PASS FAIL

Date:

Mechanic License #:

Signature:

Printed Name:

MECHANIC - I HEREBY CERTIFY THIS REPORT IS COMPLETE AND ACCURATE

COMMENTS

Muffler and exhaust systemTires, including tread depth

MCL 257.2109 (1) A limousine carrier or taxicab carrier shall not operate a limousine or taxicab, and a transportation network company shall not allow a transportation network company driver to accept trip requests through that transportation network company's digital network, unless the limousine, taxicab, or personal vehicle has undergone a safety inspection conducted annually by a mechanic licensed by this state before being used to provide transportation services. Each limousine carrier and taxicab carrier shall maintain, and each transportation network company driver shall provide to the transportation network company, documentation of the inspection required by this section showing that all of the following vehicle components were inspected:

Interior and exterior mirrorsSafety beltsDefrosting system

Front seat adjustment mechanismDoorsTurn signal lightsHornSpeedometerBumpers

WindshieldRear window and other glassWindshield wipersHeadlightsTaillightsBrake lights

CARRIER INFORMATION

VEHICLE INFORMATION

INSPECTION OF VEHICLE COMPONENTS:

Foot brakesParking brakesSteering mechanism

VIN#:LICENSE PLATE NO:

WORKSHEETVEHICLE SAFETY INSPECTION

AUTHORITY: 2016 PA 345

MAKE: MODEL: YEAR:

CARRIER NAME:

CARRIER ADDRESS:

(10/19)Page 1 of 1

Corporations, Securities & Commercial Licensing Licensing Division

P.O. Box 30018, Lansing, MI 48909517-241-9221

www.michigan.gov/tnc

MCL 257.2109 (2) The vehicle inspections described in this section are subject to audit by the department at any time.

CITY: STATE: MI ZIP:

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