"Vehicle Safety Inspection Checklist Template - Overture"

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Download "Vehicle Safety Inspection Checklist Template - Overture"

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VEHICLE SAFETY INSPECTION CHECKLIST
Name: _____________________________________ Date: _________________
Vehicle Make:__________________ Model:_____________ Year:_____________
License Plate Number: _____________ State: ______ Expires: _______________
Insurance Carrier: ____________________________ Expires: _______________
P lease check the box nex t to an item that passes; circle the item if it needs to be repaired.
LIGHTS:
Low Beam
Left Turn Signal
High Beam
Right Turn Signal
Brake Lights
Tail Lights
Back Up Lights
Emergency Flashers
INTERIOR:
Wiper Operation
Door Locks Operable
Washer Operation
Window Condition/Operable
Heater/Defroster
Horn
Seats
Seat Belts
Rear View Mirror
Brakes
Parking Brake
GAUGES:
Fuel
Volt/Amps
Oil Pressure
Temperature
EXTERIOR:
Tire Tread (1/16”)
Body Damage/Loose Parts
Tire Air Pressure
Mirrors
Windshield Condition
Wiper Blades
Not required for inspection, but recommended:
FLUID LEVELS:
Oil
Belts not frayed/cracked/loose
Coolant
Battery Connection clean/tight
Brake
Hoses (no cracks or leaks)
Power Steering
Steering
No Leaks
Shock Absorbers/Struts
As the owner/operator of the above-listed vehicle, I certify that I have completed this Vehicle
Safety Inspection Checklist and that all items checked are in good working order, and/or that I
will make any needed repairs within 30 days.
_________________________________________________________________
Signature
Date
VEHICLE SAFETY INSPECTION CHECKLIST
Name: _____________________________________ Date: _________________
Vehicle Make:__________________ Model:_____________ Year:_____________
License Plate Number: _____________ State: ______ Expires: _______________
Insurance Carrier: ____________________________ Expires: _______________
P lease check the box nex t to an item that passes; circle the item if it needs to be repaired.
LIGHTS:
Low Beam
Left Turn Signal
High Beam
Right Turn Signal
Brake Lights
Tail Lights
Back Up Lights
Emergency Flashers
INTERIOR:
Wiper Operation
Door Locks Operable
Washer Operation
Window Condition/Operable
Heater/Defroster
Horn
Seats
Seat Belts
Rear View Mirror
Brakes
Parking Brake
GAUGES:
Fuel
Volt/Amps
Oil Pressure
Temperature
EXTERIOR:
Tire Tread (1/16”)
Body Damage/Loose Parts
Tire Air Pressure
Mirrors
Windshield Condition
Wiper Blades
Not required for inspection, but recommended:
FLUID LEVELS:
Oil
Belts not frayed/cracked/loose
Coolant
Battery Connection clean/tight
Brake
Hoses (no cracks or leaks)
Power Steering
Steering
No Leaks
Shock Absorbers/Struts
As the owner/operator of the above-listed vehicle, I certify that I have completed this Vehicle
Safety Inspection Checklist and that all items checked are in good working order, and/or that I
will make any needed repairs within 30 days.
_________________________________________________________________
Signature
Date