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Annual Vehicle Inspection

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ANNUAL VEHICLE INSPECTION REPORT

VEHICLE HISTORY RECORD
REPORT NUMBER FLEET UNIT NUMBER
Date

MOTOR CARRIER OPERATOR

INSPECTOR'S NAME (PRINT OR TYPE)

ADDRESS

THIS INSPECTOR MEETS THE QUALIFICATION REQUIREMENTS IN SECTION 396.19.

CITY, STATE, ZIP CODE

VEHICLE IDENTIFICATION (V) AND COMPLETE

VEHICLE TYPE

INSPECTION AGENCY/LOCATION (OPTIONAL)
VEHICLE COMPONENTS INSPECTED
OK NEEDS REPAIR REPAIRED DATE ITEM OK NEEDS REPAIR REPAIRED DATE ITEM OK NEEDS REPAIR REPAIRED DATE ITEM
1. BRAKE SYSTEM 4. FUEL SYSTEM 9. FRAME
a. Service Brakes a. Visible leak a. Frame Members
b. Parking Brake System b. Fuel tank filler cap missing b. Tire and Wheel Clearance .
c. Brake Drums or Rotors c. Fuel tank securely attached c. Adjustable Axle Assemblies (S
d. Brake Hose 5. LIGHTING DEVICES 10. TIRES
e. Brake Tubing All lighting devices and reflectors required by Section 393 shall be operable. a. Tires on any steering axle of a power unit.
f. Low Pressure Warning Device 6. SAFE LOADING b. All other tires.
g. Tractor Protection Valve a. Part(s) of vehicle or condition of loading such that the spare tire or any part of the load or dunnage can fall onto the roadway. 11. WHEELS AND RIMS
h. Air Compressor b. Protection against shifting cargo a. Lock or Side Ring
i. Electric Brakes 7. STEERING MECHANISM b. Wheels and Rims
j. Hydraulic Brakes a. Steering Wheel Free Play c. Fasteners
k. Vacuum Systems b. Steering Column d. Welds
2. COUPLING DEVICES c. Front Axle Beam and All Steering Components Other Than Steering Column 12. WINDSHIELD GLAZING
a. Fifth Wheels d. Steering Gear Box Requirements and exceptions as stated pertaining to any crack, discoloration or vision reducing matter (reference 393.60 for exceptions)
b. Pintle Hooks e. Pitman Arm 13. WINDSHIELD WIPERS
c. Drawbar/Towbar Eye f. Power Steering Any power unit that has an inoperative wiper, or missing or damaged parts that render it ineffective.
d. Drawbar/Towbar Tongue g. Ball and Socket Joints List any other condition which may prevent safe operation of this vehicle.
e. Safety Devices h. Tie Rods and Drag Links
f. Saddle-Mounts i. Nuts
3. EXHAUST SYSTEM j. Steering System
a. Any exhaust system determined to be leaking at a point forward of or directly below the driver/sleeper compartment 8. SUSPENSION
b. A bus exhaust system leaking or discharging to the atmosphere in violation of standards (1), (2) or (3). a. Any U-bolt(s), spring hanger(s), or other axle positioning part(s) cracked, broken, loose or missing resulting in shifting of an axle from its normal position.
c. No part of the exhaust system of any motor vehicle shall be so located as would be likely to result in burning, charring, or damaging the electrical wiring, the fuel supply, or any combustible part of the motor vehicle. b. Spring Assembly
c. Torque, Radius or Tracking Components.
INSTRUCTIONS: MARK COLUMN ENTRIES TO VERIFY INSPECTION: OK, NEEDS REPAIR, IF ITEMS DO NOT APPLY, REPAIRED DATE
CERTIFICATION: THIS VEHICLE HAS PASSED ALL THE INSPECTION ITEMS FOR THE ANNUAL VEHICLE INSPECTION REPORT IN ACCORDANCE WITH 49 CFR 396.
© Copyright 1994 & Published by J. J. KELLER & ASSOCIATES, INC.• Neenah, WI 54957-0368 J. J. KELLER & ASSOCIATES, INC.• Neenah, WI 54957-0368
PRINTED IN THE U.S.A.
200-FS-C3
Rev. 3/94
ORIGINAL