Mobile Home Inspection Form
Carrier
Name
SCAC
Carrier Freight Bill #
Government Bill of Lading #
Name of the member
First Name
Last Name
Rank Pay Grade
Origin Shipping Office
GBLOC #
Origin Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Destination Shipping Office
GBLOC #
Destination Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Specifications
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Mobile Home
Make
Model
Serial #
Dimensions
Rows
Feet & Inches
Expando
Height
Length
Width
Tires (completed by carrier at origin)
Rows
Size
FLY Rating
MFR Serial #
Condition
Left 1
Left 2
Left 3
Left 4
Right 1
Right 2
Right 3
Right 4
Inspection
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Please select the relevant one(s)
Rows
Origin Yes
Origin No
Origin Not Applicable
Destination Yes
Destination No
Destination Not Applicable
Mobile home unblocked?
1
2
3
4
5
6
Spring has normal arch?
7
8
9
10
11
12
Minimum 3-inch clearance over each tire?
13
14
15
16
17
18
Over loaded Mobile Home?
19
20
21
22
23
24
Structural members appear sound?
25
26
27
28
29
30
Frame to body attachments in place and unbroken?
31
32
33
34
35
36
Exterior paneling tight and secure?
37
38
39
40
41
42
Brake and clearance lights and turn signals operable?
43
44
45
46
47
48
Wheel bearing have been packed within last 90 days?
49
50
51
52
53
54
Mobile Home equipped with operable breakes at the time of hook up?
55
56
57
58
59
60
Are wheel lugs tight?
61
62
63
64
65
66
Plumping has been drained and protected from freezing?
67
68
69
70
71
72
All appliances have been serviced?
73
74
75
76
77
78
Attached items detached and stowed inside?
79
80
81
82
83
84
All fixtures which cannot be removed anchored securely?
85
86
87
88
89
90
Utilities disconnected and secured?
91
92
93
94
95
96
All prohibited items removed?
97
98
99
100
101
102
All loose items in cabinets packed and secured?
103
104
105
106
107
108
Heavy moveable items including furniture secured above and forward of axles?
109
110
111
112
113
114
Drawers, cabinets, and sliding doors secured and taped?
115
116
117
118
119
120
Mobile home equipped with valid license or permit?
121
122
123
124
125
126
Interior contents properly inventoried and inventory provided to carrier?
127
128
129
130
131
132
Mobile home meet the transportation safety standards of destination and intermediate states?
133
134
135
136
137
138
Exterior doors lock?
139
140
141
142
143
144
Keys given to carrier?
145
146
147
148
149
150
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: