Attachment-J.2 VehicleConditionReport.pdf

Attachment‐J.2

REPORT OF VEHICLE CONDITION

Contract Number: Date:

NHTSA Number: Test Lab:

This vehicle was inspected upon delivery at the laboratory and was found to contain all the equipment and options listed on the vehicle’s Monroney label. This form should be submitted to NCAP within 2 working days of the vehicle arrival. Any and all variances should be noted. NCAP should be notified immediately if the received vehicle is not in good working order or is damaged. Submission of this form acknowledges that the vehicle was received in good working order and was undamaged.

Model Year NCAP Test Type

Make Transmission

Model VIN

Body Style Body Color

Engine Type Delivery Date

Final Drive Odometer Reading

# Seating Positions Dealer

VEHICLE RESTRAINTS AS EQUIPPED – CHECK ALL THAT APPLY

Frontal Air

Bag Side Torso Air Bag

Side Curtain Air

Bag

Knee Air Bag

Pre‐ tensioner

Other Air Bag

(Specify)

Driver

Right Front Passenger

Left Rear Passenger

Center Rear Passenger

Right Rear Passenger

Other Positions

PLEASE LIST OTHER PERTINENT INFORMATION BELOW:

RECORDED BY: DATE:

REPORT OF VEHICLE CONDITION (CONTINUED)

POST‐TEST CONDITION

Remarks:

Equipment that is no longer on the test vehicle:

Explanation for equipment removal:

Left Front –

Driver Right Front – Passenger

Left Rear – Passenger

Right Rear – Passenger

Is seat adjustable along track?

Is seat back adjustable?

Is seat damaged or deformed?

Is window operable?

Does door open and close?

Is seat air bag deployed?

Is curtain air bag deployed?

Is headliner or pillar trim damaged?

Describe the nature of any damage and if the damage is repairable/replaceable:

RECORDED BY: DATE: