Free Dot Vehicle Inspection PDF Form Get Document

Free Dot Vehicle Inspection PDF Form

The DOT Vehicle Inspection Form is a critical document used to ensure that commercial vehicles meet safety and operational standards as mandated by federal regulations. This form captures essential information about the vehicle, including inspection details, technician qualifications, and the condition of various components. Completing this form accurately is vital for compliance and vehicle safety, so make sure to fill it out by clicking the button below.

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Outline

The DOT Vehicle Inspection form plays a crucial role in ensuring the safety and compliance of commercial vehicles on the road. This form is used to document the annual periodic vehicle inspection, which is mandated by federal regulations. It includes essential details such as the name and address of the inspecting company, the registered owner's information, and the date and time of the inspection. A certified inspector, who meets specific qualifications, must complete the form, affirming that they possess the necessary skills and tools to conduct a thorough examination. The form lists various vehicle components that require inspection, including the brake system, steering, lighting devices, tires, and more. Each component is marked as either 'OK' or 'Needs Repair,' allowing for a clear assessment of the vehicle's condition. Additionally, the form requires the inspector's signature and certifies that the inspection complies with federal standards. Keeping this report on board the vehicle is essential, as it must be available for review and retained for a minimum of fourteen months. By adhering to these guidelines, motor carriers help maintain road safety and regulatory compliance.

Key takeaways

When filling out and using the DOT Vehicle Inspection form, keep these key points in mind:

  • Accuracy is crucial. Ensure that all information, including names, dates, and vehicle details, is filled out correctly to avoid issues later.
  • Check all components. Inspect each item listed on the form thoroughly. Mark them as OK, needs repair, or not applicable to clearly communicate the vehicle's condition.
  • Document repairs. If any components need repair, fill in the repair date. This helps maintain a clear record of the vehicle's maintenance history.
  • Inspector qualifications matter. Only certified inspectors should perform the inspection. Make sure the inspector meets all qualifications outlined in the regulations.
  • Keep records accessible. The inspection report must be available on board the vehicle. Retain a copy for at least fourteen months to comply with federal regulations.

Form Preview Example

Annual Periodic Vehicle Inspection Report

Name and Address of Inspecting Company or Agency

Registered Owner’s Name

 

Date

 

 

Time

 

 

 

 

 

 

Street

 

Certified Inspector’s Name (Print or Type)

 

 

 

 

 

 

 

City, State, Zip Code

 

The signing of this inspection report certifies that the technician

 

 

meets and exceeds all requirements of 49 CFR §396.17 and

Motor Carrier Operating Vehicle (If different from Owner)

compatible state regulations and that the technician has the

 

 

 

 

necessary tools, and is skilled in completion of the annual

Street

 

inspection, as listed in 49 CFR §396.17

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip Code

 

 

 

 

 

 

 

Technician’s Signature______________________________

 

 

 

 

 

License Plate Number/State

Vehicle Identification Number

Vehicle Make

Vehicle Model

Model Year

 

 

 

 

 

 

Vehicle Components Inspected

OK

Need

Repair

Item

OK

Need

Repair

Item

OK

Need

Repair

Item

 

Repair

Date

Repair

Date

Repair

Date

 

 

 

 

1. BRAKE SYSTEM

 

 

 

5. FUEL SYSTEM

 

 

 

10. SUSPENSION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjustment

 

 

 

Visible Leaks

 

 

 

Springs (cracked/broken/shifted)

 

 

 

 

Drums or Rotors

 

 

 

Fill Caps in place/intact

 

 

 

U-bolts. Hangers, etc.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hoses and/or Tubing

 

 

 

Tank(s) securely attached

 

 

 

Torque, Radius, Tracking Arms

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lining

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. LIGHTING DEVICES

 

 

 

11. FRAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Warning (Low Pressure)

 

 

 

Headlamps

 

 

 

Frame Members

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tractor Protection Valve

 

 

 

Front Turn Signals

 

 

 

Tire & Wheel Clearance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Air Compressor

 

 

 

Front ID/Clearance Lamps

 

 

 

Sliding Subframe (adj. axle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Service Brakes

 

 

 

Side Marker Lamps – Left

 

 

 

12. TIRES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Parking Brakes

 

 

 

Side Marker Lamps -Right

 

 

 

Steering Axle Tires -Condition

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Electric Brakes

 

 

 

Rear Turn Signals

 

 

 

Steering Tires - over 4/32” tread

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hydraulic Brakes

 

 

 

Stop Lamps

 

 

 

Other Tires – Condition

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vacuum Brakes

 

 

 

Tail Lamps

 

 

 

Other Tires – over 2/32” tread

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Warning (Sys Failure)

 

 

 

Rear ID/Clearance Lamps

 

 

 

 

 

 

 

 

 

 

 

 

 

13. WHEELS & RIMS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reflectors / Ref Tape

 

 

 

Lock/Slide Ring

 

 

 

 

2. STEERING SYSTEM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Free Play (Lash)

 

 

 

 

 

 

 

Fasteners

 

 

 

 

 

 

 

7. COUPLING DEVICES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Steering Column

 

 

 

5T H Wheel

 

 

 

Disk/Spoke Condition

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Front Axle Beam

 

 

 

Pintle Hooks

 

 

 

Welds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Steering Gear Box

 

 

 

Drawbar Eye

 

 

 

 

 

 

 

 

 

 

 

 

 

List any other condition

 

 

 

 

 

 

 

 

 

 

 

 

which may affect safe

 

 

 

 

Pittman Arm

 

 

 

Drawbar Tongue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

vehicle operation

 

 

 

 

Ball & Socket Joints

 

 

 

Safety Devices

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tie Rods & Drag Links

 

 

 

8. EXHAUST SYSTEM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nuts, Bolts, Fasteners

 

 

 

Leaks

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Power Steering Fluid

 

 

 

Placement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. WINDSHIELDS

 

 

 

9. SAFE LOADING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Securement Devices

 

 

 

 

 

 

 

 

4. WIPERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MARK COLUMNS AS FOLLOWS: x = OK; o = Needs repair; NA = Does not apply; Fill in Repair date as appropriate

I CERTIFY THE ANNUAL VEHICLE INSPECTION HAS BEEN DONE ACCURATELY AND COMPLETELY. I FURTHER CERTIFY THAT THIS INSPECTION COMPLIES WITH THE REQUIREMENTS OF 49 CFR §396.21.

This information must be available on board the vehicle, either as a copy of this report, or on a decal that complies with 49 CFR §396.17(c)(2). This report must be kept a minimum of fourteen months from date of completion

Certified Inspector’s Signature:

 

Date:

 

 

 

INSPECTOR QUALIFICATIONS

Certification — 49 CFR §396.19

Motor carriers are responsible for ensuring that individual(s) performing an annual inspection under §396.17 are qualified as follows:

Understands the inspection criteria set forth in Part 393 and Appendix G and can identify defective components

Is knowledgeable of and has mastered the methods, procedures, tools and equipment used when performing an inspection

Is capable of performing an inspection by reason of experience, training, or both, and qualifies in one of the following categories (check all that apply):

I.___ Successfully completed a State or Federal training program or has certificate from a State or Canadian Province which qualifies the person to perform commercial vehicle safety inspections.

Specify: _______________________________________

II.___ Have a combination of training or experience totaling at least one year as follows (check all that apply):

a.___ Participation in a truck manufacturer-sponsored training program or similar commercial training program designed to train students in truck operation and maintenance.

Where and Date: _____________________________________________________

b.___ (years) experience as a mechanic or inspector in a motor carrier maintenance program.

Name and Date: _____________________________________________________

c.___ (years) experience as a mechanic or inspector in truck maintenance at a commercial garage, fleet leasing company, or similar facility.

Name of Facility and Dates: ____________________________________________

d.___ (years) experience as a commercial vehicle inspector for a State, Provincial, or Federal Government.

Where and Dates: ____________________________________________________

I certify the above information is true and accurate to the best of my knowledge.

Employee ______________________________________

________________

Signature of Mechanic/Inspector

Date

Motor Carrier/Company ____________________________________

________________

Signature of Employer/Supervisor

Date

Evidence of Inspector Qualification is on file at:

_______________________________

BRAKE INSPECTOR QUALIFICATIONS

Certification — 49 CPR §396.25

“Brake Inspector” means any employee of a motor carrier who is responsible for ensuring all brake inspections, maintenance, service, or repairs to any commercial motor vehicle, subject to the motor carrier’s control, meet the applicable Federal standards.

No motor carrier shall require or permit any employee who does not meet minimum brake inspector qualifications to be responsible for the inspection, maintenance, service or repairs of any brakes on its commercial motor vehicles.

Minimum Qualifications

Understands and can perform brake service and inspection

Is knowledgeable of and has mastered the methods, procedures, tools and equipment necessary to perform brake service and inspection

Is capable of performing brake service or inspection by reason of experience, training, or both, and qualifies in one of the following categories (check all that apply):

I.___Has successfully completed an apprenticeship program sponsored or approved

by a State, Canadian Province, a Federal agency or labor union, or has a certificate from a State or Canadian Province which qualifies the person to perform brake service or inspections.

Specify: ________________________________________________________________

II.___ Has brake-related training or experience or a combination thereof totaling at least one year as follows (check all that apply):

a.___Participation in a brake maintenance or inspection training program sponsored by a brake or vehicle manufacturer or similar commercial training program.

Where and Date:_______________________________________________

b.___ (years) experience performing brake maintenance or inspection in a motor carrier maintenance program.

Name and Date:_______________________________________________

c.___ (years) experience performing brake maintenance or inspection at a commercial garage, fleet leasing company, or similar facility.

Name of Facility and Dates:______________________________________

I certify the above information is true and accurate to the best of my knowledge.

Employee ______________________________________

________________

Signature of Mechanic/Inspector

Date

Motor Carrier/Company ____________________________________

________________

Signature of Employer/Supervisor

Date

Evidence of Inspector Qualification is on file at:

_______________________________