AUTOMOBILE SELF-INSPECTION REPORT
This model form/template must be customized to meet your Agency’s needs.
VEHICLE SELF-INSPECTION FORM
|Operators of District-owned vehicles are responsible for the daily inspection of assigned vehicles and reporting the need for repairs between regular |
|service intervals. At the end of each day/week/month (choose frequency), send completed condition report to Fleet Administrator. |
|Operator: |Location: |Date: |
|Make of Vehicle |Model |Year |Vehicle No. |Plate No. |State |Mileage Reading |
| | | | | | | |
|Check sticker on door for mileage and date of last service |
| |Oil: |Transmission: |
| |Normal Low Leaks Noted |Normal Low Leaks Noted |
|Mileage at last service: | | |
|Date of last Service: | | |
|EQUIPMENT | |DESCRIBE AND INDICATE |
| | |ACTION TO BE TAKEN |
|Brakes |Condition. Service (or foot) and parking (or hand) |Satisfactory Needs Service |
| | |Notes: |
|Lights |Condition. Headlights, including proper focus. Rear |Satisfactory Needs Service |
| |lights, and directional signals |Notes: |
|Tires |General condition. Any cuts, bruises, excess wear, |Satisfactory Needs Service |
| |unbalanced or alignment. Cause? No. of tires: ___ Reg. |Notes: |
| |___ Snow | |
|Body |Extent and location of all exterior damage. Describe |Satisfactory Needs Service |
| |cause. |Notes: |
|Interior |Cleanliness? |Satisfactory Needs Service |
| |Cluttered condition? |Notes: |
| |Damage (how caused)? | |
|Engine |Condition |Satisfactory Needs Service |
| | |Notes: |
|Steering |Condition. |Satisfactory Needs Service |
| |Including wheel alignment. |Notes: |
|Glass |Condition |Satisfactory Needs Service |
| |(Describe any damage and how caused) |Notes: |
|Horn / Back up Alarm |Condition |Satisfactory Needs Service |
| | |Notes: |
|Heat/Air Conditioning |Condition |Satisfactory Needs Service |
| | |Notes: |
|Windshield Wipers |Condition |Satisfactory Needs Service |
| | |Notes: |
|Mirrors |Condition |Satisfactory Needs Service |
| | |Notes: |
|Emergency Lights / Strobes |Condition |Satisfactory Needs Service |
| | |Notes: |
|Fire Extinguisher / 1st Kit Aid |Condition | Satisfactory Needs Service |
| | |Notes: |
REMARKS:
Signature of Operator Date
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