Moped Safety Inspection Checklist Form
Complete this checklist to document the safety inspection of a moped. Ensure all items are checked thoroughly.
Moped Identification Number
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Tire Condition
*
Good
Worn
Needs Replacement
Brake Functionality
*
Fully Functional
Partially Functional
Not Working
Lights (Headlight, Taillight, Indicators)
*
All Working
Some Not Working
None Working
Horn Operation
*
Functional
Not Working
Mirrors
*
Both Intact
One Damaged/Missing
Both Damaged/Missing
Steering Mechanism
*
Smooth
Stiff/Loose
Needs Repair
Fluid Levels / Leak Check
*
No Leaks, Levels OK
Low Levels
Leaks Present
Overall Result / Comments
Submit Inspection
Should be Empty: