Pre-Trip Daily Vehicle inspection From Sat ____/____/____ to Fri ___/___/___

Sat Sun Mon. Tue. Wed. Thur. Fri. Vehicle: ___________

overall Cleanliness
Pre Trip Mileage
Fuel Level
Fluids
Oil
Transmission
Break
Antifreeze
Power Steering Notes:
Leakeage
General
Head Lights
Parking Lights
Break Lights
Back up Lights
Turn Signals
Registration
Insurance Card
Vehicle Tags
Tires/Pressure
Windshield Wipers
Lugs/Rims
Interior
Seats Pre -Tip
Seat Belts Employee signature:
Interior lights Sat:
Gauges Sun:
Sanizide Mon:
Gloves Tue:
Bedding Wed:
Safety Equipment thur:
Fire Extinguisher Fri:
Maps
Post -Trip
Post-Trip Mileage Post-Trip
Fuel Level Employee Signature:
Clean windshield Sat:
Clean Windows Sun:
Clean tires Mon:
Clean Interior Tue:
Stocked Gloves Wed:
Maps Thur:
Sanizide Fri:
Stretcher Ready
Wheelchair Ready Supervisor Signature:
Equipment Box
 From Sat ____/____/____ to Fri ___/___/___
Vehicle
1- The undersigned, fully aknowledge that I am signing out the specified company equipment that is to be used
for official business only. Official business is defined as the following:
1- Any pre-scheduled or non-scheduled livery tranpsortation that brings revenue to this company.
2- Transportation to and from company affiliated vendors or partners for business purposes only.
3- General transportation that is either instructed or approved by a company officer or manager or for
transportation that is necessary to accomplish the company mission.

I accept full responsability for the condition and the welfare of the equipment that I am signing out. This equipment
includes a company vehicle, corresponding cell phone, company cell phone charger, and all pertinent company and
literature. By signing this document I acknowledge that I have personally reviewed and recieved these issued pieces
of equipment. I understand that should I loose or damage any of these pieces of equipment or information beyond
expected wear and tear that I am liable and responsible for replacing the item (s) at my expense.

I agree that I will comply with AZDOT rules and regulations and will ensure that I will conduct a pre-trip
inspections of the company vehicle in my possesion. I agree to comply with any and all traffic laws while operating
this company vehicle.

Additionally, the undersigned accepts and agrees to any action that is taken on behalf of the company in response to
any violation of the terms and agreements set forth within this document to include fines, suspension,
and/or termination.

This Document will be filled out on a daily basis and turned in to dispatch every Monday morning for review and
supervisor approval.

Item Sat Sun Mon. Tue. Wed. Thur. Fri.

Company vehicle
Vehicle Keys
Company Cell Ph.
Cell ph. Charger
Equipment box
Fuel Card

Comments: Employee Signature:

Sat:
Sun:
Mon:
Tue:
Wed:
Thur:
Fri:

Supervisor Signature: