Vehicle Safety Inspection
Driver Name
*
Date
*
-
Month
-
Day
Year
Date Picker Icon
Vehicle #
*
Vehicle ( Year / Make )
*
Mileage
*
Oil Change
*
Within limits
Past Due
Take Photo of Vehicle Exterior
*
Take Photo of Vehicle Interior
*
Overall Cleanliness of Vehicle
*
1
2
3
4
5
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Vehicle Inspection
Lights (Head Lights, turn signals
*
Pass
Fail
Comment If Failed
Turn Signals (Front and Back)
*
Pass
Fail
Comment If Failed
Tail Lights
*
Pass
Fail
Comment If Failed
Brake Lights
*
Pass
Fail
Comment If Failed
Dash Board Free of Debris
*
Pass
Fail
Comment If Failed
Are Brakes Functioning Properly
*
Pass
Fail
Comment If Failed
Does Horn Work
*
Pass
Fail
Comment If Failed
Mirrors
*
Pass
Fail
Comment If Failed
Windshield Wiper Condition
*
Pass
Fail
Comment If Failed
Ladders Locked Down
*
Pass
Fail
NA
Comment If Failed
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Personnel Safety
Safety Data Sheets (SDS) on Vehicle
*
Pass
Fail
NA
Comment If Failed
Lock Out Tag Out Equipment
*
Pass
Fail (Missing items)
NA
Comment If Failed
Check fire extinguisher and replace if the extinguisher has been used or is expired. Remember fire extinguishers must be re-certified every 12 months.
Fire Extinguisher Current
*
Pass
Fail
Comment If Failed
Fall Protection- Inspect harness and lanyard for cuts, abrasion and defects. If piece equipment fails inspection take it out of service immediately.
Full Body Harness
*
Pass
Fail
NA
Comment If Failed
Retractable lanyard
*
Pass
Fail
NA
Comment If Failed
First Aid Kit- check the contents and replace missing items, also if items are damaged or old its a good time to replace the whole kit.
First Aid Kit
*
Pass
Fail
Comment If Failed
Hard Hat- A hard hat is typically good for 5 year but if hard hat is severely warn and deep scrapes are seen it is time for a new one.
Hard Hat
*
Pass
Fail
NA
Comment If Failed
Safety Glasses- Glasses should be replaced when they become scratched impairing users vision.
Safety Glasses
*
Pass
Fail
Comment If Failed
Safety Vest- When the vest becomes worn, cut or greasy it should be replaced.
Safety Vest
*
Pass
Fail
Comment If Failed
Ear Protection on Vehicle
*
Pass
Fail
Comment If Failed
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Vehicle Paperwork
Vehicle Registration
*
Current
Expired
Comment If Failed
Vehicle Insurance
*
Current
Expired
Comment If Failed
Accident Report Kit
*
Present
Missing
Comment If Failed
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Additional Comments about vehicle
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Drivers Signature
*
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Vehicle Inspected By:
*
Inspectors Signature
*
Submit
Should be Empty: