Motor Vehicle Checklist

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Motor Vehicle Checklist
Owner’s name ________________________________________________________________________
Address ______________________________________________________________________________
City, state ____________________________________________________ ZIP____________________
Driver’s license no.__________________________________ Renewal date____________________
(
)
Telephone___________________________
Insurance company _________________________ Amount of liability coverage $____________
Other drivers of same vehicle (this trip only) and driver’s license numbers:
__________________________________________, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Make of vehicle _______________________________________________________________________
Model year ___________________ Color_________________ Auto license no._________________
Basic Safety Check
Additional Safety Check
1. Seat belts for every passenger?______
1. Flares for emergencies?______
2. Tire tread okay?______ Spare?______
2. Fire extinguisher?______
Jack?______
3. Flashlight?______
3. Brakes okay?______
4. Tow chain or rope?______
4. Windshield wipers operate?______
5. First-aid kit?______
Fluid in reservoir?______
5. Current inspection sticker?______
6. Headlights and turn signals operating?
______
7. Rearview mirrors?______
8. Exhaust system okay?______

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Parent category: Business
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