Annex 4B — Safety Inspection Record (PSV)

Job Number:

Vehicle Details

Part 1A — Inside Vehicle

Key:

✓ Satisfactory

× Safety Item Defect

R Repair Required

N/A Not Applicable

M Monitor

Chk	IM Ref	Item Inspected
1	18	Driver’s Seat
2	3	Seat Belts and Supplementary Restraint Systems
3	22	Mirrors and Indirect Vision Devices
4	23	Glass and View of the Road
5	24	Accessibility Features
6	25	Windscreen Washers and Wipers
7	26	Speedometer / Tachograph
8	27	Horn
9	28	Driving Controls / Warning Lamps (inc ADAS)

Chk	IM Ref	Item Inspected
10	30	Steering Control
11	37	Service Brake Pedal
12	38	Service Brake Operation (inc ABS/EBS & ESC)
13	34	Pressure / Vacuum Warning and Build Up
14	36	Hand Lever Operating Mechanical Park Brakes and Electronic Park Brake Control
15	39	Hand Operated Brake Control Valves
16	17	Driver’s Accommodation
17	21	Interior of Body, Passenger Entrance, Exit Steps and Platforms
18	OBD	Diagnostic trouble code (DTC) check

Part 1B — Ground level & under vehicle

Chk	IM Ref	Item Inspected
1	1	Registration Plates
2	16	Passenger Doors, Driver’s Doors & Emergency Exits
3	19	Security of Body
4	20	Exterior of Body including Luggage Compartments
5	5	Exhaust Emissions / MIL
6	6	Road Wheels and Hubs
7	7	Size and Type of Tyres
8	8	Condition of Tyres (including age and date code)
9	9	Bumper Bars
10	10	Spare Wheel and Carrier
11	14	Wings & Wheel Arches
12	11	Vehicle to Trailer Coupling
13	41	Condition of Chassis
14	33	Speed Limiter
15	42	Electrical Wiring and Equipment
16	43	Engine and Transmission Mountings

Chk	IM Ref	Item Inspected
17	44	Oil and Waste Leaks
18	45	Fuel Tanks and System
19	46	Exhaust Systems and Nuisance
20	54	Steering
21	48	Suspension
22	53	Axles, Stub Axles and Wheel Bearings
23	57	Transmission
24	58	Additional Braking Devices
25	59	Brake Systems and Components
26	62	Reflectors and Rear Markings
27	63	Lamps
28	66	Direction Indicators & Hazard Warning Lamps
29	67	Aim of Headlamps
30	74	Other dangerous defects (ancillary equipment)
31	-	Safety recall check

IM8 — Condition of tyres as presented

Enter tread depth (mm) and pressure (psi). Put N/A if not applicable

C — Braking performance assessment

D — Brake temperature assessment

Ambient air temperature (°C)

Chk No	IM Ref	Item Inspected
52	71	Service Brake Performance
53	72	Secondary Brake Performance
54	73	Parking Brake Performance

Axle RBT results

Imbalance (kg)
Time Lag
Ovality (Front steer)
Bind (kg)
Max Force (kg)
Parking (kg)
Axle 1 - weight N/S / O/S
Axle 2 - weight N/S / O/S
Axle 3 - weight N/S / O/S
Axle 4 - weight N/S / O/S
EBPMS braking performance value
Assessment period
Overall Result

Inspector comments

Part 2 — Comments on faults found

Faults numbered here are Drivers Defect Report items (auto-populated)

Signature of inspector

Name of inspector

Part 3 — Action taken on faults found

Auto-populated Fault No column will match generated fault IDs. Add action details below.

Chk No	Fault No	Action taken on fault	Rectified By

Part 4 — Declaration

“I consider that the above defects have been rectified satisfactorily and this vehicle or trailer is now in a safe and roadworthy condition.”

Form generated client-side. Click submit to download a multi-page PDF replica of this page.