PASS FAIL
VEHICLE INSPECTION TO BE COMPLETED BY VEHICLE OPERATOR
FULL NAME
EMAIL ADDRESS
SIGNATURE
INSPECTION POINT
PHONE NUMBER
PASS
FAIL
DATE
INSPECTION POINT
HEADLIGHTS
FRONT SEAT ADJUSTMENT
TAIL LIGHTS
DOORS (Open/Close/Lock)
TURN INDICATOR LIGHTS
HORN
STOP LIGHTS
SPEEDOMETER
FOOT BRAKES (Pads/Shoes Thickness)
BUMPERS
Min. per Manufacturer
MUFFLER AND EXHAUST SYSTEM
Right Foot Measurements
TIRES, INCL. TREAD DEPTH
PASS
Left Foot Measurements
Right Front
(32nd’s/in)
Right Rear Measurements
Left Front
(32nd’s/in)
Left Rear Measurements
Right Rear
(32nd’s/in)
EMERGENCY/PARKING BRAKE
Left Rear
(32nd’s/in)
FAIL
INTERIOR AND EXTERIOR REAR VIEW MIRRORS
STEERING MECHANISM
SATEFY BELTS FOR DRIVER AND PASSENGERS
Ball Joints Tie Rods
VEHICLE INSPECTION RESULT
Rack & Pinion
Inspector To Circle
Bushings
PASS
WINDSHIELD Large Crack
FAIL
Small Crack REAR WINDOW AND OTHER GLASS
I NSP ECTI ON D ATE :
WINDSHIELD WIPERS
An y mar ki ng s o n the “FAIL” si de wi ll auto matica lly fai l i nspe ction . Thi s certi ficati on expir es on e (1 ) year fro m i nspectio n date.
TO BE COMPLETED BY INSPECTOR
COMPANY
VEHICLE MILEAGE
LICENSE PLATE STATE AND #
VIN#
VEHICLE MAKE
VEHICLE MODEL
INSPECTOR NAME
INSPECTION ADDRESS
INSPECTOR SIGNATURE
MODEL YEAR
# OF DOORS
STATE CERTFICATION #
FULL NAME
EMAIL ADDRESS
SIGNATURE
INSPECTION POINT
PHONE NUMBER
PASS
FAIL
DATE
INSPECTION POINT
HEADLIGHTS
FRONT SEAT ADJUSTMENT
TAIL LIGHTS
DOORS (Open/Close/Lock)
TURN INDICATOR LIGHTS
HORN
STOP LIGHTS
SPEEDOMETER
FOOT BRAKES (Pads/Shoes Thickness)
BUMPERS
Min. per Manufacturer
MUFFLER AND EXHAUST SYSTEM
Right Foot Measurements
TIRES, INCL. TREAD DEPTH
PASS
Left Foot Measurements
Right Front
(32nd’s/in)
Right Rear Measurements
Left Front
(32nd’s/in)
Left Rear Measurements
Right Rear
(32nd’s/in)
EMERGENCY/PARKING BRAKE
Left Rear
(32nd’s/in)
FAIL
INTERIOR AND EXTERIOR REAR VIEW MIRRORS
STEERING MECHANISM
SATEFY BELTS FOR DRIVER AND PASSENGERS
Ball Joints Tie Rods
VEHICLE INSPECTION RESULT
Rack & Pinion
Inspector To Circle
Bushings
PASS
WINDSHIELD Large Crack
FAIL
Small Crack REAR WINDOW AND OTHER GLASS
I NSP ECTI ON D ATE :
WINDSHIELD WIPERS
An y mar ki ng s o n the “FAIL” si de wi ll auto matica lly fai l i nspe ction . Thi s certi ficati on expir es on e (1 ) year fro m i nspectio n date.
TO BE COMPLETED BY INSPECTOR
COMPANY
VEHICLE MILEAGE
LICENSE PLATE STATE AND #
VIN#
VEHICLE MAKE
VEHICLE MODEL
INSPECTOR NAME
INSPECTION ADDRESS
INSPECTOR SIGNATURE
MODEL YEAR
# OF DOORS
STATE CERTFICATION #
