Date *

MM

DD

YYYY

Name *

First Name

Last Name

Engine Oil *

Ok

Repair

Power Steering Fluid *

Ok

Repair

Rad/Belts *

Ok

Repair

Windshield Wipers/Fluid *

Ok

Repair

Backup Warning *

Ok

Repair

Brake Warning Light *

Ok

Repair

Transmission Fluid *

Ok

Repair

Mirrors *

Ok

Repair

Door Locks & Handles *

Ok

Repair

Tire Pressure & Condition *

Ok

Repair

Lights & Reflectors *

Ok

Repair

Trailer Connections *

Ok

Repair

Seat Belts *

Ok

Repair

Fire Extinguishers/First Aid/Eye Wash *

Ok

Repair

Ownership/Insurance/Safety Policy *

Ok

Repair

Air Brakes/Brake Chamber *

Ok

Repair

Mud Flaps *

Ok

Repair

Pylons *

Ok

Repair

Hoist / Hydraulic Oil *

Ok

Repair