VEHICLE INSPECTION FORM
Check all that apply:
Bus Passenger Van Car Initial Inspection Re-inspection
DOT No. (Bus Only) ____________________________
Date |__|__|__|__|__|__| Seating Capacity |__|__| County
Facility/Home |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Address |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Street
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__| |__|__|__|__|__|-|__|__|__|__|
City State Zip Code
Phone No. |__|__|__| |__|__|__|__|__|__|__|
Area Code Number
Liability Insurance |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| / |__|__|__|__|__|__|__|__|__|__|__|__|__|
Carrier Policy Number
Chassis Make ________________________________ |__|__| Year |__|__| Mileage |__|__|__|__|__|__|
Code #
Body Make __________________________________ |__|__| Year |__|__| Bus |__|__|__|__|__|__|__|
Code #
Vehicle Identification Number (V.I.N) |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Tag Number |__|__|__|__|__|__|__|__| FL |__|__|__|__|
Expires
P R N/A P R N/A
1. Headlights 1 24. Sideview Mirror 24
2. Parking Lights 2 25. Crossover Mirror 25
3. Tail Lights 3 26. Fire Extinguisher 26
4. Brake Lights 4 27. First Aid Kit 27
5. Directional Signals 5 28. Emergency Warning Devices 28
6. Hazardous Warning Signals 6 29. Windshield 29
7. Clearance Lamps 7 30. Windows 30
8. Side Marker Lamps 8 31. Rub Rails 31
9. Identification Lamps 9 32. Bumpers 32
10. Reflectors 10 33. Pupil Warning Lamp System 33
11. Brakes 11 34. Stop Arm 34
12. Steering System 12 35. Drive Shaft Guards 35
13. Suspension 13 36. Neutral Safety Switch 36
14. Windshield Wipers 14 37. Tires 37
15. Horns 15 38. Wheels 38
16. Exhaust System 16 39. Seating + Driver Seat Belt 39
17. Fuel System 17 40. Interior Lights 40
18. Engine Compartment 18 41. Unsecured Items 41
19. Service Door 19 42. Bus Condition 42
20. Emergency Door 20 43. Electrical System 43
21. Emergency Exits 21 44. Tag + Registration 44
22. Inside Rearview Mirror 22 45. Tag Light 45
23. Outside Rearview Mirror 23 46. Liability Insurance 46
Code: P=Pass R=Rejected N/A=Not Applicable
Comments _______________________________________________________________________________________________
________________________________________________________________________________________________________
Inspected By ____________________________________________ ID # |__|__|__|__| Date of Inspection |__|__|__|__|__|__|
Business Name __________________________________________ Business Phone No. |__|__|__| |__|__|__|__|__|__|__|
Address ______________________________________ Approved Rejected Passed Reinspection
Unsafe Vehicle - Do Not Transport Children
_____________________________________________ NO CERTIFICATE WILL BE ISSUED UNTIL ALL ITEMS ARE FOUND
SATISFACTORY FOR SAFE OPERATION AS PROVIDED IN CHAPTER
Certificate Number |__|__|__|__|__|__|__| 316, FLORIDA STATUTES.
Dist 2 ChildCareLic
