New default icon

Available on

Apple Android Windows

Mobility Assistance Vehicle Survey Report - Department of Health (New Jersey) Mobile App

Easily file your Mobility Assistance Vehicle Survey Report using this handy digital app. Digital check fields allow you to tick of a simple Yes or No response to each of the items grouped under the following categories: administrative information, general vehicle requirements, vehicle markings, required ramp or lift, and more.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Mobility Assistance Vehicle Survey Report - Department of Health (New Jersey) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Provider Name

  • Ico textbox

    Name on Vehicle

  • Ico textbox

    License Plate No.

  • Ico textbox

    VIN Number

  • Ico textbox

    Vehicle Rec.

  • Ico date

    Survey Date

  • Ico dropdown

    Application and check or money order received.

  • Ico dropdown

    Application information matches vehicle

  • Ico textbox

    Model Year

  • Ico integer

    Mileage

  • Ico checkbox

    Valid DMV registration

  • Ico date

    Exp:

  • Ico checkbox

    Valid Insurance card -

  • Ico date

    Exp:

  • Ico checkbox

    Valid passing DMV sticker

  • Ico date

    Exp:

  • Ico checkbox

    Tires do not show signs of abnormal wear

  • Ico checkbox

    Exhaust system free of loose, or leaking joints,holes, leaking seams or patches

  • Ico checkbox

    Tail pipe extends beyond body and is not pinched or damaged

  • Ico checkbox

    All seats and wheelchairs have approved auto- type seat belts: seatbelt attached to wheelchair

  • Ico checkbox

    Glazing free of cracks, sharp edges, discoloration

  • Ico checkbox

    Heater - A/C working appropriately

  • Ico checkbox

    All door and window gaskets in good condition

  • Ico checkbox

    Full trade name 4" high on each side (as it appears on the vehicle license)

  • Ico checkbox

    Veh rec # on each side and rear 3" high

  • Ico checkbox

    8" Symbols of access for the handicapped on both sides and rear

  • Ico checkbox

    There are no emergency lights / siren / stretcher

  • Ico checkbox

    "No smoking" signs in patient and driver’s areas

  • ...and More!

Related Apps... and they're all free for GoCanvas subscribers!

App Name

MOT Inspection Manual Class 3,4,5 &7 ...

The MOT Inspection Manual Class 3,4,5 &7 (UK): Brake Performance Testing mobile app sets out the MOT testing procedu...

App Name

Drum Brake System Passenger / Light-D...

The purpose of the Drum Brake System Passenger/Light-Duty Vehicle Inspection Standard (Canada) mobile app is to ensure tha...

App Name

Monthly Auto Lift Inspection

Use the Monthly Auto Lift Inspection mobile app to complete your Monthly Auto Lift Inspection. The app makes it easy to ch...

App Name

Heavy Truck Inspection

This Heavy Truck Inspection Mobile App is used as a guide for conducting a courtesy inspection for heavy trucks and diesel...

App Name

Electric Vehicle Delivery Checklist

Congratulations on your decision to buy an electric car! The Electric Vehicle Delivery Checklist mobile app will guide you...

App Name

17 Point de Tracteur / Remorque d'Ins...

Compléter rapidement ce 17 Point de Tracteur / Remorque d'inspection de Sécurité dans le domaine sur un appareil mobile. C...

App Name

MOT Inspection Manual Class 3,4,5 &7 ...

The MOT Inspection Manual Class 3,4,5 &7 (UK): Hand Operated Brake Control Valves mobile app sets out the MOT testin...

App Name

Electronic Stability Control System P...

The purpose of the Electronic Stability Control System Passenger/Light-Duty Vehicle Inspection Standard (Canada) mobile ap...

More Information


  • Creator: PPS
  • Language: English
  • Country: United States of America
  • Type: Surveys
  • Tags:
  • Categories:
    no categories defined yet.

Recent Blog Posts