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)

Any markings on the ‘FAIL’ side will automatically fail inspection 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