DOT Annual Vehicle Inspection Qualification Checklist Form
Complete this checklist to verify vehicle and inspector qualification for the annual DOT inspection. Please answer all items accurately.
Inspector Full Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Contact (Email or Phone)
*
Vehicle Make and Model
*
Vehicle Plate Number
*
Odometer Reading (miles)
*
Inspection Checklist
*
Rows
Pass
Fail
N/A
Brakes
1
2
3
Lights & Signals
4
5
6
Tires & Wheels
7
8
9
Steering Mechanism
10
11
12
Windshield & Wipers
13
14
15
Overall Vehicle Condition
*
Qualified – Meets DOT Requirements
Not Qualified – Needs Repairs
Additional Comments or Notes
Submit Inspection
Should be Empty: