Program Tool
Vehicle Inspection Form
| Week/Date(s): | Please use this LEGEND to complete this form: | |||||
| Vehicle #: | Y = YesN= NoN/A = For Contracted Vehicles | |||||
| Odometer Reading: (Recorded on Monday) |
M | T | W | R | F | S |
|---|---|---|---|---|---|---|
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Items for School Pick Up/ Trip |
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| Cell phone or two way radios | ||||||
| Children’s Emergency Information | ||||||
| Children’s Pick Up Lists (if applicable) | ||||||
| 煤气卡(如果适用) | ||||||
| Statement of Insurance | ||||||
|
Outside Walk Around Inspection |
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| Tires (check for proper inflation and wear) | ||||||
| Mirrors Adjusted Properly | ||||||
| Exterior Lights (turn signals, brake lights, headlights, hazard lights) | ||||||
| Outside Body of Vehicle (check for damage) | ||||||
| Doors (check to ensure all open and close) | ||||||
|
Before Starting Engine |
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| Seats/ Seatbelts (ripped, frayed, broken) | ||||||
| Complete First Aid Kit (checklist in the kit) | ||||||
| Emergency Equipment (flares, reflective triangles, cones, etc.) | ||||||
| Emergency Procedures in Vehicle | ||||||
| Vehicle Log Book (if applicable) | ||||||
| Fire Extinguisher Charged | ||||||
|
After Starting Engine |
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| Interior Lights- Exit Signs | ||||||
| Gas Levels | ||||||
| Heating and Air Conditioning | ||||||
| Horn Works | ||||||
| Windshield Wipers (work, blades not worn, fluid full) | ||||||
|
Trip Destination |
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| Vehicle is Clean and Free of Trash | ||||||
| Complete Walk Through Vehicle Before Securing | ||||||
| Driver’s Initials Every Day | ||||||
Explanation of problems noted during pre-inspection and/or travel: (Please report problems to supervisor) |
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Adapted from Navy Child and Youth Programs: Pre-Trip Vehicle Inspection Daily Form