Vehicle Check OUT Form
(To be used when a member of staff takes a company vehicle)
Full Name:
*
Name of the person filling in this form
Full Name:
Name of Staff acquiring the vehicle
Date:
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date of Delivery
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Registration Number:
*
Mileage:
*
Please Also Take a Picture (Below)
Upload Picture of Mileage:
*
Browse Files
Upload a picture from your photo album
Cancel
of
Fuel Level:
Please enter if vehicle is Full/Half Full etc.
Upload a Picture of the FUEL Gauge:
Browse Files
Upload a picture from your photo album
Cancel
of
Delivery Address:
Address that the Vehicle was dropped off
Number of Keys
One
Two
Three
Four
Please Answer ALL the following questions:
*
Rows
YES
NO
Needs Attention
N/A
Accident Sticker
NO Smoking Sticker
Service Due
Cleanliness
Windscreen Condition
Seatbelt Condition
Dashboard Lights
Headlights
Full Beam
Main Beam
Side Lights/DRL
Rear Lights
Brake Lights
Screen Wash Level
Coolant Level
Power Steering Fluid Level
Brake Fluid Level
Add Blue Level
Beacon
Fire Extinguisher
Tyre Pressure/Depth Check
*
Rows
Good
Replace
Attention Needed
N/A
Front Left Tyre
Front Right Tyre
Rear Left Tyre
Rear Right Tyre
Spare Wheel
Vehicle Condition
*
Rows
Good
Some Damage
N/A
Front
Driver Side
Passenger Side
Rear/Backend
Front Damages:
Browse Files
Any number of Pictures for any damage found
Cancel
of
Driver Side Damages:
Browse Files
Any number of Pictures for any damage found
Cancel
of
Passenger Side Damages:
Browse Files
Any number of Pictures for any damage found
Cancel
of
Rear/Backend Damages:
Browse Files
Any number of Pictures for any damage found
Cancel
of
Signature of Staff:
*
Signature of Staff Filling in this form:
*
Damages
If there are any damages to the vehicle on allocation please take photos (This shows you are not responsible for any pre-existing damage). If there are no damages just click Submit. This confirms that you are happy to take on the vehicle in it's present condition.
Submit
Should be Empty: