"Vehicle Inspection Form - University of Chicago"

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The University of Chicago
Vehicle Inspection Form
Vehicle License Plate #________________________
Type of Vehicle [
] University owned vehicle/van
[
] Rented Vehicle
Driver______________________________________
Organization_______________________________
Dates of Travel______________________________ Destination_____________________________
Time Departure: _____________________________ Time Return___________________________
Item
Departure
Return
Explanation
Windows - Clean
Yes
No
Yes
No
Windows - Broken
Side, Rear View Mirrors – Clean
Side, Rear View Mirrors – Broken
Exterior – New Body Damage
Antenna Okay
Do Tires Need Air?
Instrument Panel Operational
Upholstery Damage
Heat/Air Operational
Clean Interior (Ash trays, floor, seats)
Headlights Operational
Turn Signals Operational
Brakes and Brake Lights Operational
Wind Shield Wipers Operational
Wiper Fluid Operational
:
Please comment on any issues
Driver’s Signature__________________________________________
Supervisor’s Signature______________________________________
Do not drive the vehicle if all of the above are not operational.
The University of Chicago
Vehicle Inspection Form
Vehicle License Plate #________________________
Type of Vehicle [
] University owned vehicle/van
[
] Rented Vehicle
Driver______________________________________
Organization_______________________________
Dates of Travel______________________________ Destination_____________________________
Time Departure: _____________________________ Time Return___________________________
Item
Departure
Return
Explanation
Windows - Clean
Yes
No
Yes
No
Windows - Broken
Side, Rear View Mirrors – Clean
Side, Rear View Mirrors – Broken
Exterior – New Body Damage
Antenna Okay
Do Tires Need Air?
Instrument Panel Operational
Upholstery Damage
Heat/Air Operational
Clean Interior (Ash trays, floor, seats)
Headlights Operational
Turn Signals Operational
Brakes and Brake Lights Operational
Wind Shield Wipers Operational
Wiper Fluid Operational
:
Please comment on any issues
Driver’s Signature__________________________________________
Supervisor’s Signature______________________________________
Do not drive the vehicle if all of the above are not operational.
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