Fillable Printable Driver Education Class D Vehicle Inspection Form
Fillable Printable Driver Education Class D Vehicle Inspection Form
![Driver Education Class D Vehicle Inspection Form](/resources/formfile/images/gov1218/driver-education-class-d-vehicle-inspection-form-page1.png)
Driver Education Class D Vehicle Inspection Form
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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.