Vehicle Reciept
To be filled out when handing over/changing a vehicle
Vehicle Registration
*
Please insert this carefully
Mileage
*
Please insert carefully
Provider Name
*
Who is providing the van?
Driver 1 Name
*
Who is receiving this van?
Driver 2 Name
Who is receiving this van?
Date
-
Day
-
Month
Year
Hour Minutes
Exterior
*
Rows
OK
NOT OK
N/A
Leaks under vehicle?
Tyres worn or damaged?
Tyres at correct pressure?
Windscreen?
Other Windows?
Doors open/close/lock?
Any bodywork damage?
Spare wheel available?
Exhaust?
Registration Plate Visible?
Interior
*
Rows
OK
NOT OK
N/A
Clean?
Free of hazards?
Seat belts function well?
Power steering functioning?
Mirrors undamaged?
Heating working?
Aircon working?
Fuel levels?
Wipers working?
Horn working?
Dash display?
Lights/Brakes
*
Rows
OK
NOT OK
N/A
Brakes working?
Handbrake working?
Headlights working?
Sidelights working?
Indicators? (Front)
Indicators? (Rear)
Brake lights?
Beacon?
Safety Equipment
*
Rows
OK
NOT OK
N/A
Reflective triangles?
First aid kit?
Eyewash?
Fire extinguisher?
Seatbelt cutter?
Additional Checks
*
Rows
OK
NOT OK
N/A
Oil levels?
Coolant levels?
Brake fluid levels?
Battery?
Transmission fluid?
AdBlue
Full NRSWA Kit
Any notes/damage to report?
In your opinion, is the vehicle fit for use?
*
Yes
No
Photo Evidence (Please select multiple photos for upload)
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Please note in here any wear and tear you feel needs attention including but not limited to, worn brakes, loose handbrake etc. Please also report this to you supervisor or line manager at the earliest opportunity. This form is not the way to report any issues and get them fixed but only a way to document it.
Cancel
of
I confirm receipt of the above vehicle in new and undamaged condition, together with Fuel Card ending in:
*
Provider's Signature
*
Driver 1 Signature
*
By signing this, you confirm that this vehicle will be maintained whilst it is in your possession and it will be returned in the same condition.
Driver 1 Name
First Name
Last Name
Driver 2 Signature
By signing this, you confirm that this vehicle will be maintained whilst it is in your possession and it will be returned in the same condition.
Name
First Name
Last Name
Submit
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