Annual Motor Vehicle Checklist Form


Annual Motor Vehicle Checklist
Date_______________ Unit____________ Den____________ Position _____________________________________
Owner’s name ________________________________________________________________________________________
Address _____________________________________________________________________________________________
City, state ____________________________________________________________________ Zip____________________
Driver’s license no._____________________________________________________
Renewal date____________________
Telephone (______) _______________________________
Alt. telephone (______) ____________________________
Insurance company ______________________________________________
Amount of liability coverage $____________
Other drivers of same vehicle (this trip only) and driver’s license numbers:
_______________________________________________ ,
Make and model of vehicle_____________________________________________________ Model year ______________
Color__________________ License no.___________________ Type__________________ Current? ______________
Basic Safety Check (required)
Additional Safety Check (optional)
1. Safety belts for every passenger?
1. Flares for emergencies?
2. Safety belts operational?
2. Fire extinguisher?
3. Tire tread OK?
3. Flashlight?
4. Spare tire present?
4. Tow chain or rope?
5. Tire jack present?
5. First-aid kit?
6. Brakes OK?
7. Windshield wipers operate?
8. Windshield washer fluid in reservoir?
9. Headlights and turn sibnals operating?
10. Mirrors:
Rear view_______ Side view_______
11. Exhaust system OK?
The online version of the Guide to Safe Scouting is updated quarterly.
Go to


00 votes

Related Articles

Related forms

Related Categories

Parent category: Life