√
Place check mark
next to each item when identified as working or functioning
properly. Circle items when malfunctioning, not working properly, or a problem has been
identified. List problems below and seek repair or corrective action.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
VEHCILE DESCRIPTION:
_____________________________
Employee Name: (Print)
_____________________________
Date and Time:
_____________________________
Supervisor Initials:_____________