ImproveAbility Vehicle Safety & Maintenance

Vehicle Insepction or Repair Request

Quarterly checklist for vehicle safety and maintenance. Also used to request repair on a vehicle.

IA Rep
*
N/A
Date of Inspection or repair request
*
N/A

MM/dd/yyyy
Is this form being filled out due quarterly vehicle inspection?
If this is a repair or item request outside of the quarterly schedule, then click NO.

N/A

Yes
No

This form is also used for ad hoc item or repair requests.
Upload Receipt of Oil Change
(Completed on a yearly basis)

N/A
Upload file
Outside items to be inspected

N/A

Checkmark denotes item is in good working order.
Inside items to be inspected

N/A

Checkmark denotes item is in good working order.
Items need to be replaced/purchased to address unchecked items above.
*
N/A

Yes
No
Items needing to be ordered/replaced due to unchecked item above.
N/A

Such as - new extinguisher, need more gloves, etc.
Repairs are needed to address unchecked items above.
*
N/A

Yes
No
Denote nature of the repair required

N/A

Such as - broken windshield, oil leak, etc.
Upload Pictures of Damage or Repair Needed

N/A
Upload file
Up to 5 pictures max
Additional Pictures

N/A
Upload file
N/A

New Vehicle Maintenance or Repair New Vehicle Maintenance or Repair