Self-Scrutiny Form Rnd 3 2026 Baden Civil Khanacross

Self-Scrutiny and Vehicle/Apparel Compliance Form - Round 3 Baden Civil SEQ Khanacross Series

This form is a combination of Motorsport Australia Statement of Vehicle/Apparel Compliance Form and the AutoTest Self-Scrutiny Checklist form. This form must be submitted prior to to close of entries.
Event Details
Round 3 2026 Baden Civil SEQ Khanacross Series

Motorsport Australia Permit: 426/1605/02
Organising Club: Gold Coast Tweed Motorsporting Club Inc.
Name of Event: Round 3 Baden Civil South East Khanacross Series
Event Address: Clutha Creek Road, Tamborine
Event Date: Saturday 16th May 2026
Type of Event: Club Khanacross
Competitor Details
Competitor: The person entering the event and responsible for the vehicle and entry. This is usually the driver but can also be a team; the car owner; a sponsor or organisation.
Competitor First Name*
Competitor Last Name*
Is the Competitor the same person as Driver 1 or Driver 2?*

YesNo
Competitor Email Address*
Competitor Mobile Number*
Format: 0000 000 000.
Competitor Address*

Competitor Street Address

Competitor Street Address Line 2

Competitor SuburbCompetitor State

Competitor Post Code
Competitor Declaration - Statement of Vehicle/Apparel and Compliance
Competitor - I being the competitor of the vehicle described on the Entry Form and being legally authorised to enter the vehicle described, hereby declare that the vehicle and all related equipment and components necessary for participation in this event shall be presented at all times and in every respect in a condition suitable for use in this activity. I have caused the vehicle to be inspected according to a maintenance schedule w hich I havedeveloped and declare that it is free from mechanical defects, be they of preparation or structural integrity, that may render the vehicle unsafe for the proposed activity. I acknowledge that where any aspect of the vehicle or related equipment and components is found, by the Chief Scrutineer,
- to be in breach of the Motorsport Australia National Competition Rules (NCR) and/or the Regulations of the Event; or
- to be subject to a serious mechanical defect,
that I may be subject to penalties under the NCR.

My signature below indicates my acceptance of the above declaration.

IMPORTANT NOTE: Even if the Competitor is the same person as Driver 1 or Driver 2, they MUST STILL AGREE AND SIGN the Competitor Declaration.
Competitor Declaration - Agreed*

TrueFalse
Competitor Declaration Signature*
Competitor - Date Signed*

DayMonthYear
Driver/s Information
Number of Drivers using the same Vehicle (MAXIMUM 2)*

1 Driver Only2 Drivers (Maximum)
Driver 1 First Name*
Driver 1 Last Name*
Driver 1 Mobile Number*
Format: 0000 000 000.
Driver 1 Email Address*
Driver 2 First Name*
Driver 2 Last Name*
Driver 2 Mobile Number*
Format: 0000 000 000.
Driver 2 Email Address*
Driver/s Declaration - Statement of Vehicle/Apparel and Compliance
Drivers - I/we being the named driver/s of the vehicle described on this form hereby declare that I/we have been fully briefed by the competitor on all aspects of the operation of the vehicle, including peculiarities relating to its handling and performance during competition, and are satisfied that the vehicle is safe and suitable for the intended competition and that my/our competition apparel is in compliance with the NCR; Schedule D – Apparel.

My/our signature/s below indicate acceptance of the above declaration.
Driver 1 Declaration - Agreed*

TrueFalse
Driver 1 Signature*
Driver 1 - Date Signed*

DayMonthYear
Driver 2 Declaration - Agreed*

TrueFalse
Driver 2 Signature*
Driver 2 - Date Signed*

DayMonthYear
Vehicle Details
Will you be using the GCTMC Junior Car for this event?*

YesNo
Vehicle Make*
Vehicle Model*
Vehicle Year*
Vehicle Colour*
Engine Capacity / Class*

Class A - Up to 1600ccClass B - 1601cc to 2000ccClass C - 2001cc to 3000ccClass D - Over 3001ccClass E - AWD/4WDClass H - SXS (Side x Side)
Is the Vehicle Registered?*

YesNo
Vehicle Regsitration Number:*
State Registered:*
PLEASE NOTE: QLD registered vehicles are required to have a compulsory third party insurance extension valid for the duration of the Event.
Does the Vehicle have a Motorsport Australia Log Book?*

YesNo
MA Log Book Number:*
The Competitor must complete the following table showing the Competition and Scrutiny Audit history of the vehicle described above for the last five relevant Events as shown in the Vehicle Log Book. If at the time of completion of this declaration the vehicle is entered into another Event yet to be held, please indicate in the space provided.

Self Scrutiny Vehicle Checks and Apparel Checks
The Motorsport Australia Self-Scrutiny Checklist is a scrutineering document designed to assist competitors to prepare their vehicle/s pre-event.

This is not a regulatory document: it has no regulatory value and should be used as a guide only. It does not constitute a check or confirmation that the vehicle complies with the relevant Motorsport Australia NCR or Event Regulations.

All items presented in this document closely match the Scrutineering Checklist used by Motorsport Australia Accredited Officials at event.

Vehicles must meet the requirements of the Motorsport Australia Manual – Auto Test Appendix - Group 4K – Khanacross Cars: https://motorsport.org.au/regulations/manual/auto-test/

Apparel must meet the requirements of Motorsport Australia Manual - Schedule D: https://motorsport.org.au/regulations/manual/technical-appendix/
Vehicle General Condition Checks - Please tick the items you have checked:*

Steering SystemBrakesFluid Levels / LeaksBattery Secure/CoveredExhaust System (Condition/noise)Throttle Return SpringTow PointsWheels and Tyres
Any Comments on the Vehicle's General Condition:*
Vehicle General Safety Checks - Please tick the items you have checked:*

Fire Extinguisher and MountingSafety Cage and Padding (if fitted)Safety Harness (seatbelts) and MountingSeat and MountingInterior – Condition/No Loose Items etc.
Any Comments on the Vehicle's General Safety:*
Apparel Check - Driver 1 Name*
Apparel Check - Driver 1 Items - Please tick the items you have checked:*

HelmetOverall/OuterwearFootwearGoggle/Visor (if in an open vehicle)
Apparel Check - Driver 2 Name*
Apparel Check - Driver 2 Items - Please tick the items you have checked:*

HelmetOverall/OuterwearFootwearGoggle/Visor (if in an open vehicle)
Minor and Parent/Guardian Details
Is Driver 1 and/or Driver 2 under 18 yrs of age?*

YesNo
Minor 1 Full Name*
Minor 2 Full Name
Parent/Guardian Role*
Parent/Guardian First Name*
Parent/Guardian Last Name*
Parent/Guardian Mobile Number*
Format: 0000 000 000.
Parent/Guardian Email Address*
Parent/Guardian Address*

Parent/Guardian Street Address

Parent/Guardian Street Address Line 2

Parent/Guardian SuburbParent/Guardian State

Parent/Guardian Post Code
I am the parent/ guardian of the above-named (‘Minor/s’) who is/are under 18 years of age. I have read this document and understand its contents, including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity, and have explained the contents to the Minor/s. I consent to the Minor/s attending or participating in the event at their own risk.
Parent/Guardian Declaration - Agreed*

TrueFalse
Parent/Guardian Signature*
Parent/Guardian - Date Signed*

DayMonthYear
Date
Should be Empty:

Rows	Scrutiny Date	Scrutiny Event/Venue	Scrutiny Conducted
1
2
3
4
5

Self-Scrutiny and Vehicle/Apparel Compliance Form - Round 3 Baden Civil SEQ Khanacross Series

Event Details

Round 3 2026 Baden Civil SEQ Khanacross Series

Competitor Details

Competitor Declaration - Statement of Vehicle/Apparel and Compliance

Driver/s Information

Driver/s Declaration - Statement of Vehicle/Apparel and Compliance

Vehicle Details

Self Scrutiny Vehicle Checks and Apparel Checks

Minor and Parent/Guardian Details