- Does the provider utilize a daily, weekly, or monthly inspection form?
Yes No
- Is current, previous, and total mileage recorded at the time of the inspection?
Yes No
- Is there evidence that the vehicle fluid levels (oil, brake, power steering, transmission, coolant, and battery) are routinely inspected?
Yes No
- Is it evident what staff member completed the vehicle inspection?
Yes No
- Are the tag, registration and insurance current?
Yes No
- Are all motor vehicle operators properly licensed?
Yes No
- Are fire extinguishers in place, properly charged, and inspected annually?
Yes No
- Is there an adequate and well-supplied first aid kit?
Yes No
- Do the seatbelts function properly?
Yes No
- Does the horn operate properly?
Yes No
- Do the wipers operate properly and are the blades in good condition?
Yes No
- Are the brakes firm when depressed?
Yes No
- Does the parking brake work properly when engaged?
Yes No
- Is there a spare tire and tire changing equipment?
Yes No
- Are the door locks functional?
Yes No
- Is the interior of the vehicle clean?
Yes No
- Does the instrument panel illuminate properly?
Yes No
- Do the gauges operate properly?
Yes No
- Do the turn signal indicators operate properly when viewed inside the vehicle?
Yes No
- Does the air conditioner blow cold?
Yes No
- Does the heater blow hot?
Yes No
- Do the windows open properly?
Yes No
- Do the doors open properly?
Yes No
- Is the exterior of the vehicle clean and not in need of repair?
Yes No
- If the vehicle is damaged, has an assessment action to repair been done?
Yes No N/A
- Do the headlights operate properly?
Yes No
- Do the turn signal indicators blink both front and rear?
Yes No
- Do the brake lights illuminate when the brake pedal is depressed?
Yes No
- Are the tires in good repair?
Yes No
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Comments:
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Printed Name of Individual Completing FormDate Completed
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