Vehicle Inspection Form

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Vehicle Inspection

TO BE COMPLETED BY VEHICLE OPERATOR

BRING THIS FORM WITH YOU TO A CERTIFIED MECHANIC.


Once your vehicle is inspected and receives a PASS, simply
take a photo of the filled out form and upload it at
http://partners.uber.com/ to complete the signup process.

FULL NAME

EMAIL ADDRESS

SIGNATURE

DATE

PHONE NUMBER

INSPECTION POINTS
HEADLIGHTS...................................................................... q
PASS

q
FAIL

REAR WINDOW & OTHER GLASS................................ q


PASS

q
FAIL

PASS
TAIL LIGHTS........................................................................ q

q
FAIL

PASS
WINDSHIELD WIPERS..................................................... q

q
FAIL

PASS
TURN INDICATOR LIGHTS.............................................. q

q
FAIL

PASS
FRONT SEAT ADJUSTMENT.......................................... q

q
FAIL

PASS
STOP LIGHTS...................................................................... q

q
FAIL

PASS
DOORS (Open/Close/Lock)............................................ q

q
FAIL

PASS
FOOT BRAKES (Pads/Shoes Thickness).................... q

q
FAIL

PASS
HORN.................................................................................... q

q
FAIL

PASS
SPEEDOMETER.................................................................. q

q
FAIL

PASS
BUMPERS............................................................................ q

q
FAIL

PASS
MUFFLER AND EXHAUST SYSTEM............................. q

q
FAIL

PASS
TIRES, INCL. TREAD DEPTH.......................................... q

q
FAIL

PASS.
Right Front (32nds/in)............................................ q.

q.
FAIL

PASS.
Left Front (32nds/in).............................................. q.

q.
FAIL

PASS.
Right Rear (32nds/in).............................................. q.

q.
FAIL

PASS.
Left Rear (32nds/in)................................................ q.

q.
FAIL

PASS
INTERIOR & EXTERIOR REAR VIEW MIRRORS....... q

q
FAIL

PASS
SAFETY BELTS FOR DRIVER & PASSENGERS.......... q

q
FAIL

Min. per Manufacturer............................................

Right Foot Measurements......................................

Left Foot Measurements........................................

Right Rear Measurements......................................

Left Rear Measurements........................................

PASS
EMERGENCY/PARKING BRAKE................................... q

q
FAIL

PASS
STEERING MECHANISM.................................................. q

q
FAIL

PASS.
Ball Joints.................................................................... q.

q.
FAIL

PASS.
Tie Rods........................................................................ q.

q.
FAIL

VEHICLE INSPECTION RESULTS (Inspector To Circle)

PASS.
Rack & Pinion.............................................................. q.

q.
FAIL

Any markings on the FAIL side will automatically fail inspection.

PASS.
Bushings....................................................................... q.

q.
FAIL

PASS
WINDSHIELD...................................................................... q

q
FAIL

PASS
Large Crack.................................................................. q

q.
FAIL

PASS
Small Crack.................................................................. q

q.
FAIL

TO BE COMPLETED BY INSPECTOR

VEHICLE MILEAGE

PASS

FAIL

INSPECTION DATE

LICENSE PLATE STATE

LICENSE PLATE NUMBER

VEHICLE MAKE

VEHICLE MODEL

INSPECTOR COMPANY

INSPECTOR ADDRESS

INSPECTOR NAME

INSPECTOR SIGNATURE

VIN

This certification expires one (1) year from inspection date.

VEHICLE YEAR

NUMBER OF DOORS

STATE CERTIFICATION NUMBER

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