Vehicle Fault Report

1

Todays Date* This field is required

Date

Month

Day

Year

Hour

Minutes

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2

VEH. MAKE/MODEL* This field is required(vehicle or Trailer with fault)

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3

Year of Vehicle* This field is required(vehicle or Trailer with fault)

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4

Are you the Driver of the Vehicle?

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5

Your Full Name* This field is required

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6

DRIVERS LIC #* This field is required

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7

LIC STATE* This field is required

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8

Contractor/Company Name* This field is required

Vehicle Owner

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9

Contractor Phone Number

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10

Detailed Decription of Fault* This field is required

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11

Upload photo Take of photo of any visible faults detected

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12

Upload photo 2nd photo if required

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13

Does the fault require immediate attention?* This field is required

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14

If the fault detected requires immediate attention then please ensure you refrain from driving and address the issue immediately. This may include calling the vehicle owner, LFT Despatch and/or a mobile service repair person.

Please DO NOT at any stage drive a motor vehicle, Truck or tow a Trailer that you believe is unsafe or may have a high risk factor.

Major faults include but are not limited to any fault detected in regards to suspension, brakes and steering.

LFT DESPATCH ( 0401 671 563)

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15

Please give reason if you believe the repair can be monitored only for now?* This field is required(Only defer a repair if it is not directly related to a safety issue or poseing a high risk )

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16

When do you belive the fault should be checked again?* This field is required(1 week / 1,000km / before next scheduled run ?)

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17

Signature* This field is required

Clear

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