ANNUAL VEHICLE INSPECTION REPORT

 

 
 
VEHICLE HISTORY RECORD
REPORT NUMBER FLEET UNIT NUMBER
   
DATE
MOTOR CARRIER OPERATOR MOTOR CARRIER OPERATOR INSPECTOR'S NAME (PRINT OR TYPE)
Address HIS INSPECTOR MEETS THE QUALIFICATION REQUIREMENTS IN
SECTION 396.19.
__ YES
CITY, STATE, ZIP CODE VEHICLE IDENTIFICATION (x) AND COMPLETE

__ LIC. PLATE NO.  __ VIN  __ OTHER

VEHICLE TYPE

__ TRACTOR __ TRAILER  __ TRUCK

__ (OTHER)

INSPECTION AGENCY/LOCATION (OPTIONAL)

 
VEHICLE COMPONENTS INSPECTED
OK
NEEDS REPAIR
REPAIRED DATE
ITEM
OK
NEEDS REPAIR
REPAIRED DATE
ITEM
OK
NEEDS REPAIR
REPAIRED DATE
ITEM
     
1. BRAKE SYSTEM
      4. FUEL SYSTEM
 
      9. FRAME
      a. Frame Members
      a. Service Brakes       a. Visble leak
      b. Tire and Wheel Clearance
      b. Parking Brake System       b. Fuel tank filler cap missing
      c. Adjustable Axle
Assemblies (Sliding Subframes)
      c. Brake Drums or Rotors       c. Fuel tank securely attached
      d. Brake Hose       5. LIGHTING DEVICES
All lighting devices and reflectors required by Section 393 shall be operable.
      10. TIRES
      e. Brake Tubing
      a. Tires on any steering axle
of a power unit.
      f. Low Pressure Warning Device
     
      b. All other tires.
      g. Trator Protection Valve
      6. SAFE LOADING
a. Part(s) of vehicle or condition of loading such that the spare tire or any part of the load or dunnage can fall unto the roadway.
      11. WHEELS AND RIMS
      h. Air Compressor
      a. Lock or Side Ring
      i. Electric Brakes
      b. Wheels and Rims
      j. Hydraulic Brakes      
      c. Fasteners
      k. Vacuum Systems
      d. Welds
      b.Protection against shifting cargo
      2. Coupling Devices
 
      12. WINDSHIELD GLAZING
      7. STEERING MECHANISM
a. Steering Wheel Free Play
      a. Fifth Wheels
      Requirements and exceptions
as stated pertaining to any
crack, discoloration or vision
reducing matter (reference
393.60 for exceptions)
      b. Steering Column
      b. Pintle Hooks
      c. Drawbar/Towbar Eye       c. Front Axle Beam and All Steering Components Other Than Steering Column
      d. Drawbar/Towbar Tongue
      e. Safety Devices
      d. Steering Gear Box
      f. Saddle-Mounts       13. WINDSHIELD WIPERS
      e. Pitman Arm
      3. EXHAUST SYSTEM
a. Any exhaust system determined to be leaking at a point forward of oe directly below the driver/sleeper compartment.
      f. Power Steering
      Any power unit that has an
inoperative wiper, or missing
or damaged parts that render
it ineffective.
      g. Ball and Socket Joints
      h. Tie Rods and Drag Links
      i. Nuts
      j. Steering System
      List any other condition which may
prevent safe operation of this
vehicle.
      b. A bus exhaust system leaking or discharging to the atmosphere in violation of standards (1), (2) or (3).
      8. SUSPENSION
      a. Any U-bolt(s), spring
hanger(s), or other axle
positioning part(s) cracked,
broken, loose or missing
resulting in shifting of an
axle from its normal position.
      c. No part of the exhaust system or any motor vehicle shall be so located as would be likely to rsult in burning, charring, or damaging the electrical wiring, the fuel supply, or any combustible part of the motor vehicle.
      b. Spring Assembly
      c. Torque, Radius or Tracking
Components.
INSTRUCTIONS: MARK COLUMN ENTRIES TO VERIFY INSPECTION: X OK, X NEEDS REPAIR, NA IF ITEMS DO NOT APPLY, __REPAIRED DATE

CERTIFICATION: THIS VEHICLE HAS PASSED ALL THE INSPECTION ITEMS FOR THE ANNUAL VEHICLE INSPECTION REPORT IN ACCORDANCE WITH 49 CFR 396.

© Copyright 1994 & Published by J. J. KELLER & ASSOCIATES, INC.• Neenah, WI 54957-0368

PRINTED IN THE U.S.A.

200-FS-C3 Rev. 3/94

ORIGINAL

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Please contact us with any repair or service work you may have:

Ed Mansell              -   General Manager
 

 

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