Previous editions may be used until stock is exhausted. Page 1 of 2

VEHICLE MECHANICAL SAFETY INSPECTION RECORD/

(AE Reg 190-1/CNE-CNA-C6F Inst 11240.6X/USAFE-AFAFRICA Inst 31-202)Second Language:Headquarters/ Owner's name and rank/ Unit, organization, APO/

License number/ Make/ Model/ Series/ Type/ Color/

Chassis number/ Power brakes/

Yes/ No/

Power steering/

Yes/ No/

Automatic transmission/

Yes/ No/

Item inspected/ Sat/ Unsat/ Remarks/ Item inspected/ Sat/ Unsat/ Remarks/

Handbrake/ LH: RH:

Footbrake/ Front LH: Front RH:

LH: RH:

Windshield wipers/

Rearview mirror/

Horn/

Headlights/

Parking lights/

Taillights/

Foglights/

Backup lights/

Suspension springs/

Seatbelts/

First-aid kit/

Warning triangle/

4-way flasher/

Directional indicator/

Steering/

Tires and wheels/

Exhaust line/

Glass/

Fuel tank and lines/

Speedometer/

Trailer connections/

Frame and body/

Additional remarks/

Official stamp/ Inspected by (name and grade)/ Date of inspection/

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Handbrake/1. Improperly adjusted - will not hold - cable broken/missing - inoperative

Footbrake/2. Improperly adjusted - right front - left front

3. Improperly adjusted - right rear - left rear

4. Brake lines badly rusted - brake hoses deteriorated

5. Wheel brake cylinder leaks - master brake cylinder leaks

6. Air in system - too much free travel

7. Brake pads worn - front - rear

Windshield wipers/8. Blade worn - left - right - inoperative - missing

Rearview mirror/9. Inside - blind - broken - loose - missing

10. Outside - left - right - blind - broken - loose - missing

Horn/11. Inoperative - sound level

Headlights/12. Improperly adjusted - control light inoperative

13. Reflector blind - left - right

14. High beam inoperative - left - right

15. Low beam inoperative - left - right

Parking lights/16. Inoperative - left - right

Taillights/17. Inoperative - left - right - license-plate light

Foglights/18. Inoperative - front - rear - control light

Backup lights/19. Inoperative - left - right

Suspension/20. Spring - front - rear - broken - sagging

21. Suspension - front - rear

22. Shock absorber - front - rear - leaks - inoperative

Seatbelts/23. Wrong type - inoperative - missing

First-aid kit/24. Approved type - missing

Warning triangle/25. Missing

4-way flasher/26. Missing - inoperative - front - rear - control light

Directional indicator/27. Inoperative - left - right - front - rear - control light

Steering/28. Excessive play - steering gear - draglink - tie rod

29. Steering wheel - not approved type - loose

Tires and wheels/30. Front wheel bearings - alignment - balance

31. Wrong type - tread - front - rear - left - right - worn - cut - cracked

Exhaust line/32. Leaks - muffler - frontpipe - tailpipe - noise level

Glass/33. Cracked on driver's side - unauthorized stickers

Fuel tank and lines/34. Leaks - loose connections

Speedometer/35. Works erratic - inoperative

Trailer connections/36. Electrical installations - fastening

Frame and body/37. Bent - rusted out - tracking impaired

38. Part of chassis - bent - rusted out