2. Vehicle Inspection Record
   This report must be completed when an operator accepts responsibility for a piece of apparatus. Completion of this form is the responsibility of the operator under the regulations of the Maryland State Department of Transportation. Anything marked "DEFICIENT" must have an explanation in the notes section at the bottom of the checkout. Any lights that are not functioning need to have the bulb number listed in the notes section.
4. Date*
   Date
5. Operator*
6. Apparatus *
8. Mileage *
9. License Plate *
10. On-Duty BC*
    -- Select One --BC HopkinsBC GrimBC CleckCaptain DaielloCaptain StoopsCaptain ChojnackiCaptain MurrayCaptain HenryCaptain Wagaman
12. Steering*

    1. Good
    2. Deficient
13. Air Pressure *

    1. Good
    2. Deficient
14. Parking Brake*

    1. Good
    2. Deficient
15. Fuel Level*
    -- Select One --Full>3/41/2-3/4<1/2
17. New Damage*

    1. Good
    2. Deficient
18. Knox Key*

    1. Good
    2. Deficient
19. Doors/Handles*

    1. Good
    2. Deficient
20. Windows/Mirrors*

    1. Good
    2. Deficient
22. Wipers*

    1. Good
    2. Deficient
23. Headlights*

    1. Good
    2. Deficient
24. Turn Signals*

    1. Good
    2. Deficient
25. Side Markers*

    1. Good
    2. Deficient
27. Tail Lights*

    1. Good
    2. Deficient
28. Brake Lights *

    1. Good
    2. Deficient
29. Reverse Lights*

    1. Good
    2. Deficient
30. Emergency Lights*

    1. Good
    2. Deficient
32. Federal Que*

    1. Good
    2. Deficient
    3. N/A
33. Electric Siren*

    1. Good
    2. Deficient
34. Vehicle Horn*

    1. Good
    2. Deficient
35. Air Horn*

    1. Good
    2. Deficient
    3. N/A
37. Instrument Panel*

    1. Good
    2. Deficient
38. Reflectors*

    1. Good
    2. Deficient
39. Reflective Triangles*

    1. Good
    2. Deficient
40. Heater*

    1. Good
    2. Deficient
42. Defroster*

    1. Good
    2. Deficient
43. Tire Condition*

    1. Good
    2. Deficient
44. On-Spot Chains*

    1. Good
    2. Deficient
    3. N/A
45. DEF*

    1. Good
    2. Deficient
    3. N/A
47. Daily Equipment Checks
49. SCBA*

    1. Good
    2. Deficient
50. Facepieces*

    1. Good
    2. Deficient
51. Spare Cylinders*

    1. Good
    2. Deficient
52. Small Tools*

    1. Good
    2. Deficient
54. Hand Lights*

    1. Good
    2. Deficient
55. Meter*

    1. Good
    2. Deficient
    3. N/A
56. EMS Equipment/CO Meter *

    1. Good
    2. Deficient
57. AED*

    1. Good
    2. Deficient
    3. N/A (RE-4 Only)
59. Smoke Detector Kits*

    1. Good
    2. Deficient
60. Portable Radios*

    1. Good
    2. Deficient
61. Traffic Vests*

    1. Good
    2. Deficient
62. EVAC Horn*

    1. Good
    2. Deficient
64. Booster Tank*

    1. Good
    2. Deficient
    3. N/A
65. Foam Tank*

    1. Good
    2. Deficient
    3. N/A
66. Foam Bucket*

    1. Good
    2. Deficient
    3. N/A
67. Scene Lights*

    1. Good
    2. Deficient
69. Generator*

    1. Good
    2. Deficient
    3. N/A
70. Quartz Lights*

    1. Good
    2. Deficient
71. Pump/Aerial*

    1. Good
    2. Deficient
72. Hose *

    1. Good
    2. Deficient
    3. N/A
74. Ground Ladders*

    1. Good
    2. Deficient
75. Thermal Imaging Camera*

    1. Good
    2. Deficient
    3. N/A
76. Mobile Data Terminal*

    (includes computer, stylus,gps,hotspot,charger)

    1. Good
    2. Deficient
    3. N/A
78. Extinguishers *

    1. Good
    2. Deficient
80. Notes
    Provide a detailed description of any deficiencies, including bulb numbers for the lights that are out.
82. I attest that this vehicle inspection record is accurate to the best of my knowledge. *
    -- Select One --YesNo
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit Submit and Print

* indicates a required field