Fillable Printable Driver Education Class D Vehicle Inspection Form

Driver Education Class D Vehicle Inspection Form

MINNESOTA DEPARTMENT OF PUBLIC SAFETY

PS 36009-04

DRIVER EDUCATION PROGRAM

CLASS D VEHICLE SAFETY INSPECTION

Minnesota Rules 7411.0850

Vehicle Owner’s Name

Name and Address of Driver Education Program Business Phone

Name and Address of Inspector Business Phone

Vehicle Information

Year Make Model

Vehicle Identification Number License Plate Number

The following items must be inspected. Each part not meeting operating specifications contained in the manufacturer’s

factory repair manual must be repaired.

(Inspector please mark the appropriate column.)

PASS REPAIRED

Accelerator (damaged, loose)

Belts (fan, power assist units)

Brakes: dual, parking (damaged, worn lines or linings)

Clutch

Doors (latches, locks, hinges, handles)

Drive train (damaged or loose)

Hood (latches, locks, hinges, handle)

Horn

Lights (head, tail, parking, brake)

Mirrors (rearview, inside, out si de right and left mirrors)

Mountings (motor, transmission, body)

Muffler (complete exhaust system)

Plates: license (attached, unobstructed)

Signs (visible, attached)

Sheeting assembly (damaged, worn, loose)

Seat belts (damaged, loose)

Steering assembly (damaged, loose)

Tires (cut, damaged, minimum tread depth of 1/16 inch)

Turn signals

Windshield: wipers, washers (unobstructed)

I certify that I am a manufacturer’s service representative, a mechanic for a licensed dealer for the vehicle, a certified technical or

vocational college mechanics instructor, or an automotive service excellence mechanic fully certified by a vocational or technical

school or college in all areas of vehicle inspection.

___________________________________________________ _______________________________

Inspector’s Signature Date

Return this form to: Driver and Vehicle Services, 445 Minnesota St., Suite 176, St. Paul, MN 55101-5176.