VEHICLE CHECK LIST - Connecticut



Vehicle Acceptance Form – FTA Section 5310

|Name of Organization: __________________________________________________________ |

|Date: | | | | |

| | | | | |

|Vehicle # | | |Mileage | |

| | | | | |

|Make | | |Model | |

| | | | | |

|Year | | |VIN # | |

|Manuf. | | |Plate # | |

|L/W | | |G/V/W | |

| | | | | |

|Seat cap. | | |W/C capacity | |

|DESCRIPTION |GOOD |FAIR |POOR |REMARKS |

| | | | | |

|Outside condition | | | | |

| | | | | |

|Inside condition | | | | |

| | | | | |

|Seats | | | | |

| | | | | |

|Lift | | | | |

| | | | | |

|Tires | | | | |

| | | | | |

|Emergency Equipment | | | | |

| | | | | |

|Mechanical | | | | |

| | | | | |

|Records / Manuals | | | | |

| REMARKS | |

| | |

| |

|INSPECTED BY: |

|DATE: |

| |

| |

Vehicle Acceptance Checklist – Explanation of Terms

Please note that this list is not exhaustive, but merely an example of what to look for under each category.

Outside Condition: Check for dents, scratches, and visible damage to the body of the vehicle, proper spelling of organizations name on the vehicle, exterior reflectors, mirrors, and condition of windshield.

Inside Condition: Overall cleanliness, free of loose objects in aisles, check interior lights, roof hatch function, exit windows, adjustment of mirrors. Check for proper tie downs for wheelchair securement, safety belts to be in operable condition and proper securement of handrails.

Seats: Check for proper number of seats ordered, proper securement of armrests, check for any visible tears to the seats, ensure seat belts fasten properly.

Lift: Check to make sure wheelchair lift is in operable condition.

Tires: Check for any visible damage to the tires, check tire treads, check for any missing lug nuts around the wheels and condition of wheels.

Emergency Equipment: Check first aid kit, check to make sure fire extinguisher is in the vehicle and secured.

Mechanical: Check for operable condition of headlights, turn signals, taillights, brake lights, hazard lights, reverse lights, windshield wipers, operable condition of horn, defrosters, heater, air conditioning, emergency brake, back up beeper, and all gauges working. Check securement and condition of muffler.

Records & Manuals: Check to be sure organization has received manual on bus or van and received a certificate of origin for the vehicle.

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