Van Issue
Date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
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Hour
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59
Minutes
Engineer Name
*
First Name
Last Name
Number Plate
*
Enter Vehicle Registration
Mileage
*
Exact Readings Only (Picture Below)
Fuel Level:
*
Tank Must ALWAYS be left above HALF
Picture of Mileage/Fuel Gauge
*
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of
Vehicle Information Needed
*
Rows
YES
NO
Checked
OK
NOT
Checked
Needs
Attention
Service Requirements
Cleanliness Inside
Cleanliness Outside
Accident Sticker
NO SMOKING Sticker
Any Noises
Any Shakes
Any Leaks Under Vehicle
Wipers Working?
Horn Working?
Brakes/Handbrake
Interior Light?
All Indicators Working?
Hazard Lights Working?
Main Beam Bulbs
Full Beams
Side Lights
Brake Lights
Rear Lights
Beacon Test
Oil Levels
Add Blu Levels
Brake Fluid Levels
Screen Washer Levels
Radiator Antifreeze Levels
Jack/Brace/Spare x1
Tyre Pressure/Tread 1
Front Left
Tyre Pressure/Tread 2
Front Right
Tyre Pressure/Tread 3
Rear Left
Tyre Pressure/Tread 4
Rear Right
Tyre Pressure/Tread 5
SPARE WHEEL
Vehicle Information Pictures
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Any Pictures to validate points above:
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Vehicle Information Comments
Any further Information/Instructions/Missing Items
Tools/SLG/PPE/Contents
Rows
Amount
GDU Cig/Charger
Power Inverter
Gate Guards x4 sets
Roadworks Ahead x2
Direction Arrow L x2
Direction Arrow R x2
Road Narrows Ahead L
Road Narrows Ahead R
Foot Path Closed
Pit Lifter x2
No4B Hydraulic Lifter
Roller Bar x 2
Water Testing Kit x1
Large Cones x12
Tele. Pole Check Rod x1
Sand Bags x4
Tent x1
Lge. A Frame and Pole
Sml. A Frame and Pole
Blue Fibre Pole Ladder Lge. x1
Ladder Tie
Safety Harness
Lanyard x 2
Large First Aid VAN Kit x1
First Aid in Exp. Date
EYE Wash x 1
EYE Wash in Exp. Date
Hand Wipes x 1
Blue Roll x 1
Spill Kit x1
PPE Kit Bag x2
Aluminum Pole Ladder Lge. x1
3m 25mm Rods
6mm Cobra
9mm Cobra
12mm Cobra
T-Keys
Large Rubber Mallet
Wire Cutters
Bell Mouth
Elephant's Trunk
Cable Roller
Tool 1
Tool 2
Tool 3
Tool 4
Tool 5
Tools/SLG/PPE Comments
Any further Information/Instructions/Missing Items
Tools/SLG/PPE Pictures
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of
Supervisor's Name
*
First Name
Last Name
Supervisor's Signature
*
Engineer's Signature
*
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