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Samara Vehicle Inspection​
Employee Name
Vehicle Number
Exact Odometer Reading
Insert Photo of Oil Change Sticker
Upload File
Upload supported file (Max 15MB)
Photo of oil level on end of dip stick
Upload File
Upload supported file (Max 15MB)
Any Needed Tools, Materials, First Aid Supplies or Resources
For the Star Rating: 5 Star= Perfect Condtion, 3= Needs work ASAP, and 1= Non working/Safe condition.
Windshield
Windshield Wipers
Windows
Tires
Mud Flaps
Engine Oil
Brakes
Head Lights
Tail Lights
Seat Belts Installed and Working
*
Yes
No
Any Leaks or warning equipment? IE reflective trailers in vehicle or trailer??
*
Yes
No
Any Werid, Strange or Unsual Sounds?
*
Yes
No
If there are issues have they been reported to your manager?
Yes
No
Any Cracks or Rock Chips in Windshield?
Yes
No
Status of Vehicle - Reason for any under 5 star rating:
Front of Vehicle Photo
Upload File
Upload supported file (Max 15MB)
Rear of Vehicle
Upload File
Upload supported file (Max 15MB)
Interior of Vehicle
Upload File
Upload supported file (Max 15MB)
Interior of Trailer - Or Trunk
Upload File
Upload supported file (Max 15MB)
Outside of Trailer
Upload File
Upload supported file (Max 15MB)
Trailer Condition
Trailer Tire Condition
If less than 5 Stars for Trailer please list reason:
Trailer Number
Is the reciever properly mounted to the tow vehicle?
Yes
No
Are the hitchball and coupler the same size and locked into place?
Yes
No
Lug Nuts Tight?
Yes
No
Are the trailer lights operational?
Yes
No
Are safety chains operational?
Yes
No
Is the brake safety cable attached ?
Yes
No
Trailer Spare Tire Present AND in good condition?
Yes
No
Springs and Shackles in Good Condition?
Yes
No
Trailer Floor Undamaged?
Yes
No
Landing gear/trailer jack functional?
Yes
No
Are breaks in good operational standing?
*
Yes
No
Is your vehicle fully stocked/prepared as shown in the image below?
*
Yes
No
NA
Does your vehicle have a jack?
*
Yes
No
NA
Is your first aid kit fully stocked as listed below?
*
Yes
No
NA
Is your dashcam recording?
*
Yes
No
NA
Your Signature
Clear
Submit Here- Wait for confirmation.
Sent-Thanks for your feedback!
Vehicle Jack
Reusable Ice Pack
Pain/Allergy Med packs
Samara Maintenance ​
Employee Name
Machine Number
Insert Photo of Oil Change
Upload File
Upload supported file (Max 15MB)
Other Photos
Upload File
Upload supported file (Max 15MB)
Check All Services Completed
*
Oil Changed
Sharpened Blades
Changed Oil Filter
Changed Spark Plugs
Greased Machine
Changed Blade Belt
Changed Wheel Belt
Washed Machine
Any Leaks or warning equipment? IE reflective trailers in vehicle or trailer??
*
Yes
No
Any Werid, Strange or Unsual Sounds?
*
Yes
No
Your Signature
Clear
Submit Here- Wait for confirmation.
Sent-Thanks for your feedback!
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