ANNUAL VEHICLE INSPECTION REPORT

REPORT NUMBER

FLEET UNIT NUMBER

DATE

MOTOR CARRIER OPERATOR

INSPECTOR'S NAME (PRINT OR TYPE)

ADDRESS

THIS INSPECTOR MEETS THE QUALIFICATION REQUIREMENTS IN SECTION 396.19.

• YES

CITY, STATE, ZIP CODE

VEHICLE IDENTIFICATION (
) AND COMPLETE

• LIC. PLATE NO.

• VIN

• OTHER

VEHICLE TYPE

• TRACTOR

• TRAILER

• TRUCK

• OTHER

INSPECTION AGENCY/LOCATION (OPTIONAL)

Service Brakes

• Yes
• No
• N / A

Parking Brake System

• Yes
• No
• N / A

Brake Drums or Rotors

• Yes
• No
• N / A

Brake Hose

• Yes
• No
• N / A

Brake Tubing

• Yes
• No
• N / A

Low Pressure Warning Device

• Yes
• No
• N / A

Tractor Protection Valve

• Yes
• No
• N / A

Air Compressor

• Yes
• No
• N / A

Electric Brakes

• Yes
• No
• N / A

Hydraulic Brakes

• Yes
• No
• N / A

Vacuum Systems

• Yes
• No
• N / A

Fifth Wheels

• Yes
• No
• N / A

Pintle Hooks

• Yes
• No
• N / A

Drawbar/Towbar Eye

• Yes
• No
• N / A

Drawbar/Towbar Tongue

• Yes
• No
• N / A

Safety Devices

• Yes
• No
• N / A

Saddle-Mounts

• Yes
• No
• N / A

Any exhaust system determined to be leaking ata point forward of or directlybelow the driver/sleepercompartment.

• Yes
• No
• N / A

A bus exhaust systemleaking or discharging tothe atmosphere in violationof standards (1), (2) or (3).

• Yes
• No
• N / A

No part of the exhaust system of any motor vehicleshall be so located aswould be likely to result inburning, charring, ordamaging the electricalwiring, the fuel supply, orany combustible part of themotor vehicle

• Yes
• No
• N / A

Visible leak

• Yes
• No
• N / A

Fuel tank filler cap missing

• Yes
• No
• N / A

Fuel tank securelyattached

• Yes
• No
• N / A

All lighting devices andreflectors required by Section393 shall be operable

• Yes
• No
• N / A

Part(s) of vehicle orcondition of loading suchthat the spare tire or anypart of the load or dunnagecan fall onto the roadway

• Yes
• No
• N / A

Protection against shifting cargo

• Yes
• No
• N / A

Steering Wheel Free Play

• Yes
• No
• N / A

Steering Column

• Yes
• No
• N / A

Front Axle Beam and All Steering Components Other Than SteeringColumn

• Yes
• No
• N / A

Steering Gear Box

• Yes
• No
• N / A

Pitman Arm

• Yes
• No
• N / A

Power Steering

• Yes
• No
• N / A

Ball and Socket Joints

• Yes
• No
• N / A

Tie Rods and Drag Links

• Yes
• No
• N / A

Nuts

• Yes
• No
• N / A

Steering System

• Yes
• No
• N / A

Any U-bolt(s), springhanger(s), or other axlepositioning part(s) cracked,broken, loose or missingresulting in shifting of anaxle from its normal position

• Yes
• No
• N / A

Spring Assembly

• Yes
• No
• N / A

Torque, Radius or Tracking Components.

• Yes
• No
• N / A

Frame Members

• Yes
• No
• N / A

Tire and Wheel Clearance

• Yes
• No
• N / A

Adjustable Axle Assemblies (Subfreezing)

• Yes
• No
• N / A

Tires on any steering axleof a power unit.

• Yes
• No
• N / A

All other tires.

• Yes
• No
• N / A

Lock or Side Ring

• Yes
• No
• N / A

Wheels and Rims

• Yes
• No
• N / A

Fasteners

• Yes
• No
• N / A

Welds

• Yes
• No
• N / A

Requirements and exceptionsas stated pertaining to anycrack, discoloration or visionreducing matter (reference393.60 for exceptions)

• Yes
• No
• N / A

Any power unit that has aninoperative wiper, or missingor damaged parts that renderit ineffective.

• Yes
• No
• N / A

List any other condition which may prevent safe operation of this vehicle.