Weekly Maintenance Inspection
Please complete by close of business each Friday.
Employee/Volunteer Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Agency Vehicle
*
Please Select
WC-05
WC-06
WC-07
WC-08
VTC-5
Oil Change Due
*
-
Month
-
Day
Year
Tires should be rotated and balanced at each oil change.
NYS Inspection Due
*
-
Month
-
Day
Year
Date
Registration Due
*
-
Month
-
Day
Year
Date
Starting Odometer
*
Ending Odometer
*
Total Miles Driven During Inspection
*
Checklist
*
Rows
Working
Needs Repair
Missing
Not Required
All interior lights working
All exterior lights working
Heat/AC working
Fire Extinguisher
Ramp (does it deploy fully, any grinding, sticking)
Doors (all doors open and close?)
Wiper Blades (are they chipped, broken, disintegrated?)
Safety Triangles present
Battery
Brakes (any grinding, scrapping, pulling etc...)
All Seat Belts & Restraints working/present
PPE for the driver present (masks, gloves, wipes, etc...)
Wheelchair (is there a spare in the van?)
Tie downs appropriate for the van present
Tires (any bubbles, breaks in belts, cracking, etc.)
Date vehicle last detailed
*
-
Month
-
Day
Year
Should be no less than 1 time every 14 days.
Tire Pressure
*
(list like this 34, 34, 34, 34)
Date ramp was last oiled
*
-
Month
-
Day
Year
Date ramp last inspected
*
-
Month
-
Day
Year
Window wash topped off (using appropriate fluid for the season)
*
Have the tires been swapped for the appropriate season?
Please Select
yes
no
scheduled
Date swapped or scheduled to swap
*
-
Month
-
Day
Year
Additional Notes
Submit
Should be Empty: