Vehicle Interlock Installation Checklist Form
Use this form to record vehicle details, installation information, checklist steps, testing results, and completion notes for a vehicle interlock installation.
Vehicle and Customer Information
Vehicle Make
*
Vehicle Model
*
Vehicle Year
*
License Plate / Vehicle Unit Identifier
*
Customer / Client Name
*
First Name
Middle Name
Last Name
Installation Appointment and Device Details
Installation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Installation Time
*
Hour Minutes
AM
PM
AM/PM Option
Device / Interlock Type
*
Please Select
Ignition Interlock
Breath Alcohol Interlock
Vehicle Immobilizer
Other
Serial Number / Equipment ID
*
Technician / Installer Name
*
First Name
Middle Name
Last Name
Pre-Installation Checklist
Vehicle condition checked
*
Yes - completed
No - not completed
Not applicable
Battery and system status checked
*
Yes - completed
No - not completed
Not applicable
Mounting area reviewed
*
Yes - completed
No - not completed
Not applicable
Wiring and access points reviewed
*
Yes - completed
No - not completed
Not applicable
Pre-existing damage noted
*
Yes - completed
No - not completed
Not applicable
Pre-install observations and notes
Installation and Testing Checklist
Device mounted securely
*
Yes
No
Not Applicable
Wiring connected properly
*
Yes
No
Not Applicable
Calibration completed
*
Yes
No
Not Applicable
System powered on
*
Yes
No
Not Applicable
Initial test passed
*
Pass
Fail
Not Applicable
User instructions reviewed
*
Yes
No
Issues encountered and corrective actions taken
Completion and Sign-Off
Completion Status
*
Completed
Completed with Notes
Incomplete
Requires Follow-Up
Final Remarks
Installer Signature
Date of Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final Confirmation
*
Confirmed: checklist is accurate and installation is complete
Not yet confirmed
Submit Checklist
Submit Checklist
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