"Weekly Pre-trip Fleet Vehicle Inspection Form" - Dawson County, Montana

This fillable "Weekly Pre-trip Fleet Vehicle Inspection Form" is a document issued by the Montana Department of Transportation specifically for Montana residents.

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Download "Weekly Pre-trip Fleet Vehicle Inspection Form" - Dawson County, Montana

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Weekly Pre-Trip Fleet Vehicle Inspection Form
DRIVER MUST INSPECT THE ASSIGNED VEHICLE BEFORE THE VEHICLE IS MOVED.
DRIVER: USE THIS CHECK LIST AS A GUIDE FOR INSPECTING THE VEHICLE.
CHECK “OK” IF ITEM FUNCTIONS PROPERLY AND “REPAIR” IF REPAIR IS NEEDED.
DEPARTMENT:______________________________________________________________________
VEHICLE RECEIVING INSPECTION:____________________LICENSE NO.________________
ODOMETER NUMBER:___________________________DRIVER NAME:__________________
Week of __________________________________________________________________________
MONDAY
TUESDAY
WEDNESDAY
THURS
FRI
SAT
SUN
INITIALS:
__________
_________
_________
_________
___________
_________
_________
ARE THERE ANY ALERTS THAT ARE LIT UP AND IF SO, LIST BELOW.
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
TIRE INFLATION
WINDOWS CLEAN INSIDE AND OUTSIDE
WINDSHIELD WIPERS CLEAN AND NOT STUCK TO WINDSHIELD
SEAT BELT FUNCTIONS CORRECTLY
EMERGENCY/INCIDENT REPORTING KITS AVAILABLE
FIRE EXTINGUISHER AVAILABLE
HEADLIGHTS FUNCTION ON BOTH HI AND LO BEAM
TURN SIGNALS FUNCTION
ANY FLUID LEAKS DISCOVERED
HORN SOUNDS
MIRRORS FUNCTION AND ARE CLEAN
BRAKES FUNCTION CORRECTLY
ANY NEW DAMAGE NOTED PRIOR TO USING THIS VEHICLE?
UPON RETURN OF THE VEHICLE – IS IT GASSED UP?
UPON RETURN OF THE VEHICLE – IS THE EXTERIOR AND THE
INTERIOR CLEAN?
________
NOTES:____________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
As directed by the Commissioners, this is a mandated checklist that is to be completed on a weekly basis and forwarded to Mary Jo
Gehnert.
I have personally inspected the vehicle above and have found it to be in the condition listed above.
Signature:___________________________________________ Date:_________________________
Weekly Pre-Trip Fleet Vehicle Inspection Form
DRIVER MUST INSPECT THE ASSIGNED VEHICLE BEFORE THE VEHICLE IS MOVED.
DRIVER: USE THIS CHECK LIST AS A GUIDE FOR INSPECTING THE VEHICLE.
CHECK “OK” IF ITEM FUNCTIONS PROPERLY AND “REPAIR” IF REPAIR IS NEEDED.
DEPARTMENT:______________________________________________________________________
VEHICLE RECEIVING INSPECTION:____________________LICENSE NO.________________
ODOMETER NUMBER:___________________________DRIVER NAME:__________________
Week of __________________________________________________________________________
MONDAY
TUESDAY
WEDNESDAY
THURS
FRI
SAT
SUN
INITIALS:
__________
_________
_________
_________
___________
_________
_________
ARE THERE ANY ALERTS THAT ARE LIT UP AND IF SO, LIST BELOW.
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
OK
REPAIR
TIRE INFLATION
WINDOWS CLEAN INSIDE AND OUTSIDE
WINDSHIELD WIPERS CLEAN AND NOT STUCK TO WINDSHIELD
SEAT BELT FUNCTIONS CORRECTLY
EMERGENCY/INCIDENT REPORTING KITS AVAILABLE
FIRE EXTINGUISHER AVAILABLE
HEADLIGHTS FUNCTION ON BOTH HI AND LO BEAM
TURN SIGNALS FUNCTION
ANY FLUID LEAKS DISCOVERED
HORN SOUNDS
MIRRORS FUNCTION AND ARE CLEAN
BRAKES FUNCTION CORRECTLY
ANY NEW DAMAGE NOTED PRIOR TO USING THIS VEHICLE?
UPON RETURN OF THE VEHICLE – IS IT GASSED UP?
UPON RETURN OF THE VEHICLE – IS THE EXTERIOR AND THE
INTERIOR CLEAN?
________
NOTES:____________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
As directed by the Commissioners, this is a mandated checklist that is to be completed on a weekly basis and forwarded to Mary Jo
Gehnert.
I have personally inspected the vehicle above and have found it to be in the condition listed above.
Signature:___________________________________________ Date:_________________________
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