Annual Vehicle Inspection Report Form
Report Number:
Date:
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector's Name:
First Name
Last Name
Inspection Place:
Vehicle Type:
Vehicle Identification:
OK
Incomplete
Vehicle Components
Check the following components of the vehicle.
Rows
OK
NEEDS REPAIR
COMMENTS
1. Break system
1
2
2. Coupling devices
3
4
3. Exhaust system
5
6
4. Fuel system
7
8
5. Lighting devices
9
10
6. Safe loading
11
12
7. Steering mechanism
13
14
8. Suspension
15
16
9. Frame
17
18
10. Tires
19
20
11. Wheels and rims
21
22
12. Windshield glazing
23
24
13. Windshield wipers
25
26
Any other comments:
Inspector Signature:
Submit
Should be Empty: