WPS_2_Attach_18_Vehicle_Safety_and_Equipment_Inspection.xlsx

XLSX spreadsheet 56 KB Posted Jul 20, 2015

Attached to: The Worldwide Protective Services (WPS) 2 program provides comprehensive protective security services to support U. S. Department of State operations around the world.
Solicitation number: SAQMMA15R0282
Issued by: Department of State Office of Acquisition Management

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WPS 2 Attach 18 Vehicle Safety and Equipment Inspections Template

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Other files

File	Type	Posted
WPS_2_A011.pdf	PDF	Jul 29, 2015
WPS_2_A010_SF_30.pdf	PDF	Jul 23, 2015
WPS_2_A009_SF30.pdf	PDF	Jul 21, 2015
WPS_2_Revised_A008.pdf	PDF	Jul 20, 2015
WPS_2_Revised_Pricing_Spreadsheet_Larger_Cells_Table_7_and_8.xlsx	XLSX spreadsheet	Jul 20, 2015
WPS_2_A008_SF30.pdf	PDF	Jul 20, 2015
WPS_2_A007_SF_30.pdf	PDF	Jul 14, 2015
WPS_2_Q_ _A_Clarification.doc.docx	DOCX document	Jul 10, 2015
WPS_2_A006_SF_30.pdf	PDF	Jul 10, 2015
WPS_2_A005_SF_30.pdf	PDF	Jul 7, 2015
WPS_2_Revised_Pricing_Spreadsheet.xlsx	XLSX spreadsheet	Jul 6, 2015
WPS_2_Revised_Attachment_1.doc.docx	DOCX document	Jul 6, 2015
WPS_2_Revised_Attachment_14.doc.docx	DOCX document	Jul 6, 2015
WPS_2_A004.pdf	PDF	Jul 6, 2015
WPS_2_A003.pdf	PDF	Jul 2, 2015
WPS_2_Section_Changes_07_01_2015.doc.docx	DOCX document	Jul 2, 2015
WPS_2_Questions_and_Answers_07_01_2015.doc.docx	DOCX document	Jul 2, 2015
WPS_2_A002.pdf	PDF	Jul 2, 2015
WPS_2_A001.pdf	PDF	Jul 2, 2015
SAQMMA15R0282_(A001).pdf	PDF	Jun 22, 2015
WPS_2_Attachment_25.xlsx	XLSX spreadsheet	Jun 22, 2015
WPS_2_Attachment_26.xlsx	XLSX spreadsheet	Jun 22, 2015
WPS_2_Attachment_19.xlsx	XLSX spreadsheet	Jun 22, 2015
WPS_2_Attachment_24.docx	DOCX document	Jun 22, 2015
WPS_2_Attachment_21.xlsx	XLSX spreadsheet	Jun 22, 2015
WPS_2_Attachment_22.xlsx	XLSX spreadsheet	Jun 22, 2015
WPS_2_Attachment_23.xlsx	XLSX spreadsheet	Jun 22, 2015
WPS_2_Attachment_20.xlsx	XLSX spreadsheet	Jun 22, 2015
WPS_2_Section_L_Matrix_Attachment_A_and_Questionnaire_Attachment_B.zip	ZIP file	May 21, 2015
WPS_2_Attachments_(2).zip	ZIP file	May 18, 2015
WPS_2_Pricing_Spreadsheet.xlsx	XLSX spreadsheet	May 18, 2015
WPS_2_Restricted_Access_Request_Form.doc.docx	DOCX document	May 18, 2015
WPS_2_Solicitation.zip	ZIP file	May 18, 2015

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Instructions and Example

Instructions

Fill in each box

Date must be in eight digit format. Example; February 8th, 2015 is 02/08/15

Sign and print form after accepting vehicle condition - do not sign for vehicle with undocumented damage

Record total miles before returning vehilce with keys and form to vehicle supervisor

Example Vehicle Safety and Equipment Inspection Checklist
DOS-Vehicle Tracking No.	License Plate		Make/Model		Year	Inspection Date
1234567	LETSGO		Chevy/Suburban		2012	02/08/15
Inspection Performed By (Print and Sign):				Robert Jones Robert Jones
Beginning Odometer Reading:		Ending Odometer Reading:			Total Mileage:
36819		37005			37005
		Condition Okay	Attention Needed		DESCRIPTION
Under Hood
Note: Refer to Tier 1 Maintenance Cable when Performing Engine Checklist Items. Mark N/A when not applicable. Refer to Checklist Criteria Workseet to determine subjective conditions.
Windshield washer fluid level
Transmission fluid level and condition
Coolant level
Engine oil level and condition				looks dark-schedule change soon?
Power steering fluid level
Brake fluid level and condition
Battery(s) secured, cables serviceable, clean, and tight
All reservoir caps secure
Belts and hoses are serviceable
Spark plug wires serviceable and tight
Interior
No Check Engine or other Warning Lights
Interior is clean				Dash d usty
Parking brake operates
Emergency brake operates				N / A
Seat condition and seatbelt operation
Defroster, A/C system operates
Mirrors operate
Windshield wipers operate
Horn sounds
Doors close properly (aligned)
Gauge readings are "normal range"
Fuel tank filled
Auxillary power outlet operates
Vehicle Equipment - See WPS II Section C, Attachment 06 for Details
BFT operates
Cam 1 operates
Cam 2 operates
Communication radio operates
Sirens and emergency lights operate
Spare tire serviceable, properly inflated, and secured
Vehicle Accident Package available
Placards/Passes/Cards available
Flashlights - 2
Emergency Extraction Equipment - See WPS II Section C, Attachment 06 for Details
Halligan bar
Sledge hammer
Vehicle extraction tool kit
Tow strap - 2
Rated floor jack
1/2 Cordless impact wrench
Partner cut-off saw
Chopper blade for cut-off saw
Emergency Tool Kit - See WPS II Section C, Attachment 06 for Details
Motor oil, 1 qt. - 2
Antifreeze, 1 gal.
Radiator sealant, 11 oz.
Spray bottle of washer fluid
Set of screwdrivers, sm. med., and lg. (flat head)
Set of screwdrivers, sm. med., and lg. (Phillips)
Lineman pliers
8" Vise Grip
8" Adjustable wrench
Rescue tape - 2 rolls
Assorted replacement hose clamps - 5
Fan belt replacement Kit
2-part solid Epoxy
Spare fuses - 2 or 3 of each type
12" jumper cables
Crimping tool kit
Electical tape - 2 rolls
10' loop of #12 Guage Wire
Spare headlight and taillight bulbs - 2 ea.
5lb Class A, B, C Fully Charged Fire Extinguisher
Tool bag
Vehicle Trauma Kit (GTM Lock and Tag)
Asherman Chest Seal - 2
Oral Airway, Lg. - 2
Cloth Tape, 2" - 3
Combine Dressing, 5x9" - 3
Emergency Fast Action Card
EMT Trauma Shears, 7 1/2"
Hemostats
Israeli Bandage 4" - 2
Israeli Bandage 6" - 2
IV Normal Saline INJ, 500cc - 2
IV Start Kit, complete -2
Krinkle Gauze - 3
Kerlix, 4.5" - 3
Needle Decompression Kit, 14ga x 3.25"
Nitrile Gloves, Per Packed Pair - 3
One Handed Tourniquet-CAT
Petrolatum Gauze, 3x9-inch
SAMS Splint - 2
Sanidex Wipes
Swift Wrap Elastic, 4” x 5 yds - 2
Swift Wrap Elastic, 6” x 5 yds
Quick-Clot Combat Gauze
Trauma Dressing, 10x30-inch
Triangular Bandage, 37-inch (muslin) - 2
Vehicle Trauma Bag
Exterior Vehicle
Windows and doors (damage, working)				chip on left back door window
License plates current and secured
Brake lights function
Back up Lights function
Turn signals function
Head lights (low and high beam) function
Parking lights function
Emergency flashers function
Fuel Cap secured
Tires have acceptable tread and correct pressure when vehicle loaded
Lug nuts secured
Body damage documented-do not use vehicle if damage is more than cosmetic				dent - left rear quarter panel
Exterior clean-especially windows
Mirrors function
FULLY DESCRIBE ANY VEHICLE DAMAGE OR MECHANICAL FAILURE BELOW:
Dust on dash and instrument panel, rear door window has small chip, left rear fender has dent near tailight

Inspection Checklist

Vehicle Safety and Equipment Inspection Checklist
DOS-Vehicle Tracking No.	License Plate	Make/Model	Year	Inspection Date

Inspection Performed By (Print and Sign):
Beginning Odometer Reading:	Ending Odometer Reading:	Total Mileage:

	Condition Okay	Attention Needed	DESCRIPTION
Under Hood
Note: Refer to Tier 1 Maintenance Cable when Performing Engine Checklist Items. Mark N/A when not applicable. Refer to Checklist Criteria Workseet to determine subjective conditions.
Windshield washer fluid level
Transmission fluid level and condition
Coolant level
Engine oil level and condition
Power steering fluid level
Brake fluid level and condition
Battery(s) secured, cables serviceable, clean, and tight
All reservoir caps secure
Belts and hoses are serviceable
Spark plug wires serviceable and tight
Interior
No Check Engine or other Warning Lights
Interior is clean
Parking brake operates
Emergency brake operates
Seat condition and seatbelt operation
Defroster, A/C system operates
Mirrors operate
Windshield wipers operate
Horn sounds
Doors close properly (aligned)
Gauge readings are "normal range"
Fuel tank filled
Auxillary power outlet operates
Vehicle Equipment - See WPS II Section C, Attachment 06 for Details
BFT operates
Cam 1 operates
Cam 2 operates
Communication radio operates
Sirens and emergency lights operate
Spare tire serviceable, properly inflated, and secured
Vehicle Accident Package available
Placards/Passes/Cards available
Flashlights - 2
Emergency Extraction Equipment - See WPS II Section C, Attachment 06 for Details
Halligan bar
Sledge hammer
Vehicle extraction tool kit
Tow strap - 2
3 ton service/floor jack
1/2 Cordless impact wrench
Partner cut-off saw
Chopper blade for cut-off saw
Emergency Tool Kit - See WPS II Section C, Attachment 06 for Details
Motor oil, 1 qt. - 2
Antifreeze, 1 gal.
Radiator sealant, 11 oz.
Spray bottle of washer fluid
Set of screwdrivers, sm. med., and lg. (flat head)
Set of screwdrivers, sm. med., and lg. (Phillips)
Lineman pliers
8" Vise Grip
8" Adjustable wrench
Rescue tape - 2 rolls
Assorted replacement hose clamps - 5
Fan belt replacement Kit
2-part solid Epoxy
Spare fuses - 2 or 3 of each type
12" jumper cables
Crimping tool kit
Electical tape - 2 rolls
10' loop of #12 Guage Wire
Spare headlight and taillight bulbs - 2 ea.
5lb Class A, B, C Fully Charged Fire Extinguisher
Tool bag
Vehicle Trauma Kit (GTM Lock and Tag)
Asherman Chest Seal - 2
Oral Airway, Lg. - 2
Cloth Tape, 2" - 3
Combine Dressing, 5x9" - 3
Emergency Fast Action Card
EMT Trauma Shears, 7 1/2"
Hemostats
Israeli Bandage 4" - 2
Israeli Bandage 6" - 2
IV Normal Saline INJ, 500cc - 2
IV Start Kit, complete -2
Krinkle Gauze - 3
Kerlix, 4.5" - 3
Needle Decompression Kit, 14ga x 3.25"
Nitrile Gloves, Per Packed Pair - 3
One Handed Tourniquet-CAT
Petrolatum Gauze, 3x9-inch
SAMS Splint - 2
Sanidex Wipes
Swift Wrap Elastic, 4” x 5 yds - 2
Swift Wrap Elastic, 6” x 5 yds
Quick-Clot Combat Gauze
Trauma Dressing, 10x30-inch
Triangular Bandage, 37-inch (muslin) - 2
Vehicle Trauma Bag
Exterior Vehicle
Windows and doors (damage, working)
License plates current and secured
Brake lights function
Back up Lights function
Turn signals function
Head lights (low and high beam) function
Parking lights function
Emergency flashers function
Fuel Cap secured
Tires have acceptable tread and correct pressure when vehicle loaded
Lug nuts secured
Body damage documented-do not use vehicle if damage is more than cosmetic
Exterior clean-especially windows
Mirrors function
FULLY DESCRIBE ANY VEHICLE DAMAGE OR MECHANICAL FAILURE BELOW:

&"Arial,Regular"&10Vehicle Safety and Equipment Inspection Checklist, Section C, Appendix H

Revision 0 &P of &N 8 Feb 15

Checklist Criteria

Checklist Criteria				12 FAM 380
Number	Item	Correct Indications	Problems
11	Transmission fluid	Clear	Color pink or dark maroon
		Red	Particles in fluid
		No burning odor	Burned odor
		No particles in fluid
13	Engine oil	Clear	Brown or black color
		Amber color	Visible particles
		No burning odor	Burned odor
		No particles in oil
15	Brake fluid	Clear	Wrong color
		Pale amber/colorless (DOT 3, 4)	Particles in fluid
		Pale purple (DOT 5)	Congealed material
16	Battery	No case cracks, leaks	Excessive corrosion
		Cables not badly corroded or frayed
18	Belts, hoses	No hose cracks or punctures	Burned rubber odor
		No cracks across the belt width	Residue wipes off belt or hose
			Cross cracking shows near failure
19	Spark plug wires	Wire insulation is clean, intact	Insulation burned, or worn
30	Doors	Door gap when closed is even	Door sagging
		Door latches correctly

File details come from the government source that posted it. Updated Nov 14, 2017.