<p>COURTESY INSPECTION REPORT Your Logo Here</p><p>Cust Name:______RO #:______Tech:______Date:____/____/____ Yr:______Make:______Model:______Mileage :______Service Advisor: ______</p><p>Legend: = OK, passed at this time = Marginal, recommend in near future = Failed, recommend now </p><p>*Engine Oil Level before Test Drive: full low ______qts. Condition: ok dark black ______</p><p>P M F Interior/Exterior Inspection: Comments: Interior:  Scratch  Scuff  Stain  Other ______Exterior:  Scratch  Scuff  Dent  Windshield Crack  Other ______</p><p>P M F INITIAL TEST DRIVE RESULTS: Comments: Brake Operation:  noisy  pulling  pulsation  low pedal  dash light on______Steering/Suspension:  noisy  pulling  looseness  shimmying  stiffness______Dash/Instruments:  check engine light on  maint / service light on  other______Horn:  weak  intermittent  non-op______A/C Performance Check:  doesn’t blow vent temp_____F______Windshield Wipers/Washers/Glass:  non-op  worn  skipping  missing  plugged______Rear View Mirrors:  loose  damaged  missing______</p><p>Copyright 2015: Cecil Bullard, All Rights Reserved Inspection Report Page 2 Your Logo Here</p><p>P M F MOBILITY EQUIPMENT RESULTS: Comments: Hand Controls:  Gas/Brake Rod  Clearance dash/door  Operation ______EZ Lock:  Plugs/Connections  Bolts/Pins  Wiring  Buzzer  Non-OCC Button  Operation __ Manual Tie Down:  Belts  Track Fittings  Operation ______Remote:  Connections  Switches  3rd Station Switches  Battery  Operation ______Kneel System:  Chain/Boot  Operation ______Ramp:  Wiring/Conns  Motor Bolts  Limit Switches  Operation______Chair/Scooter Lifts:  Fluid Levels/Leaks  Wiring/Battery Connections  Grips/Bumpers ______Chair/Scooter Lifts Continued:  Mounts  Interlock Functionality  Operation ______Power Doors:  Clearance  Wiring/Conns  Hardware/Mounts  missing  Operation ______Seat Base:  Seatbelt  Sliders/Rollers  Harness/Conns  Switches  Operation ______</p><p>EXTERIOR & LIGHTS INSPECTION: Comments: Headlights High/Low:  non-op  broken  dim______Taillights/Stop Lights/License Lights:  non-op  broken  dim______Turn Signals/Emergency Flashers/Back-Up:  non-op  erratic  broken______</p><p>UNDERHOOD INSPECTION & MAINTENANCE : Comments: Air filter & housing:  filter dirty  housing broken or missing screws: ______Coolant Condition / Level Check: good to ____ degrees, PH______ low  contaminated______Battery Condition/Cables:  low  corroded  damaged  loose, Battery test passed failed ___ Brake Fluid:  low  contaminated moisture content_____%______Transmission Fluid / Power Steering:  low  dark  burnt______Belts  cracked  glazed  loose ______Hoses (inspected as possible):  cracked  soft  bloated  leaking______</p><p>UNDERCAR INSPECTION & MAINTENANCE: Comments: Brake Pads/Shoes Remaining*: F/_____% R/_____% (visual inspection only, % is only best guess)_____ Tire Pressure/Condition: LF____/______RF____/______LR____/______RR____/______Oil / Fluid Leaks:  engine  transmission  other______Tires Tread Depth: LF_____/32 RF_____/32 LR_____/32 RR_____/32 ______</p><p>Additional Comments: ______</p><p>Copyright 2015: Cecil Bullard, All Rights Reserved</p>