Annual Motor Vehicle Checklist Form printable pdf download

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.

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Annual Motor Vehicle Checklist Form