WHS_FORM_21.4 Light Vehicle Safety Inspection

• Audit Title (Format YYYY_MM_DD_Rego)

• Vehicle Registration

• Conducted on

  Date
• Location
  Address

• Prepared by

• When "At Risk" is selected option to add comments and photo is enabled

External Check List

• Visual Inspection for Exterior Damage <br>(Recommend taking pic of any vehicle damage and report to Manager / Supervisor)

  No Damage

  Mild Existing Damage

  Major Damage

  N/A

• Is the vehicle drivable?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Leaks under the vehicle

  Yes

  No

  N/A

• Check Tyres for Wear and Pressure, inc. spare (Manufacturers specification pressure)

  Safe

  Unsafe

  N/A

Under Bonnet Check List

• Check under the Bonnet of the Vehicle

• Check inside the engine compartment for any leaks and loose items

  Safe

  Unsafe

  N/A

• Check Engine Oil Level

  Ok

  Re-Fill

• Check Power Steering Oil

  Ok

  Re-Fill

• Check Brake Fluid

  Ok

  Re-Fill

• Check Washer Fluid Level

  Ok

  Re-Fill

• Check Coolant Level

  Ok

  Re-Fill

• Check Power Steering Fluid Level

  Ok

  Re-Fill

• Check Battery / Terminal (battery terminals cleaned and Vaseline applied)

  Safe

  Unsafe

  N/A

Check Inside Vehicle

• Check list to be conducted inside of Vehicle

• Odometer Reading

• Check Service Sticker (on windscreen) for scheduled service date/mileage

  Safe

  At Risk

  N/A

• Check Ignition Key (Bent, Worn etc)<br>

  Safe

  Unsafe

  N/A

• Start Engine

  Yes

  No

  N/A

• Check Windscreen integrity (cracks/chips)

  Safe

  Unsafe

  N/A

• Check Windshield Wipers / Washers (front and rear)

  Safe

  Unsafe

  N/A

• Check Horn

  Safe

  Unsafe

  N/A

• Check Heater / Defroster / Air conditioner

  Working

  Not Working

• Check Headlights / Indicators / Hazard Lights / Tail Lights / Reverse Lights / Beacon / Spot Lights / Brake Lights

  Safe

  Unsafe

  N/A

• Check Mirrors for Damage and Adjustments

  Safe

  Unsafe

  N/A

Safety Equipment

• Safety equipment that is required to be in the vehicle.

• Check First Aid Kit

  Yes

  No

  N/A

• Defibrillator

  Yes

  No

  N/A

• Check Fire Extinguisher

  Yes

  No

  N/A

• Check High Visibility Vest and Leather Gloves

  Yes

  No

  N/A

• Radio / UHF / CB

  Yes

  No

  N/A

• Seat Belts Working

  Safe

  Unsafe

  N/A

• Covid PPE (Mask, Gloves and Hand Sanitizer)

  Yes

  No

  N/A

• Check Wheel chocks, Warning Signs, Jack and Wheel spanner

  Yes

  No

  N/A

• Check LED Torch (working)

  Yes

  No

  N/A

• Check Fuel Gauge (Vehicle must be refueled at end of trip if under half)

  Ok

  Re-Fill

• Add signature

  Sign