Kaizen Autosport 2021 Annual Technical Inspection Form

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1. Technical Car Ins p ection checkli s t to drive your car on track at VIR V e h i c l e On G r o u nd : S e a t s , B el t s , G l a ss , Li gh t s □ Seats are securely mounted and in good shape □ Seat belts functional and in good condition □ If so equipped, the safety harness is FIA or SFI certified and installed to manufacturer’s spec and within expiration date □ Vehicle glass in good condition, no damage □ If roll bar or cage is installed, it meets requirements for the event and vehicle type – owner must provide documentation Un d er Hoo d: B a t t e r y, H o s e s , Fl uid L e ve l s , Fuel S ys t e m To E ng in e □ Brake fluid levels checked and OK, changed in accordance with manufacturer’s specs □ No fluid leaks on any lines, oil, engine coolant, intercoolers □ Fuel lines in good condition, no leaks or structural corrosion anywhere, fuel filter(s) clamps on flax hose, no cracks or leaks □ Battery is firmly tied down, battery box used for remote battery. Positive terminal covered. □ Carburetor, fuel injection systems, injectors: no leaks □ Belts are in good condition S t e e r i n g , S u s p e n s i o n and B r a k e s □ Ball joints/swivel point: within wear limits, grease seals intact, attachments secure □ Idler arm, pitman arm, links & tie rod/link end: within wear limits, secure attachment, seals intact □ Bearings: hubs properly adjusted within manufacturer’s specs, cotter pins or locking devices secure □ General condition of system: springs, shocks, bushings, frame attachments, anti - sway mountings all OK □ Brake friction materials: pads or shoes greater than 50% of manufacturer’s thickness specs □ Calipers and/or brake cylinders: no leaks, operates freely, attachment hardware secure □ Steel and flexible brake lines: fittings, attachments, mounting and integrity all OK □ Brake lights functional B od y and U n d e r s i d e : E x h au s t and Fu el S ys t e m □ Body and chassis are secure with no rust perforations □ Exhaust system: no leaks at pipe flanges or joints, flanges, hanger and brackets securely mounted □ Exhaust pipe terminates to the side (behind driver) or rear of car, exhaust sound within limits of the event □ Gas tank or fuel cell: no leaks, attachment secure, filler cap and vent cap present □ Fuel lines: no leaks, secure routing. If fuel cell installed, roll over valve(s) are installed and working properly □ Gas cap closes properly Ti r e s and W h e e l s □ Tires: no cords showing, no cuts, no interference with body throughout range of motion □ Wheels and Tire Valves: in good visual condition with no cracks □ Tires are properly seated on wheels □ All lug nuts/studs are present and fully threaded for secure attachm ent 1131 North Paddock Lane, Alton, VA 24520 TEL: 919 - 741 - 7151 ` www.kaizenautosport.com Driver Name: Year: Make/Model: Is This Car a Convertible? □ YES □ NO If Yes, does it have a roll bar or roll cage that is at least 2” above your head? □ YES □ NO Vehicle/ Driver Information I certify that the above inspections have been conducted by qualified individual according to the guidelines set forth, and that all deficiencies have been corrected. I understand that I and I alone am liable for the condition and suitability of the vehicle. I release the inspector, grid inspectors, and Formula Experiences , LLC DBA Ka ize n Autosport from any liability arising from a failure of this vehicle for any reason, including failure of the i tems listed or not listed on this inspection form. I also certify that my required safety gear is in compliance with the VIR rules and regulations. Driver/Owner Signature:


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