Transportation Safety Quality Control Survey
Help us assess and improve transportation safety by completing this quality control survey.
Inspector's Full Name
*
First Name
Last Name
Position/Role
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Transportation
*
Please Select
Bus
Truck
Train
Van
Other
Safety Equipment Checklist: Please indicate compliance for each item below.
*
Rows
Compliant
Non-Compliant
Not Applicable
Seat Belts
1
2
3
Fire Extinguisher
4
5
6
Emergency Exits
7
8
9
First Aid Kit
10
11
12
Reflective Triangles
13
14
15
Rate the overall condition of the vehicle.
*
1
2
3
4
5
How would you rate the driver/operator's adherence to safety procedures?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Were there any safety incidents or near misses during this inspection?
*
Yes
No
If yes, please describe the incident(s). If no, skip this question.
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Additional comments or suggestions for improving transportation safety
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