Laserfiche WebLink
PRE -TRIP VEHICLE INSPECTION FORM <br />Date: / f <br />Vehicle ID #: <br />Fuel added: gallons <br />Oil added: <br />quarts <br />Maintenance Reminder Box <br />Current Mileage: <br />❑ Maintenance due within 500 miles <br />Maintenance due at: ❑ Maintenance past due! <br />(According to Preventative Maintenance Schedule) (Miles) <br />Inspect each item below. If there is not a problem, place a check (4) in the box next <br />to the item. If there is a problem, an item needs maintenance or if damage is found, <br />place an x in the box next to the item and include a description in the space provided <br />to the right. <br />UNDER HOOD <br />SAFETY EQUIPMENT: <br />Oil level <br />Fire extinguisher <br />Radiator level <br />First aid kit <br />Battery level <br />Back-up alarm <br />Windshield wash level <br />Rear door alarm. <br />Engine/ hoses belts <br />Protective Kit <br />EXTERIOR <br />Bloodborne pathogen <br />Tires <br />Web cutter <br />Turn signal <br />Headlights <br />WHEELCHAIR LIFT <br />Tail brake lights <br />Driver must run one 1 <br />Windshield wipers <br />full cycle <br />Fresh body damage <br />Floor anchors clean <br />Cleanliness <br />Manual jack handle <br />INTERIOR <br />Restraints stored properly <br />Brakes <br />Steering <br />Stra ps & belts in good <br />Transmission <br />working condition <br />Mirror (adjust) <br />Gauges/instruments <br />Complete operational <br />Controls (equipment) <br />instructions on board <br />Radio (two-wa <br />Damage/ cleanliness <br />All securement stations <br />Horn <br />properly equipped <br />Blower fan <br />Time In: <br />Time Out: <br />Be ginnin g Odometer Reading. <br />Ending Odometer Reading: <br />COMPLETE REVERSE SIDE <br />Attachment number 4 \n <br />F -9 <br />Page 285 <br />