Ng Form 4670-7v - Van Inspection Form

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William J. Hughes Technical Center
Motor Vehicle Program Office
VAN INSPECTION FORM
VEHICLE DESCRIPTION
DATE/TIME OF INSPECTION
Date:
Time:
Make:
Tag No.:
Odometer Reading:
Org.:
Location:
Inspector:
VEHICLE WALK-AROUND
Head Lights
Tail Lights
Signal Lights
Dashboard Warning Lights On
Wiper Blades
☐ Working
☐ Working
☐ Working
☐ Working
Yes
☐ Not Working
☐ Not Working
☐ Not Working
☐ Not Working
No
Driver’s Front Tire
Driver’s Rear Tire
Passenger Front Tire
Passengers Rear Tire
Good Condition
Good Condition
Good Condition
Good Condition
☐ Yes
☐ Yes
☐ Yes
☐ Yes
☐ No
☐ No
☐ No
☐ No
Interior - Needs Vacuum
Exterior - Needs Wash
Snow Brush in Vehicle
☐ Yes
☐ Yes
☐ Yes
☐ No
☐ No
☐ No
DESCRIBE PROBLEMS/WARNING INDICATORS:
(REPORT ACCIDENTS)
NG Form 4670-7V (02/17)
Electronic (Adobe)

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