Vehicle Check Form

Drivers Name

Inspection Completed By

Email Address

Business Unit

Retail Area

Sales Area

Vehicle Registration Number (No spaces please i.e. ABC123)

Vehicle Status

ODO Reading

Hub Reading (if applicable)

Do you need more RUC?

YesNo

Which Farmlands branch do you want RUC label sent to?

Current WOF

YesNo

Registration Current

YesNo

Is this your first time submitting mileage on this vehicle?

YesNo

What date did you take over the vehicle?

Who was the previous driver?

I confirm I have completed Farmlands approved driver training (If unsure please contact the Learning & Development Team)

YesNoBooked

How many sets of keys do you have for your vehicle?

Reminder: If your circumstances changes please provide an update to the Property & Asset Team. This includes partner / spouse changes.

Driver information

I have sent a copy of my spouses/partners drivers licence to the Property & Asset TeamI will send a copy of my spouses/partners drivers licence ASAPI am the sole driver

General Safety Checklist

If windscreen is chipped please call NZ Autoglass on 0800 80 50 20

Does your Double cab ute have a Smart Strap System installed? (TFO's + Retail where required)

YesNoN/A

Is it in good condition?

YesNo

	Okay	Fault	N/A
Clean and tidy
Engine oil level
Radiator coolant level
Windscreen wash reservoir
Windscreens (clean & no stone chips)
Windscreen wipers
Mirrors
Tyres: tread must be more than 1.5mm
Tyres: tyre pressure as per the manufacturers recommendations
Tyres: don't forget the spare
Brakes
Lights (including indicators)
Horn
Tow ball (firm, safe & trailer compatible) - Where applicable also check the hitch pin has not been removed or damaged
Trailer wiring
Anchor points (if applicable)
Jack

DG & Emergency Checklist

	Okay	Fault	N/A
DG placards
DG paper work holder
Fire extinguisher (replace immediately if used)
First aid kit (check contents regularly)
Vehicle spill kit
Quad bike helmet (only if applicable)
Hi-viz vest
Head lamp/torch
Tie on flag (for extended loads)
Safety goggles/glasses
Leather gloves

Comments and actions required

Any new vehicle damage?

Yes NoEnsure all damage is recorded in the Vehicle Incident form in i2R

Have you completed i2R

Yes No

Important: If this check highlights any unsafe issues the vehicle must not be operated until repairs have been carried out by qualified personnel and the vehicle is in a safe operating condition.

Vehicle Use (Do not complete for Trucks)

Have you used your vehicle for personal use on any day (including weekends) other than to and from work each day? (Incidental use such as stopping off at store on way home is not considered personal use.) http://www.ird.govt.nz/fringe-benefit-tax/fbt-types/fbt-motor-vehicles/#04

Yes No

Please enter the dates

From Date

To Date

Comments

i.e. Holiday with family

Have you left your vehicle at a branch, at an airport, at a garage for a repair or service, or taken your vehicle away on a work related trip for more than 24 hours?

Yes No

Please enter the dates

From Date

To Date

Comments

Any additional comments on vehicle FBT

Contact Information