Form DCF-F-CFS52 "Vehicle Safety Inspection - Child Care Centers" - Wisconsin

What Is Form DCF-F-CFS52?

This is a legal form that was released by the Wisconsin Department of Children and Families - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Wisconsin Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DCF-F-CFS52 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Children and Families.

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Download Form DCF-F-CFS52 "Vehicle Safety Inspection - Child Care Centers" - Wisconsin

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DEPARTMENT OF CHILDREN AND FAMILIES
STATE OF WISCONSIN
Division of Early Care and Education
VEHICLE SAFETY INSPECTION – CHILD CARE CENTERS
Use of form: Use of this form is mandatory to comply with the child care licensing rules DCF 250.08(5)(b), DCF 251.08(5)(b), and DCF
252.09(5)(b). Failure to comply may result in issuance of a noncompliance statement.
Instructions: At 12-month intervals, the licensee shall provide this form to the garage, dealership, or auto repair shop to be completed by the
inspector upon completion of the vehicle inspection. The licensee shall submit the completed form to the Licensing Specialist.
Facility Name
Program Type
Day Camp
Family Child Care
Group Child Care
Vehicle Year
Make
Model
Color
Odometer Reading
License Plate Number
Name of Inspecting Company or Agency
Name of Inspector
Telephone Number
Address of Inspecting Company or Agency
City
State
Zip Code
Repair /
Repair /
Item
Pass
Replace
Item
Pass
Replace
SAFETY FEATURES
BRAKES
1. Turn signals operational
22. Failure indicator light
2. Head lights
23. System integrity
3. Tail lights
24. Pedal reserve
4. Brake lights
25. Disc / drum condition
5. Horn
26. Hoses and assembly
6. Windows / windshield (cracks / chips)
7. Front seat safety belts condition
EXHAUST SYSTEM
8. Back seat safety belts condition
27. Leaks
9. Door locks operational
28. Legal muffler
10. Child care vehicle safety alarm
29. Tailpipe
WIPERS / WIPER BLADES
TIRES – FRONT LEFT
11. Wipers operational
30. Tread depth
12. Blades contact
31. Matching
13. Blades condition
32. Condition
TIRES – FRONT RIGHT
STEERING
33. Tread depth
14. Lash
34. Matching
15. Free turning
35. Condition
16. Linkage play
TIRES – REAR LEFT
17. Power system
36. Tread depth
37. Matching
SUSPENSION
38. Condition
18. Shock absorbers / struts
TIRES – REAR RIGHT
19. Springs
39. Tread depth
20. Shackles
40. Matching
21. Modifications
41. Condition
Brief Comments – Refer to Item Number
SIGNATURE – Inspector
Date – Inspection
DCF-F-CFS52 (R. 10/2019)
DEPARTMENT OF CHILDREN AND FAMILIES
STATE OF WISCONSIN
Division of Early Care and Education
VEHICLE SAFETY INSPECTION – CHILD CARE CENTERS
Use of form: Use of this form is mandatory to comply with the child care licensing rules DCF 250.08(5)(b), DCF 251.08(5)(b), and DCF
252.09(5)(b). Failure to comply may result in issuance of a noncompliance statement.
Instructions: At 12-month intervals, the licensee shall provide this form to the garage, dealership, or auto repair shop to be completed by the
inspector upon completion of the vehicle inspection. The licensee shall submit the completed form to the Licensing Specialist.
Facility Name
Program Type
Day Camp
Family Child Care
Group Child Care
Vehicle Year
Make
Model
Color
Odometer Reading
License Plate Number
Name of Inspecting Company or Agency
Name of Inspector
Telephone Number
Address of Inspecting Company or Agency
City
State
Zip Code
Repair /
Repair /
Item
Pass
Replace
Item
Pass
Replace
SAFETY FEATURES
BRAKES
1. Turn signals operational
22. Failure indicator light
2. Head lights
23. System integrity
3. Tail lights
24. Pedal reserve
4. Brake lights
25. Disc / drum condition
5. Horn
26. Hoses and assembly
6. Windows / windshield (cracks / chips)
7. Front seat safety belts condition
EXHAUST SYSTEM
8. Back seat safety belts condition
27. Leaks
9. Door locks operational
28. Legal muffler
10. Child care vehicle safety alarm
29. Tailpipe
WIPERS / WIPER BLADES
TIRES – FRONT LEFT
11. Wipers operational
30. Tread depth
12. Blades contact
31. Matching
13. Blades condition
32. Condition
TIRES – FRONT RIGHT
STEERING
33. Tread depth
14. Lash
34. Matching
15. Free turning
35. Condition
16. Linkage play
TIRES – REAR LEFT
17. Power system
36. Tread depth
37. Matching
SUSPENSION
38. Condition
18. Shock absorbers / struts
TIRES – REAR RIGHT
19. Springs
39. Tread depth
20. Shackles
40. Matching
21. Modifications
41. Condition
Brief Comments – Refer to Item Number
SIGNATURE – Inspector
Date – Inspection
DCF-F-CFS52 (R. 10/2019)