Annual Staff Vehicle Inspection Form

Staff Information

Name Department Inspection Date

Vehicle Details

Make Model Year License Plate VIN

Inspection Checklist

Item	Pass	Fail	Comments
Lights (Headlights, Tail lights, Indicators)
Brakes
Tires
Mirrors
Horn
Windshield/Wipers
Seat Belts
Fluid Levels
First Aid Kit
Fire Extinguisher

Additional Comments

Inspector Name Signature Date