ANNUAL VEHICLE INSPECTION FORM
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Inspection Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
1
Vehicle Type
Please Select
Automobile
Bus
Tractor
Truck
Other
Vehicle Model
Vehicle Mileage
VIN (Vehicle Identification Number)
EVALUATIONS
1. COUPLING DEVICES
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Saddle-Mounts
2
3
4
Yes
No
2. Safety devices
5
6
7
Yes
No
3. Pintle hooks
8
9
10
Yes
No
4. Fifth wheels
11
12
13
Yes
No
5. Drawbar/Towbar tongue
14
15
16
Yes
No
6. Drawbar/Towbar eye
17
18
19
Yes
No
2. STEERING MECHANISM
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Steering gear box
20
21
22
Yes
No
2. Power steering
23
24
25
Yes
No
3. Steering column
26
27
28
Yes
No
4. Steering system
29
30
31
Yes
No
5. Steering wheel free play
32
33
34
Yes
No
6. Pitman arm
35
36
37
Yes
No
7. Ball & Socket joints
38
39
40
Yes
No
8. Nuts
41
42
43
Yes
No
9. Tie rods & Drag links
44
45
46
Yes
No
10. Front axle beam & All steering components other than the steering column
47
48
49
Yes
No
3. WHEELS & RIMS
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Wheels & Rims
50
51
52
Yes
No
2. Lock / Side ring
53
54
55
Yes
No
3. Welds
56
57
58
Yes
No
4. Fasteners
59
60
61
Yes
No
4. BRAKE SYSTEM
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Air compressor
62
63
64
Yes
No
2. Brake hose
65
66
67
Yes
No
3. Brake tubing
68
69
70
Yes
No
4. Drums & Rotors
71
72
73
Yes
No
5. Electric brakes
74
75
76
Yes
No
6. Hydraulic brakes
77
78
79
Yes
No
7. Low-Pressure warning devices
80
81
82
Yes
No
8. Parking brakes
83
84
85
Yes
No
9. Service brakes
86
87
88
Yes
No
10. Tractor protection valve
89
90
91
Yes
No
11. Vacuum systems
92
93
94
Yes
No
5. EXHAUST SYSTEM
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Exhaust system with finding(s) of leaking in front of or directly below the driver/sleeper compartment (Any point)
95
96
97
Yes
No
2. Finding of an exhaust system leaking gas into the atmosphere in motor vehicles contrary to the standards
98
99
100
Yes
No
3. Evidence that any part of a motor vehicle's exhaust system has been located in such a way as to cause combustion, charring, or damage to the motor vehicle's electrical wiring, fuel supply, or combustible parts.
101
102
103
Yes
No
6. FRAME
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Adjustable axle assembly (Sliding subframes)
104
105
106
Yes
No
2. Frame members
107
108
109
Yes
No
3. Tire & Wheel clearance
110
111
112
Yes
No
7. FUEL SYSTEM
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. No visible leak
113
114
115
Yes
No
2. Fuel tank filler cap missing
116
117
118
Yes
No
3. Fuel tank securely attached
119
120
121
Yes
No
8. SUSPENSION
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Finding of cracks, broken, loose or missing parts
122
123
124
Yes
No
2. Spring assembly
125
126
127
Yes
No
3. Torque, radius, or tracking components
128
129
130
Yes
No
9. SAFE LOADING
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. The situation in which any of the vehicle's part(s), spare tire, load, or dunnage does not fall onto the roadway while in motion.
131
132
133
Yes
No
2. Protection against shifting cargo
134
135
136
Yes
No
10. TIRES
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Condition of tires on any steering axle of a power unit
137
138
139
Yes
No
2. Condition of all other tires
140
141
142
Yes
No
11. LIGHTING DEVICES
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. All lighting devices and reflectors required by Section 393 shall be operable
143
144
145
Yes
No
12. WINDSHIELD GLAZING
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. No evidence of cracks, discoloration, or vision-reducing substance was found in the vehicle, except for requirements and exceptions. (Examine for reference 49 CFR 393.60)
146
147
148
Yes
No
13. WINDSHIELD WIPERS
Rows
Fail
Pass
N/A
Needs Repair
Notes
1. Inoperative wiper or any evidence of missing or damaged parts that may impair / disable the power unit.
149
150
151
Yes
No
Other Findings & Comments
Inspection Agency Name
Inspection Agency Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Inspector's Name
First Name
Last Name
Inspector's Signature
Submit
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