Vehicle Windshield Damage Inspection Checklist
Please complete this checklist to document the condition of the vehicle's windshield. Ensure all relevant details and observations are recorded accurately.
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector's Full Name
*
First Name
Last Name
Vehicle Owner's Full Name
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Vehicle Information
*
Rows
Make
Model
Year
License Plate
Vehicle Details
Windshield Damage Assessment
*
Rows
Present
Severity (Minor/Moderate/Severe)
Location (Driver Side/Passenger Side/Center/Edge)
Chips
1
Minor
Moderate
Severe
Driver Side
Passenger Side
Center
Edge
Cracks
2
Minor
Moderate
Severe
Driver Side
Passenger Side
Center
Edge
Scratches
3
Minor
Moderate
Severe
Driver Side
Passenger Side
Center
Edge
Star Breaks
4
Minor
Moderate
Severe
Driver Side
Passenger Side
Center
Edge
Bullseye
5
Minor
Moderate
Severe
Driver Side
Passenger Side
Center
Edge
Other
6
Minor
Moderate
Severe
Driver Side
Passenger Side
Center
Edge
Is the windshield obstructing the driver's view?
*
Yes
No
Upload Photos of the Windshield (close-up and wide shots)
*
Upload a File
Drag and drop files here
Choose a file
Cancel
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Additional Observations or Comments
Repair or Replacement Recommendation
*
No Action Needed
Repair Recommended
Replacement Recommended
Inspector's Signature
*
Submit Inspection Report
Submit Inspection Report
Should be Empty: