Vehicle Data Form Vehicle Data Vehicle Data Before taking a vehicle on the road/submitting a vehicle for service/repair, tick items as appropriate below: Day 12345678910111213141516171819202122232425262728293031 Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year 20232024 Registration Number * -- Please Select --J135114J146772J134320J19624J135245J92762J46493J145041J48380J127512J126898J78042J148249J154377J33054 Coolant / Water OK? * Yes No Windscreen Washer Liquid OK? Yes No Engine Oil OK? Yes No Hydraulic Oil OK? Yes No Mirrors OK? * Yes No Vehicle Insurance Disk present? * Yes No Work Lights working? * Yes No Wipers Condition OK? * Yes No Indicators Working & Clean? * Yes No Tail Lights Working & Clean? * Yes No Brake Lights Working & Clean? * Yes No Reversing Lights Working & Clean? * Yes No Reversing Alarm Working? * Yes No Vehicle Amber Beacons Working & Clean? * Yes No CCTV Camera Working & Clean? * Yes No Vehicle Horn Working? * Yes No Insurance Disk Displayed? * Yes No Any Oil/Fuel Leaks? * Yes No Tyres & Wheel Fixings OK? * Yes No First Aid Kit Available? * Yes No Reversing Camera Working & Clean? * Yes No Vehicle Cleanliness (cab) OK? * Yes No Vehicle Cleanliness (body) OK? * Yes No If you have answered "No" to any of these questions, please state details below. Record of Defects Noted: Drivers Name * -- Please Select --AntonioArturColinJose CovaJose De SousaLuisMarcoPaulRui I can confirm that this is a true record of the vehicle condition * Yes No If you are human, leave this field blank. Submit
