Motor Vehicle Self-Inspection Checklist
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1
2Motor Vehicle Self-Inspection Checklist
Center Name: ________________________________________________
Vehicle Make and Model:_______________________________________
Vehicle Year: _________________________________________________
1. Does the provider utilize a daily,
9. Do the front (and rear, if applicable)
weekly, or monthly inspection form?
windshield wipers operate properly?
Yes
Daily
Weekly
Monthly
Yes
No
No
10. Are the wiper blades in good
condition?
2. Is the odometer reading recorded at
the time of the inspection?
Yes
No
Yes
No
11. Are the brakes firm when depressed?
3. Is there evidence that the vehicle
Yes
No
fluid levels (oil, brake, power
steering, transmission, coolant) and
12. Does
the
parking
brake
work
battery are routinely inspected?
properly when engaged?
Yes
No
Yes
No
4. Are the vehicle’s tags, registration
13. Is there a spare tire and tire-changing
and insurance current?
equipment in the vehicle?
Yes
No
Yes
No
5. Are fire extinguishers in place,
14. Are the door locks functional?
properly charged, and inspected
Yes
No
annually?
Yes
No
15. Does the instrument panel illuminate
properly?
6. Is there an adequate and well-
Yes
No
supplied first-aid kit in the vehicle?
Yes
No
16. Do the gauges operate properly?
Yes
No
7. Do the seatbelts function properly?
Yes
No
17. Do the turn signal indicators operate
properly when viewed inside the
8. Does the horn operate properly?
vehicle?
Yes
No
Yes
No
1
Revised 5/29/2013
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Parent category: Miscellaneous