ANNUAL VEHICLE INSPECTION REPORT

VEHICLE HISTORY RECORD

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  SUV  BUS  VAN INSPECTION AGENCY/LOCATION (OPTIONAL)

SEATING CAPACITY BEHIND DRIVER _______________________

 TRACTOR  TRAILER  TRUCK  (OTHER) _____________

V E H I C L E COMPONENTS INSPECTED
NEEDS REPAIRED NEEDS REPAIRED NEEDS REPAIRED
OK REPAIR DATE ITEM OK REPAIR DATE ITEM OK REPAIR DATE ITEM

1. BRAKE SYSTEM 4. FUEL SYSTEM 9. FRAME

a. Service Brakes a. Visible leak a. Frame Members
b. Parking Brake System b. Fuel tank filler cap missing b. Tire and Wheel Clearance
c. Brake Drums or Rotors c. Fuel tank securely attached c. Adjustable Axle
d. Brake Hose Assemblies (Sliding
e. Brake Tubing Subframes)
f. Low Pressure Warning Device 5. LIGHTING DEVICES
g. Tractor Protection Valve All lighting devices and 10. TIRES
h. Air Compressor reflectors required by Section a. Tires on any steering axle
i. Electric Brakes 393 shall be operable. of a power unit.
j. Hydraulic Brakes b. All other tires.
6. SAFE LOADING
k. Vacuum Systems a. Part(s) of vehicle or condition of 11. WHEELS AND RIMS
loading such that the spare tire a. Lock or Side Ring
or any part of the load or b. Wheels and Rims
dunnage can fall onto the c. Fasteners
2. COUPLING DEVICES roadway. d. Welds
a. Fifth Wheels b. Protection against shifting cargo
b. Pintle Hooks 12. WINDSHIELD GLAZING
c. Drawbar/Towbar Eye Requirements and exceptions
d. Drawbar/Towbar Tongue as stated pertaining to any
e. Safety Devices 7. STEERING MECHANISM
a. Steering Wheel Free Play crack, discoloration or vision
f. Saddle-Mounts reducing matter (reference
b. Steering Column
c. Front Axle Beam and All 393.60 for exceptions)
Steering Components Other
3. EXHAUST SYSTEM Than Steering Column 13. WINDSHIELD WIPERS
a. Any exhaust system determined d. Steering Gear Box Any power unit that has an
to be leaking at a point forward e. Pitman Arm inoperative wiper, or missing
of or directly below the f. Power Steering or damaged parts that render
driver/sleeper compartment. g. Ball and Socket Joints it ineffective.
b. A bus exhaust system leaking or h. Tie Rods and Drag Links
discharging to the atmosphere in i. Nuts 14. INTERIOR
violation of standards (1), (2) or j. Steering System (UPHOLSTERY/APPERANCE)
(3).
c. No part of the exhaust system of 15. SEAT BELTS (DRIVER
any motor vehicle shall be so AND PASSENGERS)
located as would be likely to
result in burning, charring, or 8. SUSPENSION List any other condition which
damaging the electrical wiring, a. Any U-bolt(s), spring hanger(s), may prevent safe operation of this
the fuel supply, or any or other axle positioning part(s) vehicle.
combustible part of the motor cracked, broken, loose or
vehicle. missing resulting in shifting of
an axle from its normal position.
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.