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

Engine Oil

Replace

Engine Oil Filter

Replace

Engine Idle Speed

Inspect

Brake System

Inspect

Nuts, Bolts, Fasteners

Inspect

Steering Head Bearings

Inspect