| Driver Name | Date | ||
|---|---|---|---|
| Vehicle Make/Model | Year | ||
| License Plate | VIN |
| Item | Pass | Fail | Notes |
|---|---|---|---|
| Headlights | |||
| Tail lights | |||
| Brake lights | |||
| Turn signals | |||
| Tires (tread/wear) | |||
| Windshield & mirrors | |||
| Wipers | |||
| Doors & windows |
| Item | Pass | Fail | Notes |
|---|---|---|---|
| Seat belts (all) | |||
| Horn | |||
| Heating & AC | |||
| Cleanliness | |||
| Dashboard indicators off |
| Item | Present | Missing | Notes |
|---|---|---|---|
| Valid Registration | |||
| Insurance Card | |||
| Spare Tire & Tools |