Vehicle Glass Inspection & Early Detection Form
*this form is to be used during a glass inspection and/or immediate damage/breakage of glass on a company owned vehicle.
Driver Name or Person Submitting Form
*
First Name
Last Name
Last 6 of Vehicle VIN #
*
Photo of Windshield (Entire Windshield)
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of
Photo of Windshield (Breakage Photo)
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of
Side Window (If Any Chips, Cracks, Splits etc.) - otherwise no pic required
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of
Rear Windows ((If Any Chips, Cracks, Splits etc.) - otherwise no pic required
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Have you let your manager know there is breakage of glass on the vehicle?
*
Yes
No
N/A
Has a repair facility been contacted and waiting on glass?
*
Yes
No
N/A
If Any - Is the chip/break smaller than a quarter?
*
Yes
No
N/A
Notes regarding Glass.
Provide any info.
Submit
Should be Empty: