CAMPUS SAFETY AND MOBILITY OFFICE

MOTOR VEHICLE INSPECTION REPORT Form 5A

VEHICLE NO. _____________________

TO: CSMO

ATTENTION: This is to certify that I have made preliminary inspection and testing of the
School Bus Service vehicle described as follows:

Type of vehicle: ____________________ Make: ______________________

Model: ____________________________ Plate No.: ___________________

Engine No.: ________________________ Chassis No.: _________________

Registration No.: ____________________ Capacity: ___________________

Please check (✔):

The school bus service vehicle is roadworthy and safe.

The school bus service vehicle needs repair and improvement as follows:
______________________________________________________________________________
______________________________________________________________________________

___________________________________
Licensed/Authorized Mechanic
(Signature over Printed Name)

Address: ___________________________

Contact No.: ________________________

Date of Inspection: ___________________

__________________________________
Signature over Printed Name of Operator

Note: Use one (1) form per vehicle.