Licensed Vehicle Tester
Corrective Action Response Sheet
Please email this form to: [email protected] or Fax to (03) 9811 8248
LVT No. EX
Date of Audit
D
D M M
Y
Y
Y
Y
Licence Name
I have had a VicRoads Audit and the following matters that were found have been attended to:
Non Conformances
Issue
I
Action Taken
being the holder/representative of the licence indicated above hereby declare
that I have taken the above listed action(s) to resolve the non-conformance(s) identified by an Officer of VicRoads. Where necessary I have attached
invoices or photographs as proof of my compliance.
D
Signature of Licence Holder/Representative
D M M
Y
Y
Y
Y
Date Signed
Please find attached/Included
Telephone: 13 11 71 TTY (for hearing impaired): 1300 652 321 Website: vicroads.vic.gov.au
VRPINXXXXX 11.11
VRPIN02857 12.11-V1 Authorised and published by VicRoads - 60 Denmark Street, Kew, Victoria, 3101. ABN 61 760 960 480
No.