Vehicle Inspection Checklist Template - Panera
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1Vehicle Inspection Checklist
This form must be completed electronically monthly for each Delivery Team Member and kept on file. If a vehicle does
not pass inspection it cannot be used for Panera until the problem has been fixed and another inspection is
completed.
DTM Name:
______________________
Date:__________
Vehicle Inspection
Make and Model:
Year:
The following items are functioning and in good condition
License Plate #:
Mark if
Fails
Tail Lights
Comments:
Left Side Not
Right Side Not
Have the driver turn on the lights and observe the
Working
Working
rear red tail lights.
Neither Side
All Working
Working
Brake Lights
Comments:
Left Side Not
Right Side Not
Have driver press brake pedal. Observe rear brake
Working
Working
.
lights
Neither Side
All Working
Working
Back-Up Lights
Comments:
Left Side Not
Right Side Not
Have driver put car in reverse. Observe back-up
Working
Working
lights.
Neither Side
All Working
Working
Turn Signals
Comments:
Left Side Not
Right Side Not
Observe both directions front and back.
Working
Working
Neither Side
All Working
Working
Horn
Comments:
Does not
Have driver press horn. Listen for proper operation.
Works
work
Windshield Wipers
Comments:
Left Side Not
Right Side Not
Have driver turn on windshield wipers. Observe for
Working
Working
proper operation.
Neither Side
All Working
Working
Safety Gear
Comments:
Does not
Seat Belt properly latching
Works
work
Headlights
Comments:
Left Side Not
Right Side Not
Observe left and right headlights.
Working
Working
Observe high beams.
Neither Side
All Working
Working
Tires
Comments:
No
Yes
Inspect tires for bald spots.
License Plate
Comments:
No
Yes
Observe that license plates are current and placed
per the state requirements.
Auto Insurance
Comments:
Verify that auto insurance is valid.
No
Yes
Manager Completing Inspection:____________________ DTM Signature: __________________________
8/11/2016
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