Submission Month
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
The date/month that this form relates to.
Registration
*
Make
*
Model
*
Odometer
*
Next Service Due
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
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Vehicle Condition
Good - No fault found | Fault - Fault found but still operable | Critical - Critical fault found, urgent repair required before use
Vehicle Condition
*
Rows
Good
Fault
Critical
N/A
Oil level
Wiper washer fluid
Wiper blades
Lights
Seat belts
Tyres
Spare tyre
Cleanliness - interior
Cleanliness - exterior
Windscreen (note any chips/cracks)
First aid kit
Fire extinguisher
Electrical tools & equipment
Fire extinguisher test & tag date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Comments
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Next
Vehicle Damage
Please upload images of any damage to the vehicle since last report (if applicable)
Damage on front of car (if applicable)
Damage on rear of car (if applicable)
Damage on LHS of car (if applicable)
Damage on RHS of car (if applicable)
Please list any damage that has occurred since last report.
Completed by name
*
Signed
*
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