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4 4 4 4 4 4 4 x x x \ x x x \ x x x d d d d d d MOTORCYCLE SAFETY INSPECTION
Name: _________________________ Unit: ______________________Ph#:_________
Year/Make/Model Motorcycle: _____________________________________________
Drv. Lic#/State/Exp: _____________________________ Lic. Plate#:______________
Base Sticker #/Exp:_______________________ Safety Course Date:______________
Insurance Company/Exp:__________________________________________________________
Vehicle Inspection
Brakes: Front / Rear PASS FAIL Headlight/Taillight: PASS FAIL
Mirrors (2 req): PASS FAIL Brake Light: PASS FAIL
Muffler: PASS FAIL Turn Signals (4 req): PASS FAIL
Chain Guard: PASS FAIL Horn: PASS FAIL
Front Fender: PASS FAIL Lic.Plate Mount/light PASS FAIL
Rear Fender: PASS FAIL Tire Condition 2/32: PASS FAIL
Required Rider Gear
Full Fingered Gloves: PASS FAIL Foot Gear: PASS FAIL
Jacket / Long Sleeves: PASS FAIL DOT Helmet: PASS FAIL
Pants: PASS FAIL
Eye Protection: PASS FAIL
Inspected By: ___________________________________________ Date: ___________
Rider Signature: ________________________________________ Date: ____________
Vehicle Inspection
Clarification
Brakes: Front / Rear : Firm application, no leaks, no excessive wear of pads/discs.
Headlight/Taillight: High and Low beams, rear running light.
Mirrors (2 req.): DOD requirement regardless of motorcycle age.
Brake Light: Activates with both front lever and rear brake pedal application.
Mufflers: DOD requirement. Straight pipes must have baffling. Sound cannot be excessive (below 85 db).
Turn Signals (4 req.): DOD requirement regardless of motorcycle age. Must be visible from front/rear of motorcycle. Must be DOT approved.
Chain Guard: Chain/Belt drives must be guarded.
Horn: Must be of clear, audible sound.
Front Fender: Must have one.
Rear Fender : Must have one.
License Plate & Mount: Plate must be clearly visible from rear of motorcycle. Must be illuminated with clear (white) light.
Tire Condition: Minimum tread of 1/32. No dry rot (cracking/splitting)
Required Rider Gear
Clarification
Full Fingered Gloves: No exposed skin from wrist to fingers. No half-gloves.
Foot Gear: Must be of leather construction with defined heel. No tennis shoes.
Jacket / Long Sleeves: Jacket not required if shirt is long sleeved. Utility uniform always sleeves-down. Only rider-designed jackets worn over any uniform (black or brown).
DOT Helmet: DOT/ANSI/Snell approved rating. No metal spikes or plastic fasteners.
Pants: No shorts or sweat-pants.
Appropriate Eye Protection: Face shield or eye encapsulating, shatter-resistant goggles or glasses. No sunglasses.
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