1730 S. Cherry St. P: 832.698.8000 Tomball, TX 77375 F: 832.698.8001

APPENDIX B

MONTHLY REPORT

Make____________ Model________________ Year_____________

VMI #_____________________ UNIT #_________

DATE_______________________

Current Odometer Reading ______________________

Are items below in good operating condition Yes No NotesSafety belts working?Windshield wiper blades and fluid?Horn?Brakes with adequate stopping power?Emergency brake?Turn/direction signals?Good tires with adequate tread and corrective pressure?Oil/Coolant/Brake Fluid Levels?Brake lights?Tail lights?Steering?License plate light?Tight muffler system?First Aid Kit?Intact windshield, with no cracks?Is all seating in the vehicle secured to frame?Are appropriate notices posted in each vehicle as a reminder that all employees and their passengers are required to wear seat belts?New monthly odometer sheet? Last month’s OD sheet turned in to accounting?Safety book with insurance current?No Dashboard indicator lights lit up? If No, please specify which.Vehicle Damage Free- interior/exterior? If no, please specify location.No unusual noises or vibrations?Oil changed within manufactures warranty or within last 7,000 miles?Rear-view mirror if applicable?Blank Vehicle Accident ReportsRegistration current?Inspection current?DOT Emergency Response Guide Book.Exterior and interior presentable and clean.Cargo (tools and equipment) carried inside the vehicle is properly secured?Equipment carried on roof rack and roof rack is secure (if applicable)?Accident Procedure?MSDS list in vehicle?Mileage report turned in for month.

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Saturday, May 06, 2023

Employee Signature ______________________________________

Repair Approval _________________________________________

Supervisor Signature _____________________________________

The Completion: ________________________________________________________________________________________________________________________________________________________________________________________________________________

The completion of this checklist indicates that we have undertaken a limited survey of the vehicle. The findings of this document are limited to certain conditions that were observed and evaluated at the time of the survey. The survey or the completed checklist is not a substitute for any mechanical inspection made by a qualified technician. Any observations or recommendations enumerated in this document do not constitute a safety inspection and in no way supplant your duty to maintain your vehicle in safe operating condition. Completion of any or all of the recommendations contained in this document does not assure that every hazard has been adequately controlled or that no other hazards exist. By completion of this checklist we do NOT warrant that any or all vehicles or equipment are safe or in compliance with any law, rule, regulation or ordinance.