Driver Equipment Inspection Form
Complete this form to document the results of your vehicle and driver equipment inspection.
Inspector's Full Name
*
First Name
Last Name
Inspection Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Vehicle Identification (Make, Model, Plate Number)
*
Odometer Reading
*
Pre-Trip Inspection Completed?
*
Yes
No
Equipment Condition Checklist
*
Rows
Pass
Fail
Needs Attention
Brakes
1
2
3
Lights/Indicators
4
5
6
Mirrors
7
8
9
Tires/Wheels
10
11
12
Windshield/Wipers
13
14
15
Horn
16
17
18
Seat Belts
19
20
21
Emergency Equipment (Triangle, Fire Extinguisher, First Aid Kit)
22
23
24
Fluid Levels (Oil, Coolant, Washer)
25
26
27
Driver's Logbook
28
29
30
Comments / Notes on Any Issues Found
Overall Vehicle Condition Rating
*
1
2
3
4
5
Immediate Follow-Up Actions Required?
*
Yes
No
Describe Follow-Up Actions (if any)
Inspector's Signature
*
Submit Inspection
Submit Inspection
Should be Empty: