Read Microsoft Word - FR Form 31 POV Inspection 3 Aug 07.doc text version

POV INSPECTION FORM OPERATOR NAME: Last, First MI Insurance Company Name Expiration Date Vehicle: Year Rank/ Section DOD Tag #/Expiration Make Model

State License Tag #/Expiration MO/YR Driver's License/State /Expiration Date NOTE: Any NO would constitute failing the inspection and must be corrected.

DATE & Initials of Inspector DATE & Initials of Inspector

Supervisor Name/Rank

DATE & Initials of Inspector DATE & Initials of Inspector DATE & Initials of Inspector

PASS

FAIL

PASS

FAIL

PASS

FAIL

PASS

FAIL

PASS

FAIL

BRAKES

1. Emergency/parking brake operates properly? 2. Brake fluid is clean and at proper level? 3. Brakes operate both rear lights?

YES

NO

YES

NO

YES

NO

YES

NO

YES

NO

EXHAUST SYSTEM

1. Free of holes and leaks? 2. Exhaust system securely mounted?

MIRRORS

1. Rear view mirror securely mounted? 2. Rear vision is not obstructed by personal items or decals on rear glass as well as hanging from the front mirror? Large items create blind spots. FR FORM 31-E Aug 07 (Rev)

1

NAME: LIGHTS

1. All light covers clean and serviceable free of damage/cracks etc? 2. High and Low beam headlights working properly? 3. All lights are the proper colors? 4. Turn signals operate properly, both front and rear? 5. Rear license plate light operating?

YES NO YES NO YES NO YES NO YES NO

TIRES

1. Tires are inflated to specifications? 2. Radial and Bias-ply tires not mixed? 3. Tires not excessively worn? 4. Treads and sidewalls free of damage; spots, cuts, etc? 5. Spare tire, jack, and lug wrench present and serviceable?

WINDSHIELD

1. Windows intact and free of vision obstructions and cracks? 2. Wipers and washer system operational?

FR FORM 31-E Aug 07 (Rev)

2

NAME: SEAT BELTS

1. Restraint systems available for all occupants, and are? 2. Safety seats provided for each child under 4 years of age? 3. Drivers with children have the proper seats installed for the size and age of the children?.

YES NO YES NO YES NO YES NO YES NO

PICKUP TRUCKS

1. Driver(s) are aware that in the State of Kansas persons 14 years of age and younger are prohibited from riding in any portion of a vehicle not intended for passengers? This includes riding in the back of pickup trucks.

GENERAL

Individual understands and was briefed on all Federal and State Law dealing with Driving Under the Influence (DUI).

ADDITIONAL COMMENTS: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

REINSPECTION DATE (if required)_____________________________________________

FR FORM 31 Aug 07 (Rev)

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Microsoft Word - FR Form 31 POV Inspection 3 Aug 07.doc