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Smog Check Form

This smog checklist can be used by smog technicians to report the measured vehicle emissions and register if they are within tolerable levels according to regulations. Register measured Hydrocarbons (HC), Carbon Monoxide (CO), and Oxides of Nitrogen (NOx) to decide if the vehicle passed or failed the smog check.

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Smog Check Form

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Smog Check

General Information

VIN number:

License plate number:

Mileage:

Exhaust configuration, when indicated (single or dual):

Vehicle model designation:

Vehicle make:

Body type:

Certification type:

Transmission type:

BAR referee label number:

Fuel type:

Number of cylinders:

Engine size:

Engine make:

Engine year

Attach a photo of vehicle:

Exhaust Emission Test Result

Hydrocarbons in ppm (HC):

Oxides of nitrogen in ppm (NOx):

Carbon monoxide percentage (CO):

COMPLETION

Comments:

Name and signature of technician:

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