Vehicle Inspection & Training Confirmation

Interlock Installers Name *

First

Last

Service Centre State *

Interlock Participants Name *

First

Last

Date of Inspection *

Vehicle Registration Plate *

Acknowledgement *

ACCEPTABLE CONDITION – I acknowledge that I have inspected the below participants vehicle and found it to be acceptable.
I acknowledge that I have inspected the below participants vehicle and include specific condition notes below.
UNACCEPTABLE CONDITION – I note this vehicle condition is unacceptable and have not completed the interlock installation.

Optional

I have informed the participant that installation of the ignition interlock into the above stated vehicle may require screwing into the vehicle’s dash in order to properly secure the interlock in accordance with vehicle safety rules and regulations.

Vehicle Condition Notes

Add any notes on the vehicles condition at installation.

Training Confirmation *