73A Monthly Vehicle Inspection for ADA Equipped Vehicles

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					   Form # 073A Org: Rev: 01/11

                                      Satilla Community Services
                        MONTHLY VEHICLE INSPECTION FOR VEHICLES EQUIPPED FOR ADA

Site: ______________________________________        Date:_____________________________
Vehicle Number: ____________________________
Operator's Name:____________________________

                                                    Corrections or Adjustments
    Items to be Inpected         OK     Deficient                                   Remarks
                                                              Made
Wheelchair/Standard Lift
  /Lift/Cycle Test
  /Hydraulic Leaks
  /Battery Connection
  /Tie-Down Equipment
  /Priority Seat Sign
  /Mo. Cycle Test Back Up
 /Lift Safety Belt

Accessible Equipment
  /Keep Tracks Clean
 /Check for Defrayed or
Worn Belts


Each Secure Station Fully
Equipped With:
  /Lap Belts
  /Shoulder Harness
  4 ea. Secure Straps


The Following Must be in
Good Condition:
  /Check Frayed or
Damaged Webbing
  /Improper Functioning
Buckles
  /Broken or Worn Parts
  /Floor Anchors Secure and
Clean
  /Clean Dry Container for
Storage
  /Seat Belt/WebCutter
   /Printer Operating
Instructions

Other Problems or Remarks:

				
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