March 2015 -Fleet Monthy survey

* Your first and last name (No division information here)

Date Report Completed

Month	Day	Year

* Enter your division (deployment techs please choose deployment).

Vehicle Information

* Please enter the last 6 digits of the VIN.

* Odometer Reading "at time of survey" (Please round off, do not include 10ths of miles)

* License Plate Number

* The state vehicle license plate is registered in.

* Does the state that this vehicle is registered in require a vehicle inspection? (Driver's are responsible for having this completed at least 3 weeks prior to due date.)

Yes

No

State Inspection Due Date

Month	Day	Year

* Registration Expiration Date

Month	Day	Year

* Year

* Make

* Model

Vehicle Maintenance Information

* Date of Last Service

Month	Day	Year

* Services Received

* Vehicle Lighting
* Check to acknowledge each item is in working order or, comment listing any repairs(s) needed.

Turn Signals, front and rear, left and right sides

Running Lights, front and rear

Brake Lights, left and right

License Plate Light

Dash Lights

Emergency Flashers

Interior Lights

Comment:

* Glass and Mirrors
* Check to acknowledge that each item is in working order or, comment listing the repair(s) needed.

* Tire Condition

New (replaced within the last 5,000 miles)

Good (based on information received at time of last service)

Need Replacing (3/32nd of an inch or less tread left)"Please discuss getting these replaced with your manager as soon as possible"

Comments:

* Fluid Levels (verify at each oil change)Your answers are based on the information received at the last service completed on this vehicle.

Please verify that the vehicle has a spare tire. Many drivers find they are missing once they need them.

Yes, it has a spare tire.

No, it does not have a spare tire.

comments

Accident Information

* Has this vehicle been involved in an accident within the last 30 days?

Yes

No

Comment:

If so,have you reported this to Fleet Management, Human Resources, and completed the Vehicle Accident Report Form posted on SharePoint?

Please list any damage to this vehicle. This would include any dents or scratches that were not reported in a prior survey. (A dent is defined as anything larger than a Quarter. A scratch is defined as anything longer than 5 inches). You may be asked to submit photos of any damages.

Miscellaneous Questions

Acknowledgement

* By Entering you name, you acknowledge that you have conducted this inspection and verify its accuracy.