WEEKLY LIGHT TRANSIT VEHICLE (LTN/LTV) INSPECTION CHECKLIST (One driver per form)

Driver’s Signature:______Week of : ______

Driver’s Name: ______

Manufacturer: ______Model Year:______Last six digits of vin#______Agency Vehicle # ____

______Beginning Mileage ______Ending Mileage

Manufacturer’s Recommended Service Interval______miles:

______Maintenance due within 500 miles

______Maintenance past due

______Mechanical failure, describe on back of form

Inspect and check each item below:______(Open emergency windows at least once every 3 months)

S / M / T / W / T / F / S / S / M / T / W / T / F / S
Vehicle Exterior / Electrical Continued
No signs of leaks under vehicle / Emergency flashers
Tires inflated / Horn
Windows and mirrors clean / Windshield wipers
Doors open/close / Brakes
Dual rear wheels inflated / CHECKED BY ANOTHER PERSON OR BY MIRROR
Under hood / Brake Lights
Oil level / Backup lights
Windshield washer fluid / Rear left turn signal
Hoses, dripping fluids, cracked or leaking / Rear right turn signal
Belts not frayed or cracked / Clearance lights
VEHICLE INTERIOR / Marker lights
Clean interior / SAFETY EQUIPMENT
Floor free of hazards / Reflective triangles or flares
Seat belts in good condition / First aid kit
Adjust mirrors / Fire extinguisher
Check brakes / Biohazard kit
Heater (Spring-Winter-Fall) / Vehicle accident package
A/C (Spring-Summer-Fall) / Vehicle insurance card
Defrosting system / Seatbelt cutter
Adequate Fuel / Check only if agency requires daily check
Any warning lights on / Coolant level
Two-way communication / Brake fluid
Doors locking / Transmission fluid
Brakes / Power steering fluid
Electrical / Corrosion on battery
Turn signals: / Accessibility Equipment
Front Left / Cycle lift
Front right / Proper number of seatbelts and Securement devices
High beams / Belts and Securement devices in good condition
Low beams / Emergency handle
Back up alarm, if equipped / Leaking hydraulic fluid

Indicate any physical damage to the exterior of body. Additional information may be provided on back