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   MCI Inspection Report
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Inspection Report                                                            

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Repair Facility Contact Name:
Claim#

 

Order date & Time (24 hour) 

 

Contract #

Facility Name:

Address:

Address (cont):

City:

County:

State:

Zip / Postal Code:

Phone:

Phone 2:

Email:

Reason for Inspection

 

 

Inspection Data
~~~~~~~~~~~~~~~~
Adjuster: 

 

Agency Name:

 

Vehicle Data
Year, Make, Model

 

VIN Number (verify!)

 

Mileage

 

Inspection Date/Time/Time Zone (24 hour clock)

 

Labor Rate/Type

 

Engine Type:

 

Transmission/Model:

 

Wheel Drive Type, (i.e. 4-wheel, front wheel, etc.)

 

Fluid Levels & Condition
Engine Oil Level

 

Condition

 

Coolant Level

 

Condition

 

Transmission Level

 

Condition

 

Power Steering Level

 

Condition

 

Brake Fluid Level

 

Condition

 

Differential Fluid Level

 

Condition

 

Transfer Case Level

 

 

Miscellaneous Comments:

 

Commercial Use? Modifications? Collisions? If yes, why, what, when, how, etc

 

Tow Hitch? If yes, type.

 

Towed or Driven in?
 

 

Belts & Hoses

 

Overall Condition

 

Customer Complaint, Repair Order Number, Dated Opened, Shop Name on Repair Order

 

State of Assembly?

 

Any Recall TSB's, Oasis/Function 70, Parts Warranty?

 

Failed Components & Extent of Damage?

 

Cause of Failure

 

Recommendations for Repair

 

Inspector Name

 

   
         
 

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