Autonomous Vehicle Inspection Checklist Form
Complete this checklist to document the pre-operation inspection of an autonomous vehicle.
Inspector Name
*
First Name
Last Name
Inspector ID
*
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Vehicle Location
*
Vehicle Model
*
Vehicle ID
*
Current Operating Mode/Status
*
Please Select
Manual
Autonomous
Standby
Maintenance
Other
Exterior Condition
*
Please Select
No damage
Minor damage
Major damage
Other
Sensor/Camera/Lidar/Radar Status
*
All operational
Camera issue
Lidar issue
Radar issue
Calibration required
Other
Tire Condition
*
Please Select
Good
Worn
Damaged
Low pressure
Other
Lights and Signals Status
*
Please Select
All functional
One or more not working
Other
Braking System Status
*
Please Select
Operational
Requires maintenance
Not operational
Steering/Controls Status
*
Please Select
Operational
Requires maintenance
Not operational
Battery/Fuel Level
*
Please Select
Full
75-99%
50-74%
25-49%
Below 25%
Software/Firmware Version
Error/Fault Codes or Alerts
Cleanliness/Obstructions
*
Please Select
Clean and clear
Minor obstructions
Major obstructions
Overall Inspection Outcome
*
Pass
Fail
Inspection Notes and Corrective Actions
Submit Inspection
Should be Empty: