California Vehicle Inspection Form for Uber

CALIFORNIA VEHICLE INSPECTION REPORT (RIDESHARE)

INSTRUCTIONS: This form must be completed by a certified mechanic or a licensed vehicle inspection facility. All items must be inspected to ensure the vehicle meets the safety and operational standards required for Transportation Network Company (TNC) operations in the State of California.

I. VEHICLE INFORMATION

• Make: [___________]
• Model: [___________]
• Year: [___________]
• License Plate Number: [___________]
• Vehicle Identification Number (VIN): [_________________________________]
• Current Odometer Reading: [___________]

II. INSPECTION CHECKLIST

Mark (P) for Pass, (F) for Fail, or (N/A) for Not Applicable.

III. INSPECTOR CERTIFICATION

I, the undersigned inspector, certify that I have conducted a comprehensive safety inspection of the vehicle described above on this date. I am a licensed mechanic or authorized representative of a qualified inspection facility.

• Overall Vehicle Condition: [ ] Pass [ ] Fail
• Inspection Facility Name: [_________________________________]
• Facility Address: [_________________________________]
• Inspector Name (Printed): [_________________________________]
• License/Certification Number: [_________________________________]
• Date of Inspection: [_____/_____/20___]

Signature of Inspector:

IV. DRIVER ACKNOWLEDGMENT

I certify that the vehicle listed above is the vehicle I intend to operate for TNC (Uber) services. I understand that I am responsible for maintaining the vehicle in safe operating condition at all times, including adhering to all California Vehicle Code requirements.

• Driver Name (Printed): [_________________________________]

Signature of Driver:

Date: [_____/_____/20___]

Note: This document serves as a record of vehicle condition. It does not replace the requirement for annual registration or mandatory state-level compliance checks. Maintain a copy of this completed form for your records.