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ABQ
:
(505) 256-1610
Las Cruces
:(575) 815-3054
Rio Rancho
:(505) 917-9344
Santa Fe
:(505) 469-0510
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Drivers please complete the form below
Vehicle Maintenance Form should be filled out at the beginning of a shift.
Driver Name
(Required)
First
Last
Manager Name
(Required)
First
Last
Vehicle License Plate
Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Date
(Required)
MM slash DD slash YYYY
Vehicle Location
(Required)
Albuquerque (Main)
Rio Rancho
Santa Fe
Las Cruces
Vehicle Route
(Required)
East Mountains
South of ABQ
West of ABQ
NW ABQ
NE ABQ
SE ABQ
SW ABQ
Rio Rancho
Las Cruces
Santa Fe
Discharges/ In-town
Vehicle Lights Check
(Required)
Headlights / Brake Lights / Turn Signals
All Vehicle Lights work
One or more lights are not functioning
Oil Check
(Required)
Full
Half Full
Quarter
Empty
I have contacted my manager about the oil
(Required)
Yes, I have contacted my manager
No, I have yet to contact my manager
Coolant Check
(Required)
Full
Half Full
Quarter
Empty
I have contacted my manager about the coolant
(Required)
Yes, I have contacted my manager
No, I have yet to contact my manager
Current Vehicle Mileage (Odometer)
(Required)
Gas / Fuel level
(Required)
Full tank
3/4 Full
1/2 Full
1/4 Full
Empty
Comments on vehicle
Please let us know any issues with vehicle. If no issue leave blank
Driver Consent
(Required)
I take responsibility for the vehicle and consent the information provided is both timely and correct. I understand that falsifying information or not submitting on time can result in a written warning and if not resolved can lead to termination.
I agree to the driver consent policy.
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Home
All Products
Bath Safety
Compression Wear
Men
Women
General DME
Home Respiratory
Portable Concentrators
Mobility
Wheelchairs
Standard
Light-weight
Ultra light-weight
Bariatric
Power Mobility
Sleep Therapy
CPAP
Stairlift
Lift Chairs
About Us
FAQ – Frequently Asked Questions
Contact Us
Employment
Sleep Therapy Solutions
Rentals
Online Bill Pay
Public Disclosure
Shop