Motor Vehicle Self-Inspection Checklist Page 2
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218. Do the turn signal indicators operate
26. Do
the
headlights
operate
properly when viewed from outside
properly?
of the vehicle (in both the front and
Yes
No
rear of the vehicle)?
Yes
No
27. If the vehicle is damaged, has an
appointment been set to have
19. Does the air conditioner blow cold
repairs made?
air?
Yes
No
N/A
Yes
No
28. Do the brake lights illuminate
20. Does the heater blow hot air?
when
the
brake
pedal
is
depressed?
Yes
No
Yes
No
21. Do the windows open properly?
29. Are the tires in good repair?
Yes
No
Yes
No
22. Do the doors open properly?
30. Are all motor vehicle operators
Yes
No
properly licensed?
Yes
No
23. Is the exterior of the vehicle clean
and not in need of repair?
31. Are all motor vehicle operators
Yes
No
properly insured?
Yes
No
24. Is the interior of the vehicle clean
and not in need of repair?
Yes
No
25. Who (name and position title) is responsible for maintaining the vehicle?
___________________________________________________________________
Comments:
STAFF ATTESTATION:
I attest that I, the undersigned, have read the above-listed questions and attest that the answers I
provided are true and complete to the best of my knowledge.
_______________________________________
____________________________
Printed Name of Individual Completing the Form
Date Completed
________________________________________
Signature of Individual Completing the Form
2
Revised 5/29/2013
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