Annual Vehicles Inspection Form Annual Vehicles Inspection Form Today's Date: Report Number: Fleet Unit Number: Motor Carrier Operator: AddressAddress Line 1 Address Line 2 City State Zip Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaSamoaYemenZambiaZimbabweVehicle Type: Tractor Trailer Truck Otherothers Vehicle Identification Number: License Plate Number: Inspector's First Name Inspector's Last Name Inspector Meets Requirements of Section 396.19. Yes NoVehicle Inspected ComponentsBrake SystemPassed Inspection Needs Repair N/AService BrakesParking BrakeBrake Drums/RotorsBrake HoseTubingLow Pressure Warning DeviceAir CompressorTractor Protection ValveElectric BrakesHydraulic BrakesVacuum SystemsBrake Repair: Brake Repair: Brake Repair: Brake Repair Date: Coupling DevicesCheck All That Apply:Passed InspectionNeeds RepairN/AFifth WheelsSaddle-MountsDrawbar/Towbar TongueDrawbar/Towbar EyePintle HooksRepair Repair Date: Repair Repair Date: Steering MechanismCheckbox GridPassed Inspection Needs Repair N/ASteering Column Steering System Steering Gear Box Pitman Arm Power Steering Steering Wheel Free Play Front Axle Beam + Related Components Tie Rods and Drag Links Ball and Socket Joints Repair Repair Date: SuspensionCheck All That Apply:Passed InspectionNeeds RepairN/AU-bolts, Springs, Etc. Cracked or BrokenTorque, Radius or Tracking ComponentsSpring AssemblyRepair Repair Date: Exhaust SystemCheck All That Apply:Passed InspectionNeeds RepairN/ALeaks found at a point forward of or directly below the driver/sleeper compartmentFound burning, charring, or damage to the electrical wiringRepair Repair Date: Fuel SystemCheck All That Apply:Passed InspectionNeeds RepairN/AVisible LeakFuel Tank Filler Cap MissingRepair Repair Date: FrameCheck All That Apply:Passed InspectionNeeds RepairN/AAdjustable Axle Assemblies Tire and Wheel Clearance Frame Members Repair Repair Date: Tires, Wheels and RimsCheck All That Apply:Passed InspectionNeeds RepairN/ATire Tread Lock or Side Ring Wheels and Rims Not Bent Fasteners Welds Repair Repair Date: Windshield and WipersCheck All That Apply:Passed InspectionNeeds RepairN/ACracks or Holes That Impede Vision Wiper Missing PartsWipers Fully FunctionalRepair Repair Date: Other Misc:Other Observations/Issues to Address: I have read and agree to the Terms and Conditions and Privacy PolicySubmit Form
