Uber Inspection Form

Uber Inspection Form
Name
First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
LIGHTS
Rows Satisfied Unsatisfied
Head Lights 1 2
Tail Lights 3 4
Responsiveness 5 6
Turn Indicator Lights 7 8
STEERING
Rows Satisfied Unsatisfied
Bushings 9 10
Shocks/Springs 11 12
Tie Rods 13 14
Ball Joints 15 16
WINDOWS
Rows Satisfied Unsatisfied
Windows 17 18
Windshield 19 20
Windshield Wipers 21 22
BRAKES
Rows Satisfied Unsatisfied
Right Rear 23 24
Left Rear 25 26
Right Front 27 28
Left Front 29 30
Parking Brake 31 32
TIRES
Rows Satisfied Unsatisfied
Left Front 33 34
Left Rear 35 36
Right Front 37 38
Right Rear 39 40
DON'T FORGET TO CHECK
Rows Satisfied Unsatisfied
Safety Belts 41 42
Mirrors 43 44
Bumpers 45 46
Mufflers 47 48
Speedometer 49 50
Horn 51 52
Doors 53 54
Since all the boxes above are chosen as "satisfied", this vehicle passed the inspection.
Since all the boxes above are NOT chosen as "satisfied", this vehicle failed the inspection.
This part must be submitted by the technician.
Rows Information
Vehicle Make
Vehicle Model
Vehicle Year
Licence Plate
VIN #
Technician Name
First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Company of Technician
Technician Signature
Clear
Please indicate the inspection address.
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Should be Empty:

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