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NERA Daily Chairvan Equipment Checklist
Inspection Date
-
Month
-
Day
Year
Date Picker Icon
Crew Last Name
*
Truck #
Please Select
CC17
CC25
CC27
Other
Odometer mileage
Oil Change due mileage
Cab Area
Paperwork
*
Fail
Pass
Clipboard
*
Fail
Pass
First Aid Kit
*
Fail
Pass
Gloves
*
Fail
Pass
Antibacterial Wipes
*
Fail
Pass
Wheelchair
*
Fail
Pass
GPS Unit
*
Fail
Pass
Tie Downs
*
Fail
Pass
9 Foot Straps (2)
*
Fail
Pass
Map Book
*
Fail
Pass
Emesis Bags (4)
*
Fail
Pass
Hand Sanitizer
*
Fail
Pass
Tissues
*
Fail
Pass
Fire Extinguisher
*
Fail
Pass
Trash Barrel
*
Fail
Pass
Blankets (2)
*
Fail
Pass
Umbrella
*
Fail
Pass
Gas Card
*
Fail
Pass
Business Cards
*
Fail
Pass
Glass Cleaner
*
Fail
Pass
All Purpose Cleaner
*
Fail
Pass
Paper Towels
*
Fail
Pass
Whisk Broom
*
Fail
Pass
Milk Crate
*
Fail
Pass
Road Safety Kit
*
Fail
Pass
TB Mask
*
Fail
Pass
Backup Camera Working
*
Fail- Notify Dispatch
Pass - Camera Works
Final
Equipment Inspection Result
*
Unsatisfactory (Notify Dispatch Immediately)
Satisfactory
Submit Checklist
Should be Empty: