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R4

ANNUAL VEHICLE INSPECTION


INSPECTION POINT

PASS

FAIL

1 Foot brakes

INSPECTION POINT

PASS

FAIL

Turn indicator lights

Min. pad/shoe thickness per manufacturer

10 Stop Lights

Right front

Measurements

11 Front seat adjustment

Left front

Measurements

12 Doors (open, close, lock)

Right rear

Measurements

Left rear

Measurements

13 Horn
14 Speedometer

2 Emergency brake (parking brake)

15 Bumpers

3 Steering mechanism

16 Muffler and exhaust system

Ball joints

17 Tires, incl. tread depth

Tie rods
Rack & pinion
Bushings
4 Windshield

Large crack
Small crack

Right front

[32nds / In]

Left front

[32nds / In]

Right rear

[32nds / In]

Left rear

[32nds / In]

18

Interior and exterior rear view mirrors

19

Safety belts for driver and passanger(s)

5 Rear window and other glass


6 Windshield wipers

VEHICLE INSPECTION
(Please circle)

7 Headlights

PASS

FAIL

Must pass all inspection points to pass vehicle inspection

8 Tail lights

PARTNER NAME

PARTNER SIGNATURE

EMAIL ADDRESS

PARTNER PHONE NUMBER

DATE

TO BE COMPLETED BY INSPECTOR

COMPANY

VEHICLE MILEAGE

LICENSE PLATE #

VIN#

VEHICLE MAKE

VEHICLE MODEL

VEHICLE YEAR

INSPECTOR SIGNATURE

INSPECTION DATE

ADDRESS

INSPECTOR NAME

This form expires one (1) year from the inspection date

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