Vehicle Service Inspection Checklist Form
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3Vehicle Service Inspection Checklist Form
Date
Mileage In
Mileage Out
Customer Name
Year
Make
Model
VIN
Gas
¼
½
¾
F
Incoming Inspection By:
Outgoing Inspection By:
ITEM
IN
OUT
ITEM
IN
OUT
Battery
Gauges
Brakes
Dash Lights
Front Air Conditioning
Suspension Noises
Rear Air Conditioning
Other Chassis Problems
Heater
Radio
Speakers/Radio
Carpet
Walls
Headliner
Jacks/Tools
Door Locks
Power Window – Driver Side
Power Window – Passenger Side
Sun Visors
Dome Lights
Headlights
Tail Lights
Brake Lights
Directional’s
Adaptive Equipment:
Lift
Lift Control
Magnet Entry
Hand Control
Power Door Opener
Power Parking Brake
List Other Equipment:
Antenna(s)
Inside Mirror
Aux. Battery
Cell Phone
Vehicle Side Mirrors
Passenger’s Seat
Driver’s Seat
Rear Seat
nd
nd
2
Row Driver’s Seat
2
Row Passenger’s Seat
Cargo Door
Wash/Wiper
Spare Tire
Power Steering
Television
Cruise Control
Key: OK (Passed Inspection)
X (Not Acceptable)
N/A (Not Applicable)
Notes:
PLEASE READ CAREFULLY BEFORE SIGNING: In understand that this checklist reflects the general condition of my
Dealer Name
vehicle when released to
Here, Inc. for service but does not include mention of any hidden defects.
Dealer Name
Should such defects appear/be found during the service of my vehicle, I instruct
Here, Inc. to contact me,
or my representative, for authorization to repair any defect that would affect the proper and safe completion/operation of said
Dealer Name
service, provided it is in their capacity to repair. My authorization gives
Here, Inc. permission to make the
necessary repairs at my expense. I also understand that these additional repairs may cause some delay in completion of my
service. I further understand that some, or possibly all, of the gasoline in my vehicle will be used to move my vehicle in and
about your premises for road testing and reasonable additional mileage will be accrued.
Customer/Representative Signature:
Inspector:
Date:
QAP‐F22 (A) – Sample Vehicle Service Inspection Checklist Form
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