YYK VEHICLE INSPECTION Safety and Health

• Vehicle inspection

• Document No.

• YYK LOT

• Conducted on

  Date

• Prepared by

• Location
  Address

• YYK Lot

  SWRMC

  Other

• Safety Technician

• Ron Pivaro

  Carlos Sosa

  Temo Ochoa

  Joey the Hook

  Driver Complaint

• Date and Time audit began

  Date

VEHICLE DESCRIPTION

• Vehicle Number

• Odometer Reading at Inspection

EXTERIOR LIGHTING

• High and Low Beams Operational

  Yes

  No

  N/A

• Left and Right Tail Lights Operational

  Yes

  No

  N/A

• Left and Right Front Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Rear Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Break Lights Operational

  Yes

  No

  N/A

• Left and Right Reversing Lights Operational

  Yes

  No

  N/A

EXTERIOR BODY AND GLASS (Take Photos of any noted damage)

• Windscreen Free of Cracks and Chips

  Yes

  No

  N/A

• Left Mirrors adjustable and Free of Damage

  Yes

  No

  N/A

• Bonnet, Grill and Bumper free of Damage

  Yes

  No

  N/A

• Left Wing Free of Damage

  Yes

  No

  N/A

• Left Door Free of Damage

  Yes

  No

  N/A

• Left Side Free of Damage

  Yes

  No

  N/A

• Left Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Rear WIndow Free of Cracks and Chips

  Yes

  No

  N/A

• Rear of Vehicle and Bumper Free of Damage (Tailgate if included)

  Yes

  No

  N/A

• Right Side Free of Damage

  Yes

  No

  N/A

• Rear Registration Number Plate Intact

  Yes

  No

  N/A

• Right Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Right Door Free of Damage

  Yes

  No

  N/A

• Right Front Wing Free of Damage

  Yes

  No

  N/A

• Right Mirror Adjustable and Free of Damage

  Yes

  No

  N/A

• Vehicle is Clean and Free of Road Grime and Dirt

  Yes

  No

  N/A

TYRES

• Front Driver Tyre in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Driver Tyre in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Passenger Tyre in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Front Passenger Tyre in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Adequate Spare Tyre is Available if Necessary in Good Repair with No Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

• Rear Driver and Passenger Wheel/Tyre Trim Rings in Place

  Yes

  No

  N/A

INTERIOR

• Is vehicle free of trash?

  Yes

  No

  N/A

• Add media

  Media

• Has any HAZMAT been left in vehicle?

  Yes

  No

  N/A

• Add media

  Media

• Have supplies been left in vehicle?

  Yes

  No

  N/A

• Add media

  Media

• Driver Seat Belt Operational with Shoulder Harness

  Safe

  At Risk

  N/A

• Windshield Wipers Functioning Appropriately

  Yes

  No

  N/A

• All Gauges are Operating and Show within Appropriate Ranges

  Yes

  No

  N/A

• Passenger Seat Belts Operational

  Safe

  At Risk

  N/A

SAFETY EQUIPMENT

• Securely mounted First Aid Kit (Ensure Completely Stocked)

  Safe

  At Risk

  N/A

• Fire Extinguisher Charged and Inspected Monthly?

  Safe

  At Risk

  N/A

REQUIRED DOCUMENTATION

• Valid Vehicle Registration is located in Vehicle (Note where kept)

  Yes

  No

  N/A

• Valid Vehicle Insurance Certificate is Located in Vehicle (Note where kept)

  Yes

  No

  N/A

• Date of Last Service (List Details of Last Service, i.e. New Tyres, Oil Change, ect...)

  Date

SIGNATURES

• Signature of Auditor

  Sign

• Signature of Driver

  Sign