"Vehicle Inspection Form" - Florida

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VEHICLE INSPECTION FORM
Check all that apply:
Bus
Passenger Van
Car
Initial Inspection
Re-inspection
DOT No. (Bus Only) ____________________________
Date |__|__|__|__|__|__|
Seating Capacity |__|__|
County
Facility/Home |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Address
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Street
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__| |__|__|__|__|__|-|__|__|__|__|
City
State
Zip Code
Phone No. |__|__|__| |__|__|__|__|__|__|__|
Area Code
Number
Liability Insurance |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| / |__|__|__|__|__|__|__|__|__|__|__|__|__|
Carrier
Policy Number
Chassis Make ________________________________
|__|__|
Year |__|__|
Mileage |__|__|__|__|__|__|
Code #
Body Make __________________________________
|__|__|
Year |__|__|
Bus |__|__|__|__|__|__|__|
Code #
Vehicle Identification Number (V.I.N) |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Tag Number |__|__|__|__|__|__|__|__|
FL |__|__|__|__|
Expires
P
R
N/A
P
R
N/A
1.
Headlights
1
24.
Sideview Mirror
24
2.
Parking Lights
2
25.
Crossover Mirror
25
3.
Tail Lights
3
26.
Fire Extinguisher
26
4.
Brake Lights
4
27.
First Aid Kit
27
5.
Directional Signals
5
28.
Emergency Warning Devices
28
6.
Hazardous Warning Signals
6
29.
Windshield
29
7.
Clearance Lamps
7
30.
Windows
30
8.
Side Marker Lamps
8
31.
Rub Rails
31
9.
Identification Lamps
9
32.
Bumpers
32
10.
Reflectors
10
33.
Pupil Warning Lamp System
33
11.
Brakes
11
34.
Stop Arm
34
12.
Steering System
12
35.
Drive Shaft Guards
35
13.
Suspension
13
36.
Neutral Safety Switch
36
14.
Windshield Wipers
14
37.
Tires
37
15.
Horns
15
38.
Wheels
38
16.
Exhaust System
16
39.
Seating + Driver Seat Belt
39
17.
Fuel System
17
40.
Interior Lights
40
18.
Engine Compartment
18
41.
Unsecured Items
41
19.
Service Door
19
42.
Bus Condition
42
20.
Emergency Door
20
43.
Electrical System
43
21.
Emergency Exits
21
44.
Tag + Registration
44
22.
Inside Rearview Mirror
22
45.
Tag Light
45
23.
Outside Rearview Mirror
23
46.
Liability Insurance
46
Code: P=Pass R=Rejected N/A=Not Applicable
Comments _______________________________________________________________________________________________
________________________________________________________________________________________________________
Inspected By ____________________________________________ ID # |__|__|__|__| Date of Inspection |__|__|__|__|__|__|
Business Name __________________________________________ Business Phone No. |__|__|__| |__|__|__|__|__|__|__|
Address ______________________________________
Approved
Rejected
Passed Reinspection
Unsafe Vehicle - Do Not Transport Children
_____________________________________________
NO CERTIFICATE WILL BE ISSUED UNTIL ALL ITEMS ARE FOUND
SATISFACTORY FOR SAFE OPERATION AS PROVIDED IN CHAPTER
Certificate Number |__|__|__|__|__|__|__|
316, FLORIDA STATUTES.
Dist 2 ChildCareLic
VEHICLE INSPECTION FORM
Check all that apply:
Bus
Passenger Van
Car
Initial Inspection
Re-inspection
DOT No. (Bus Only) ____________________________
Date |__|__|__|__|__|__|
Seating Capacity |__|__|
County
Facility/Home |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Address
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Street
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__| |__|__|__|__|__|-|__|__|__|__|
City
State
Zip Code
Phone No. |__|__|__| |__|__|__|__|__|__|__|
Area Code
Number
Liability Insurance |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| / |__|__|__|__|__|__|__|__|__|__|__|__|__|
Carrier
Policy Number
Chassis Make ________________________________
|__|__|
Year |__|__|
Mileage |__|__|__|__|__|__|
Code #
Body Make __________________________________
|__|__|
Year |__|__|
Bus |__|__|__|__|__|__|__|
Code #
Vehicle Identification Number (V.I.N) |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Tag Number |__|__|__|__|__|__|__|__|
FL |__|__|__|__|
Expires
P
R
N/A
P
R
N/A
1.
Headlights
1
24.
Sideview Mirror
24
2.
Parking Lights
2
25.
Crossover Mirror
25
3.
Tail Lights
3
26.
Fire Extinguisher
26
4.
Brake Lights
4
27.
First Aid Kit
27
5.
Directional Signals
5
28.
Emergency Warning Devices
28
6.
Hazardous Warning Signals
6
29.
Windshield
29
7.
Clearance Lamps
7
30.
Windows
30
8.
Side Marker Lamps
8
31.
Rub Rails
31
9.
Identification Lamps
9
32.
Bumpers
32
10.
Reflectors
10
33.
Pupil Warning Lamp System
33
11.
Brakes
11
34.
Stop Arm
34
12.
Steering System
12
35.
Drive Shaft Guards
35
13.
Suspension
13
36.
Neutral Safety Switch
36
14.
Windshield Wipers
14
37.
Tires
37
15.
Horns
15
38.
Wheels
38
16.
Exhaust System
16
39.
Seating + Driver Seat Belt
39
17.
Fuel System
17
40.
Interior Lights
40
18.
Engine Compartment
18
41.
Unsecured Items
41
19.
Service Door
19
42.
Bus Condition
42
20.
Emergency Door
20
43.
Electrical System
43
21.
Emergency Exits
21
44.
Tag + Registration
44
22.
Inside Rearview Mirror
22
45.
Tag Light
45
23.
Outside Rearview Mirror
23
46.
Liability Insurance
46
Code: P=Pass R=Rejected N/A=Not Applicable
Comments _______________________________________________________________________________________________
________________________________________________________________________________________________________
Inspected By ____________________________________________ ID # |__|__|__|__| Date of Inspection |__|__|__|__|__|__|
Business Name __________________________________________ Business Phone No. |__|__|__| |__|__|__|__|__|__|__|
Address ______________________________________
Approved
Rejected
Passed Reinspection
Unsafe Vehicle - Do Not Transport Children
_____________________________________________
NO CERTIFICATE WILL BE ISSUED UNTIL ALL ITEMS ARE FOUND
SATISFACTORY FOR SAFE OPERATION AS PROVIDED IN CHAPTER
Certificate Number |__|__|__|__|__|__|__|
316, FLORIDA STATUTES.
Dist 2 ChildCareLic
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