UES MONTHLY FLEET VEHICLE INSPECTION CHECKLIST – Team GFA

Vehicle Maintenance Inspections Are Due By The Last Week Of Every Month. If you have any questions about your vehicle please contact your Fleet Manager.

Driver Information

Driver's Name *

First

Last

Department Number *

Driver's Email *

Driver's Mobile Phone Number *

Vehicle Information

Vehicle Number *

Current Odometer Reading *

Year *

Make *

Model *

Vehicle Inspection

Date / Time of Inspection *

Date

Time

Date of Last Oil Change *

Current registration and insurance card are in the vehicle's glove compartment *

Yes
No

Dashboard gauges, window controls, shifter, and radio are in working order *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

Functional lights and horn (inspect all lights, signals and lenses) *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

Seatbelt check (fabric, buckles, mounting and retractability) *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

Windows and mirrors check (check for damages, cracks, and chips on windshield, side view, rear view mirrors) *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

Check body condition for rust, dings, dents, scratches, etc. *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

Check condition of windshield wiper function and make sure wiper blades do not need replacing *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

All fluid levels checked (visually inspect under the vehicle for leaks, etc.) *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

Check wheels and tires (wheel lugs for tightness, tire for damage and wear, check air pressure, spare tire, jack, lug wrench and emergency brakes) *

Satisfactory
Unsatisfactory

If unsatisfactory, please explain *

Company signs are legible *

Satisfactory
Unsatisfactory

Vehicle Photos

Five (5) photos are included with this report displaying all sides and the interior of the vehicle (front, back, right and left sides and interior)

Front of vehicle *

Click or drag a file to this area to upload.

Left side of vehicle *

Click or drag a file to this area to upload.

Rear of vehicle *

Click or drag a file to this area to upload.

Right side of vehicle *

Click or drag a file to this area to upload.

Interior of vehicle *

Click or drag a file to this area to upload.

Driver Acknowledgment

The company (“Employer”) vehicle is provided to you for company business use only and is considered a privilege subject to Corporate Fleet Management guidelines.

By signing below, I hereby certify that I have read and understand and agree to comply with the following Fleet Vehicle policies, procedures, and instructions. I understand that failure to follow each element of the policy may result in progressive guidelines up to termination. *

I acknowledge that vehicles owned by the Employer are to be used for business purposes only and no personal use is allowed. Also, the vehicle shall not be driven or ridden in by non-employees including spouses, children, friends, family, etc. Once the vehicle is parked it should remain parked until the next business day.
I acknowledge that use of a mobile communications device (Cell phones, tablets, laptops, etc.) while operating a vehicle while on duty is strictly prohibited and could result in disciplinary action up to termination.
I acknowledge that as a driver of a vehicle owned by the Employer that I am expected to adhere to the rules of the road, including the posted speed limit, always wear my seat belt when driving. I will always back in when my company vehicle when parking unless posted otherwise.
I acknowledge that the vehicle I will be driving will be equipped with a GPS asset device that will monitor speed, aggressive driving as well as some undisclosed alerts and my location at all times. Any Tampering with the GPS device with be grounds for immediate termination.
I acknowledge that it is my responsibility to ensure that the vehicle is in safe working order and has the proper documentation before driving the vehicle and if not, notify my Supervisor or the Fleet Manager Immediately.
If a vehicle is assigned to me on a full-time basis, I acknowledge that it is my responsibility to properly maintain the vehicle at an approved vendor with authorization from either my Manager or corporate Fleet Manager. The driver is responsible to report maintenance / safety issues immediately to his / her supervisor or the Fleet Manager.
I acknowledge that I am responsible for keeping the vehicle clean inside and out as well as making sure there is no loose debris that can fly out when driving. Any damages from flying debris will be the driver’s responsibility (Up to $1,000.00)
I acknowledge that the company fuel card is for company vehicles only (no car washes) “no personal use” which could result in immediate termination and / or criminal prosecution.
I acknowledge that, if I am assigned a vehicle on a full-time basis that I will be required to complete and sign a monthly vehicle checklist that is due by the last week of every month. I also acknowledge that failure to comply may result in disciplinary action.
I acknowledge that I will always be aware of my surroundings including where I park on job sites to prevent damage to myself and the company vehicle.
I acknowledge that I have read and received the instructions on how to properly adjust my mirrors on my company vehicle.
I acknowledge that I understand that the vehicle policy can be requested at any time. If I am found to be at fault for an accident / incident by the accident committee, I am responsible for the insurance deductible (Up to $1,000.00)
I acknowledge that each vehicle has a “Safety First” decal. If a call is made on the driver, they will have to provide a written statement (regardless if they were at fault or not) Failure to comply is grounds for immediate termination.

Signature *

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