Light Vehicle Inspection Report Form printable pdf download

Light Vehicle Inspection Report Form

LIGHT VEHICLE INSPECTION REPORT FORM

The inspection report form is required for every 5,000 km. A separate report must be completed for each unit.

After completion this report shall be forwarded to the DBN Drywall & Acoustics Ltd Manager.

EMPLOYEE INFORMATION

Name:

License Number:

Work Location:

Work Phone Number:

VEHICLE INFORMATION

Operations:

Year:

Date:

License #:

Vehicle unit number:

Serial #:

Make:

Mileage:

Model:

Cylinders:

Other _________

INSPECT AND CHECK ONE:

LIGHTS

STATUS

VEHICLE PART

STATUS

Head Lights:

 OK  Out

Back-up Lights:

Parking Lights:

 OK  Out

Side Lights:

Tail Lights:

 OK  Out

Flashers Lights:

Directional Lights:

 OK  Out

Others Lights:

INSPECT AND CHECK ONE:

TIRES

STATUS

VEHICLE PART

STATUS

Front left Tire:

 Good

 Fair

 Poor

 Good

 Fair

 Poor

Front right Tire:

Rear left Tire:

 Good

 Fair

 Poor

 Good

 Fair

 Poor

Rear right Tire:

Conventional spare:

 Good

 Fair

 Poor

 Yes  No

Snow tires:

Mini spare:

 Yes

 No

 Good

 Fair

 Poor

Note and explain

uneven wear:

INSPECT AND CHECK ONE:

BRAKES

STATUS

VEHICLE PART

STATUS

Check Brake Pedal:

Check Brake Fluid:

 High

 Low

 Full

 Low

Check for master cylinder

leaks; explain conditions:

INSPECT AND CHECK ONE:

EXTERIOR

STATUS

COMMENT – DAMAGE

Exterior Paint Condition:

 Good

 Fair

 Poor

Chrome Condition:

 Good

 Fair

 Poor

Windshield Wipers:

 Good

 Fair

 Poor

200 Louth Street, St. Catharines, Ontario L2S 2R6

Tel: 905 – 684 – 2371

Fax: 905 – 684 – 8080

Light Vehicle Inspection Report Form

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