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Date: <br />Vehicle: <br />Mileage: Maintenance Due Date: Wheelchair Lift Cycles: <br />UNDERHOOD <br />❑ Oil level <br />❑ Oil added quarts <br />❑ Radiator level <br />❑ Battery level <br />❑ Windshield washer fluid level <br />❑ Engine/hoses/belts <br />EXTERIOR <br />❑ Tires <br />❑ Tum signals <br />❑ Headlights <br />❑ Tail/brakes lights <br />❑ Windshield wipers <br />❑ Fresh body damage <br />❑ Cleanliness <br />❑ Cycle lift (light oil every 2 wks) <br />ACCESSIBILITY EQUIPMENT <br />❑ Fully operable wheelchair lift <br />❑ Proper number of belts/securement devices <br />Inspector Signature: <br />Management Comments: <br />Management Signature: <br />SAFETY EQUIPMENT <br />❑ Fire extinguisher <br />❑ Web cutter <br />❑ Triangles <br />❑ First Aid Kit <br />❑ Back-up alarm <br />❑ Rear door buzzer (LTV only) <br />❑ Bloodbome Pathogen Kit <br />INTERIOR <br />❑ Brakes <br />❑ Steering <br />❑ Transmission <br />❑ Mirrors <br />❑ Gauge/instruments <br />❑ Controls (equipment) <br />❑ Radio (two-way) <br />❑ Damage/cleanliness <br />❑ Wheelchair lift ramp <br />❑ Belts/securement devices in good condition <br />AWachmenl number 3 \n <br />F-5 Page 279 <br />