Date:
        __________________________

Performed By:
                       ____________________________

Actual Mileage:
                        ___________________________

ITEM

Action

NOTES

(Information such as type of oil, spark plugs, oil filters, etc. 
Also, keep/staple receipts for records

Air Cleaner

Replace

Engine Idle Speed

Inspect

Evaporative Emission Control
System

Inspect

Brake Fluid

Replace

Brake Pad Wear

Inspect

Clutch Fluid

Replace