sign

Maintenance Notes

• Please note the added amount (if applicable) for the following items:

• Fluids added, how much.

• Burning oil or leaks

• Engine lacks power, rough idle

• Overheating

• Noisy belt, brakes

• Noisy transmission, improper shifting, slips out of gear

• Hard steering, wheel play, wheel shimmy, pulling to the side L or R

• Slow tire air leak

• Exhaust fumes

• Recommendations/Comments