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AM/PM Option
VEHICLE INFORMATION
Vin# Bar Code Scan
Manufacturer
Year
Model
Mileage
Sticker mileage when next oil change is due
Initial Customer Concerns
STATE FARM AGENT
First Name
Last Name
OFFICE
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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VEHICLE LAMPS and SWITCHES (EXTERIOR AND INTERIOR)
Dashboard Indicator Lights - CRITICAL
On
None illuminated
Dash Lights
ABS - Anti-Lock Brake System (IBrake - Brake Light (Parking Brake, Hydraulic Pressure)
Check/Service Engine Soon (Abnormality in vehicle computer system)
Battery Light (Battery issue or loose wire)
Temperature Warning Light (Engine Overheating)
Tire Pressure Light (Check tire pressure)
Low Fuel Light (Need for fuel)
Oil Pressure Light (Check oil levels)
Traction Control Light (Normally will engage in slippery conditions)
Air Bag Light (Issue with deployment of air bag)
Other (See Below for explanation)
Explanation of Codes associated with above warning light
Tech View Photo (Vehicle Information)
Comments on Photo
Interior Electrical (Lighting and Switches)
Functional
Non-Functional
Not Applicable
See Comments
Dome/Map Light
Instrument Cluster Panel
Climate Control Panel Lights
Visor Lamps
Window Switches
Door Locks
Power Mirror Switches
Seat Switches
Cruise Control Switches
Headlamps
Driver Running Light
Passenger Running Light
Driver Marker Light
Passenger Marker Light
All check OK
Working
Not Working
Running / Marker Lights
Driver Front
Passenger Front
Driver High Beam
Driver Low Beam
Passenger High Beam
Passenger low Beam
Fog Lamp Out
All Check OK
Working
Not Working
Turn Signals
Driver Front
Passenger Front
Passenger Rear
Driver Rear
All Check OK
Working
Not Working
Tail Lights
Driver Rear
Passenger Rear
Passenger Brake Light
Driver Brake Light
Cyclops
License Plate Light
All Check OK
Working
Not Working
Reverse Lights
Driver Side Rear
Passenger Side Rear
Both Check OK
Working
Not Working
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VEHICLE GLASS / MIRRORS
Vehicle Glass and Mirrors
Good Condition
Rock Chip
Cracked (needs replacement)
Cracked (needs repair)
Other
See Comments
Front Windshield
Driver Side Mirror Glass
Driver Side Window
Rear Driver Side Window
Rear Windshield
Rear Passenger Side Window
Passenger Side Window
Passenger Side Mirror Glass
Rear View Mirror
Vehicle Glass Inspection Comments
Tech View Photo (GLASS)
Comments on Photo
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VEHICLE WIPERS/GAS CAP
Vehicle Wipers
Good Condition
Poor Condition
Torn
Streaking
Consider Replacement
See Comments
Not Applicable
Front Wiper Blades
Front Wiper Arms
Front Spray Nozzle
Rear Wiper Blades
Rear Wiper Arm
Rear Spray Nozzle
Condition of Gas Cap
Please Select
Good
Poor Condition
Replace
Automatic Operating Antenna
Please Select
Good
Poor Condition
Replace
Comments on Wipers and Gas Caps
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UNDERHOOD FLUIDS CHECK
Refillable Vehicle Fluids (If fluids are low below, it could mean there is a problem and therefore should be checked as soon as possible.
Container Full
Container Low
Container Critically Low
Shows Signs of Leaking
Over Filled
Washer Fluid
Anti Freeze (coolant)
Power Steering
Critical Lubricating Oils (These lubricating oils are critical to the operating of your vehicle and should be always maintained at the proper level)
Full
Half to a Quart Low
Critically Low
Over Filled
Check Comments
Motor oil Dipstick Measure
Transmission Fluid Dipstick Measure
Brake Fluid
Clutch Fluid (manual transmissions only)
Fluid Color Indicating Usefulness or needed maintenance
Clear
Dark
Viscosity (Thickness)
See Comments
Motor Oil
Transmission Oil
Brake Fluid
Power Steering
Anti Freeze
Comments regarding Vehicle Fluids
Tech View Photo (Fluids)
Comments on Photo
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UNDERHOOD MAINTENANCE
Hose Inspection
Good
Cracked/Damaged
Show Signs of Leakage
Unable to Visually Inspect
Not Applicable
Radiator Hoses (UPPER)
Radiator Hoses (LOWER)
Heater Hoses
Power Steering Hoses
Comments on Hose Inspection
Additional Maintenance Item Inspection
Operating Normal
OEM (Original Equpment)
Needs Attention
Unable to visually inspect
Not Applicable
Spark Plugs
Spark Plug Wires
Air Filter
Cabin Air Filter
Drive Belt (Serpentine)
Timing Belt
Tensioner
Starter
Alternator
Oil Filler
Comments on Maintenance Inspection
Heating and Cooling Inspection
Operating Normal
Signs of Leakage
OEM (Original Equipment)
Needs Attention
Radiator
Radiator Cap
Water Pump
Air Conditioning Compressor
Evaporator Core
Condensor
Receiver Dryer
Comments on Heating and Cooling Inspection
Battery Inspection
Good
Signs of Wear (acceptable)
Corrosion visible
Needs Attention
Unable to Visually Inspect
Older Battery
Not correct battery for vehicle
Battery
Battery Cables
Battery Terminals
Battery "Hold Down"
Comments on Battery Inspection
Tech View Photo (Under Hood Maintenance)
Comments on Under Hood Photo #1
Tech View Photo (Under Hood Maintenance #2)
Comments on "Under Hood" Photo #2
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STEERING AND SUSPENSION
Components below are critical to the driver's ability to handle the vehicle
STEERING
Good
Poor Condition
Loose
Shows sign of leakage
Needs Attention (Replacement)
Not Applicable for this Vehicle
See Suspension Comments
Pitman Arm
A Arm
Idler Arm (Safety item)
Rack and Pinion
Inner Tie Rods
Outer Tie Rods
Gearbox
SHOCKS
Good
Poor Condition
OEM (Original)
Signs of Leakage
Not Applicable for this Vehicle
See Suspension Comments
Driver Side Front Shock
Passenger Side Front Shock
Driver Side Rear Shock
Passenger Side Rear Shock
STRUTS
Good
Poor Condition
OEM (Original)
Signs of Leakage
Not Applicable for this Vehicle
See Suspension Comments
Driver Side Front STRUT
Passenger Side Front STRUT
Driver Side Rear STRUT
Passenger Side Rear STRUT
BALL JOINT INSPECTION (Ball Joint's keep your wheels level to the road and hold the wheels to the frame)
Good
Poor Condition
Needs Attention (Replacement)
Not Applicable for this vehicle
See Suspension Comments
Driver Side Front Upper Ball Joint
Driver Side Front Lower Ball Joint
Passenger Side Front Upper Ball Joint
Passenger Side Front Lower Ball Joint
Driver Side Rear Ball Joint
Passenger Side Rear Ball Joint
STABILIZER INSPECTION (Stability in controlling the Steering of a vehicle)
Good
Poor Condition
Needs Attention (Replacement)
Not Applicable for this Vehicle
See Suspension Comments
Vehicle Sway Bar
Driver Side Front Stabilizer Link
Passenger Side Front Stabilizer Link
Driver Side Rear Stabilizer Link
Passenger Side Rear Stabilizer Link
Front Sway Bar Bushings
Rear Sway Bar Bushings
Wheel Bearing Inspection (a component in the wheel that separates moving parts and takes a load)
Good
Poor Condition
Needs Attention (Replacement)
See Suspension Comments
Driver Side Front Wheel Bearing
Passenger Side Front Wheel Bearing
Driver Side Rear Wheel Bearing
Passenger Side Rear Wheel Bearing
Tech View Photo (Suspension #1)
Explanation of Suspension Photo #1
Tech View Photo - Suspension #2
Explanation of Suspension Photo #2
Comments on visual inspection of Suspension
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BRAKE SYSTEM
CRITICAL SAFETY INSPECTION
Brake Pad Inspection
80% Remaining
60% Remaining
40% Remaining
20% Remaining
Less than 20%
NOT APPLICABLE FOR THIS VEHICLE
See Comments
Driver Front Brake Pads
Passenger Front Brake Pads
Driver Rear Brake Pads
Passenger Rear Brake Pads
Brake Shoe Inspection
80% Remaining
60% Remaining
40% Remaining
20% Remaining
Less than 20%
NOT APPLICABLE FOR THIS VEHICLE
See Comments
Driver Front Brake SHOES
Passenger Front Brake SHOES
Driver Rear Brake SHOES
Passenger Rear Brake SHOES
Brake Rotor Inspection
Smooth (OK)
Groove (Marginal)
Require attention soon
Require attention immediately
Not Applicable for this Vehicle
See Comments
Driver Front Brake Rotors
Passenger Front Brake Rotors
Driver Rear Brake Rotors
Passenger Rear Brake Rotors
Brake Drums Inspection
Smooth (OK)
Groove (Marginal)
Require attention soon
Require attention immediately
Not Applicable for this Vehicle
See Comments
Driver Front Brake DRUMS
Passenger Front Brake DRUMS
Driver Rear Brake DRUMS
Passenger Rear Brake DRUMS
Comments on Brake Inspection
Brake Caliper Visual Inspection
Visual Inspection Operating Normal
Caliper Pins require lubrication
Caliper Piston Not Working
Caliper needs attention
Not Applicable for this vehicle
Driver Front Caliper
Passenger Front Caliper
Driver Rear Caliper
Passenger Rear Caliper
Driver Wheel Cylinder
Passenger Wheel Cylinder
Tech View Photo (Brake Inspection #1)
Explanation of Photo #1
Tech View Photo (Brake Inspection #2)
Explanation of Photo #2
Tech View Photo (Brake Inspection #3)
Explanation of Photo #3
Tech View Photo (Brake Inspection #4)
Explanation of Photo #4
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TIRES
Tire and Wheel Condition
Good Condition
Cracking/Bulging Tread
Tread Pulling Away
Uneven treads (alignment)
Worn Treads
Missing Lug Nuts
Broken Studs
Missing Wheel Fasteners
Bent Rims
Driver Side Front
Passenger Side Front
Driver Side Rear
Passenger Side Rear
Tread Depth (tread depth gauge vertical measurement)
Original Tread Depth (10/32 to 11/32)
8/32 Tread Depth (25% worn)
6/32 Tread Depth (50% worn)
4/32 Tread Depth (80% worn)
3/32 or less (Legally "Worn Out")
See Comments
Driver Side Front
Passenger Side Front
Driver Side Rear
Passenger Side Rear
Comments regarding Tire Condition
Front Driver Side P.S.I at Inspection
Please Select
Less than 26 P.S.I
28 P.S.I
30 P.S.I
32 P.S.I.
34 P.S.I.
36 P.S.I.
38 P.S.I.
40 P.S.I
More than 40 P.S.I
P.S.I. Pressure Recommended by Tire manufacturer
Front Passenger Side P.S.I at Inspection
Please Select
Less than 26 P.S.I
28 P.S.I
30 P.S.I
32 P.S.I.
34 P.S.I.
36 P.S.I.
38 P.S.I.
40 P.S.I
More than 40 P.S.I
P.S.I. Pressure Recommended by Tire manufacturer
Rear Passenger Side P.S.I at Inspection
Please Select
Less than 26 P.S.I
28 P.S.I
30 P.S.I
32 P.S.I.
34 P.S.I.
36 P.S.I.
38 P.S.I.
40 P.S.I
More than 40 P.S.I
P.S.I. Pressure Recommended by Tire manufacturer
Rear Driver Side P.S.I at Inspection
Please Select
Less than 26 P.S.I
28 P.S.I
30 P.S.I
32 P.S.I.
34 P.S.I.
36 P.S.I.
38 P.S.I.
40 P.S.I
More than 40 P.S.I
P.S.I. Pressure Recommended by Tire manufacturer
Tech Photo - Tire Inspection
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UNDER VEHICLE INSPECTION
Casing Fluid Full
Casing Fluid Low
Needs Fluid Replacement
Not Applicable for this Vehicle
TRANSFER CASE FLUID
Good Condition
Marginal Condition
OEM, Original
Not Applicable for this Vehicle
FRONT DIFFERENTIAL INSPECTION CONDITION
Casing Fluid Full
Casing Fluid Low
Needs Fluid Replacement
Not Applicable for this Vehicle
FRONT DIFFERENTIAL FLUID LEVEL
Good Condition
Marginal Condition
OEM, Original
Not Applicable for this Vehicle
REAR DIFFERENTIAL INSPECTION CONDITION
Casing Fluid Full
Casing Fluid Low
Needs Fluid Replacement
Not Applicable for this Vehicle
REAR DIFFERENTIAL FLUID LEVEL
Good Condition
Poor Condition
Needs Attention
Shows Signs of Leakage
Not Applicable for this Vehicle
DRIVER SIDE FRONT AXLE SEALS
Good Condition
Poor Condition
Needs Attention
Shows Signs of Leakage
Not Applicable for this Vehicle
PASSENGER SIDE FRONT AXLE SEALS
Good Condition
Poor Condition
Needs Attention
Shows Signs of Leakage
Not Applicable for this Vehicle
PASSENGER SIDE REAR AXLE SEALS
Good Condition
Poor Condition
Needs Attention
Shows Signs of Leakage
Not Applicable for this Vehicle
DRIVER SIDE REAR AXLE SEALS
Good Condition
Poor Condition
Needs Attention
Shows Signs of Leakage
Not Applicable for this Vehicle
UNIVERSAL JOINTS (IF APPLICABLE)
Good Condition
Poor Condition
Needs Attention
Shows Signs of Leakage
Not Applicable for this Vehicle
FRONT CV JOINTS
Good Condition
Poor Condition
Needs Attention
Shows Signs of Leakage
Not Applicable for this Vehicle
REAR CV JOINTS
Exhaust Inspection
Good
Signs of Wear (acceptable)
Needs Attention
Unable to visually inspect
See Tech View Photos
SEE COMMENTS
Flex Pipe
Catalytic Converter
Muffler
Tail Pipe
Manifold
Exhaust Brackets
Muffler Heat Shield
Tech View Photo - Under Vehicle #2
Explanation of Tech View (Under Vehicle) #1
Tech View Photo - Under Vehicle #1
Explanation of Tech View (Under Vehicle) #2
Comments on Under Vehicle Inspection
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SUMMARY
Overall Under Hood Condition
1
2
3
4
5
6
7
8
9
10
Critical Condition
Excellent Condition
1 is Critical Condition, 10 is Excellent Condition
Under Hood Comments
Overall Exhaust Condition
1
2
3
4
5
6
7
8
9
10
Critical Condition
Excellent Condition
1 is Critical Condition, 10 is Excellent Condition
Exhaust Comments
Overall Suspension Condition
1
2
3
4
5
6
7
8
9
10
Critical Condition
Excellent Condition
1 is Critical Condition, 10 is Excellent Condition
Suspension Comments
Overall Brake Condition
1
2
3
4
5
6
7
8
9
10
Critical Condition
Excellent Condition
1 is Critical Condition, 10 is Excellent Condition
Brake Comments
Overall Under Vehicle Inspection
1
2
3
4
5
6
7
8
9
10
Critical Condition
Excellent Condition
1 is Critical Condition, 10 is Excellent Condition
Under Vehicle Comments
RECOMMENDATIONS FOR CONSIDERATION
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