"Mechanical Fitness Assessment Form" - Alberta, Canada

This printable "Mechanical Fitness Assessment Form" is a document issued by the Alberta Ministry of Transportation specifically for Alberta residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

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Download "Mechanical Fitness Assessment Form" - Alberta, Canada

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MECHANICAL FITNESS ASSESSMENT
As required by Vehicle Inspection Regulation (A/R 211/2006)
Dealer:
AMVIC License Number:
Address:
VEHICLE INFORMATION
Year :
Make:
Model:
Previous Province of Registration:
Vehicle Identification Number:
Odometer Reading:
( km / mi )
m
m
m
m
m
m
m
m
Truck
Motorcycle
Bus
Van
Light Truck
Auto
Motorized RV
Other
Please check mark (
) each item as C = Complies N = Non-Compliant N/A=Not Applicable
ü
Powertrain
C
N
Brakes
C
N
Frame & Body
C
N
Accelerator
Parking/Emergency Brake
Hood Latch
Fuel System
Hydraulic System
Door Latches & Hinges
Exhaust
Vacuum System
Bumpers
Transmission
Drum Brakes
Windshield Wipers & Washer
Front/Rear/Spindles Axles
Disc Brakes
Rear Wiper & Washer
Clutch
Shoes/Pads
Windshield
Fluid Levels (power steering, brake)
Anti-Lock (if OEM equipped)
Windows
CV Joints
Defrost/Heaters
Steering
C
N
Mirrors
Lamps
C
N
Steering Lash
Seats
Head Lamp Hi Beam
Steering Linkage
Seat Belts/Airbags
Head Lamp Lo Beam
Rack & Pinion
Mudguards
Head Lamp Location
Power Steering System
Window Glazing
Daytime Running Lamps
King Pin
Structural Integrity
Tail Lamps
Ball Joints
Tires & Wheels
C
N
Brake Lamps
Suspension
C
N
Turn Signal Lamps
Tread Depth
Leaf springs
Hazard Warning Lamps
Tread Section
Struts and Shocks
Licence Plate Lamp
Sidewalls
Coil spring
Back-up Lamps
Wheels
Torsion Bar
Instruments
C
N
Electrical
C
N
Independent/Multilink Rear
Wiring
Speedometer/Odometer
Computer Controlled
Battery
Indicator Lamps
Diagnostic
C
N
Switches
Horn
Diagnostic Trouble Codes
Hi Beam Indicator
Alternator
Technician Comments
This is to certify that I have assessed the vehicle described above in accordance
I, the buyer of this vehicle, acknowledge
with the Traffic Safety Act, Vehicle Equipment Regulation (A/R 122/2009). By
receipt of this assessment.
signing this assessment, I verify the contents of this document are true and correct.
Signature of Buyer
Signature of Certified Journeyman Technician:
Buyer (Print)
Technician Name (Print):
Signature of Salesperson
Technician Trade Certificate Number:
Salesperson (Print)
Date:
Date
MECHANICAL FITNESS ASSESSMENT
As required by Vehicle Inspection Regulation (A/R 211/2006)
Dealer:
AMVIC License Number:
Address:
VEHICLE INFORMATION
Year :
Make:
Model:
Previous Province of Registration:
Vehicle Identification Number:
Odometer Reading:
( km / mi )
m
m
m
m
m
m
m
m
Truck
Motorcycle
Bus
Van
Light Truck
Auto
Motorized RV
Other
Please check mark (
) each item as C = Complies N = Non-Compliant N/A=Not Applicable
ü
Powertrain
C
N
Brakes
C
N
Frame & Body
C
N
Accelerator
Parking/Emergency Brake
Hood Latch
Fuel System
Hydraulic System
Door Latches & Hinges
Exhaust
Vacuum System
Bumpers
Transmission
Drum Brakes
Windshield Wipers & Washer
Front/Rear/Spindles Axles
Disc Brakes
Rear Wiper & Washer
Clutch
Shoes/Pads
Windshield
Fluid Levels (power steering, brake)
Anti-Lock (if OEM equipped)
Windows
CV Joints
Defrost/Heaters
Steering
C
N
Mirrors
Lamps
C
N
Steering Lash
Seats
Head Lamp Hi Beam
Steering Linkage
Seat Belts/Airbags
Head Lamp Lo Beam
Rack & Pinion
Mudguards
Head Lamp Location
Power Steering System
Window Glazing
Daytime Running Lamps
King Pin
Structural Integrity
Tail Lamps
Ball Joints
Tires & Wheels
C
N
Brake Lamps
Suspension
C
N
Turn Signal Lamps
Tread Depth
Leaf springs
Hazard Warning Lamps
Tread Section
Struts and Shocks
Licence Plate Lamp
Sidewalls
Coil spring
Back-up Lamps
Wheels
Torsion Bar
Instruments
C
N
Electrical
C
N
Independent/Multilink Rear
Wiring
Speedometer/Odometer
Computer Controlled
Battery
Indicator Lamps
Diagnostic
C
N
Switches
Horn
Diagnostic Trouble Codes
Hi Beam Indicator
Alternator
Technician Comments
This is to certify that I have assessed the vehicle described above in accordance
I, the buyer of this vehicle, acknowledge
with the Traffic Safety Act, Vehicle Equipment Regulation (A/R 122/2009). By
receipt of this assessment.
signing this assessment, I verify the contents of this document are true and correct.
Signature of Buyer
Signature of Certified Journeyman Technician:
Buyer (Print)
Technician Name (Print):
Signature of Salesperson
Technician Trade Certificate Number:
Salesperson (Print)
Date:
Date