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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

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

Included Features

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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!

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