VERMONT STATE POLICE
Dept of Public Safety
MAINTENANCE FORM
Items to be checked for Department’s 16,000 mile vehicle safety inspection.
|( Alignment |( Tie Rod Ends |
|( Springs |( Ball Joints |
|( Shocks |( C.V. Boots |
|( Control Arm & Bushings |( Stabilizers & Bushings |
|( Strut System |( Complete Steering System |
|( Wheel Bearings |( Complete Brake System |
|( Front Suspension |( Rear Suspension |
|( Complete Charging System |( All Air/Cabin and Fuel filters |
|( Complete Cooling System -__F |( Windshield Wiper System |
|( Complete Drive Train |( Complete Emission System |
|( Complete Fuel System |( All Fluid Levels |
|( Belts and Hoses |( Complete Exhaust System |
|( Motor Mounts |( Complete Lighting System |
|( Fluid Leaks |( All Glass |
|( Body Fatigue/Rust |( Hood & Trunk Operation |
|( All Door Hinges/Locks |( All Seat Operations |
|( All Seat Belt Operation |( SRS/Air Bag System |
|( Complete Starting System |( State Inspection with new sticker affixed. |
This inspection far exceeds the normal periodic inspection under 23 V.S.A. §1222. Therefore, no additional fee will be charged for state inspection.
Tune up includes Spark Plugs, Spark Plug Wires or Spark Plug Boots and an inspection of the coil pack or individual coils.
Transmission Flush is preferable to removing the pan and changing the filter as it cleans all of the fluid and not just what is in the transmission pan.
SCHEDULED MAINTENANCE SERVICES
(Continued on the back of this form.)
|SERVICE |SERVICE INTERVALS |
| |4K |
| |100K |104K |108K |
|Street | |Fax Number | |
|City/Town | |VT Inspection Station # | |
|State | |Date of Service | |
|Zip Code | | | |
SIGNATURE OF TECHNICIAN THAT PERFORMED THE SERVICE
(Please include first name, middle initial, last name)
PRINT NAME ______________________________ SIGNATURE _______________________________
VEHICLE INFORMATION
Vehicle Plate Number _______ Make __________________ Model ________________ Year ________
Last four digits of Vehicle’s VIN # ____________________ Mileage _____,_______
REPAIR POLICY
• All vehicles that are in for service will have a Department signed work order.
• The Department will supply all parts for repair unless prior arrangements were made.
• Call the officer or person that the vehicle is assigned to for authorization for any additional repairs that were not scheduled.
• All repairs in excess of $350.00 need to have an authorization number. This number is to be written on all the repair invoices.
• While the vehicle is in for service it will be kept inside at night in a secure area until picked up.
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