Vehicle Inspection
TO BE COMPLETED BY VEHICLE OPERATOR ↓
_____________________________________________________________________________________________________________ _____________________________________________________________
FULL NAME PHONE NUMBER
INSPECTION POINTS
HEADLIGHTS
..........................................................
◻
PASS
◻
FAIL
TAIL LIGHTS
............................................................
◻
PASS
◻
FAIL
TURN INDICATOR LIGHTS
.....................................
◻
PASS
◻
FAIL
STOP LIGHTS
...........................................................
◻
PASS
◻
FAIL
FOOT BRAKES
(Pads/Shoes thickness)…......
◻
PASS
◻
FAIL
EMERGENCY/PARKING BRAKE
.............................
◻
PASS
◻
FAIL
STEERING MECHANISM
.........................................
◻
PASS
◻
FAIL
WINDSHIELD
...........................................................
◻
PASS
◻
FAIL
SAFETY BELTS FOR DRIVERS & PASSENGERS
....
◻
PASS
◻
FAIL
REAR WINDOW & OTHER GLASS
...........................
◻
PASS
◻
FAIL
WINDSHIELD WIPERS
.............................................
◻
PASS
◻
FAIL
FRONT SEAT ADJUSTMENT
...................................
◻
PASS
◻
FAIL
DOORS
(Open/Close/Lock)………….....................
◻
PASS
◻
FAIL
HORN
........................................................................
◻
PASS
◻
FAIL
SPEEDOMETER
........................................................
◻
PASS
◻
FAIL
BUMPERS
.................................................................
◻
PASS
◻
FAIL
MUFFLER AND EXHAUST SYSTEM
.......................
◻
PASS
◻
FAIL
TIRES, INCL TREAD DEPTH
....................................
◻
PASS
◻
FAIL
INTERIOR & EXTERIOR REAR VIEW MIRRORS
....
◻
PASS
◻
FAIL
VEHICLE INSPECTION RESULTS (Inspector to circle)
$Q\PDUNLQJVRQWKHť)$,/ŦVLGHZLOODXWRPDWLFDOO\IDLOLQVSHFWLRQ7D[LVDQGFRPPHUFLDOO\ZUDSSHG
YHKLFOHVZLOODXWRPDWLFDOO\IDLOLQVSHFWLRQ$OOILHOGVRIWKHYHKLFOHLQVSHFWLRQIRUPPXVWEHFRPSOHWHGE\
\RXULQVSHFWRUWREHDFFHSWHGXSRQXSORDGWR\RXU8EHUGULYHUDFFRXQW
PASS FAIL
____________
Inspection Date
TO BE COMPLETED BY INSPECTOR ↓
_______________________________ ___________________________ ________________________________ _____________________________________________________________________
VEHICLE MILEAGE LICENSE PLATE STATE LICENSE PLATE NUMBER VIN
________________________________________ ________________________________________ ____________________________ ___________________________________________________
VEHICLE MAKE VEHICLE MODEL VEHICLE YEAR NUMBER OF DOORS
_______________________________________________________________ __________________________________________________________________________________________________________
HAS REGISTRATION STICKER? (YES/NO) REGISTRATION STICKER MONTH/YEAR (MM/YY)
_______________________________________________________________ __________________________________________________________________________________________________________
INSPECTOR COMPANY INSPECTOR ADDRESS
_______________________________________________________________ _________________________________________________________________ ______________________________________
INSPECTOR NAME INSPECTOR SIGNATURE STATE CERTIFICATION NUMBER
,69(+,&/(7$;,25&200(5&,$//<:5$33('"..◻<(6◻12
)25083'$7('