ATS Checkoff
Date
-
Month
-
Day
Year
Date Picker Icon
Employee 1
*
First Name
Last Name
Employee 2
First Name
Last Name
Unit Number
*
Mileage
*
Oil Change Mileage
*
Tire/Spare Condition
*
Excellent
Good
Fair
Poor
Wheelchair Lift
Working
Broken
N/A
Fuel Level
*
Full
3/4
1/2
1/4
Empty
Fluids
Full
Low
Oil
Transmission
Power Steering
Coolant
Washer
Brakes
Exterior Vehicle
Functioning
Non-Functioning
Horn
Side Mirrors
Lights
Backup Alarm
Turn Signals
Parking Brake
Explain
*
Pt Compartment
Functioning
Broken
Missing
4/8 Wheelchair Ties
2 Wheelchair Seatbelts
2 Shoulder Straps
A/C Heat
No Smoking Sign
No Eating/Drinking Sign
Interior Equipment
Functioning
Broken
Missing
Seat Belts
Seat Belt Cutter
First Aid Kit
AED
Road Triangles
Gloves
Jumper Cables
CPR Mask
2 6ft Straps
Spill Kit
Misc.
Present
Missing
Registration
Insurance Card
Tablet/Zipit
Comments
Indicate where damage is on vehicle.
Submit
Should be Empty: