Dot Vehicle Inspection Forms – Fill Out and Use This PDF

Fill in the Name and Address of Inspecting Company or Agency, the Registered Owner's Name, the Date, the Time, the Street, the Certified Inspector's Name (Print or Type) and the City, State, Zip Code. For the Motor Carrier Operating Vehicle (If different from Owner), fill in the Street and the City, State, Zip Code.

Enter the License Plate Number/State, Vehicle Identification Number, Vehicle Make, Vehicle Model and Model Year.

The Technician's Signature certifies that the technician has the necessary tools, and is skilled in completion of the annual inspection, as listed in 49 CFR §396.17.

Vehicle Components Inspected, by Item: 1. BRAKE SYSTEM: Adjustment, Drums or Rotors, Hoses and/or Tubing, Lining, Warning (Low Pressure), Tractor Protection Valve, Air Compressor, Service Brakes, Parking Brakes, Electric Brakes, Hydraulic Brakes, Vacuum Brakes, Warning (Sys Failure). 2. STEERING SYSTEM: Free Play (Lash), Steering Column, Front Axle Beam, Steering GearBox, Pittman Arm, Ball & Socket Joints, Tie Rods & Drag Links, Nuts, Bolts, Fasteners, Power Steering Fluid. 3. WINDSHIELDS. 4. WIPERS. 5. FUEL SYSTEM: Visible Leaks, Fill Caps in place/intact, Tank(s) securely attached. 6. LIGHTING DEVICES: Headlamps, Front Turn Signals, Front ID/Clearance Lamps, Side Marker Lamps - Left, Side Marker Lamps -Right, Rear Turn Signals, Stop Lamps, Tail Lamps, Rear ID/Clearance Lamps, Reflectors / Ref Tape. 7. COUPLING DEVICES: 5TH Wheel, Pintle Hooks, Drawbar Eye, Drawbar Tongue, Safety Devices. 8. EXHAUST SYSTEM: Leaks, Placement. 9. SAFE LOADING: Securement Devices. 10. SUSPENSION: Springs (cracked/broken/shifted), U-bolts. Hangers, etc., Torque, Radius, Tracking Arms. 11. FRAME: Frame Members, Tire & Wheel Clearance, Sliding Subframe (adj. axle). 12. TIRES: Steering Axle Tires -Condition, Steering Tires - over 4/32” tread, Other Tires - Condition, Other Tires - over 2/32” tread. 13. WHEELS & RIMS: Lock/Slide Ring, Fasteners, Disk/Spoke Condition, Welds.

List any other condition which may affect safe vehicle operation.

Mark columns as follows: x = OK; o = Needs repair; NA = Does not apply; Fill in Repair date as appropriate. The Certified Inspector's Signature and Date certify that the annual vehicle inspection has been done accurately and completely and 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.

Under 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.

The inspector understands the inspection criteria set forth in Part 393 and Appendix G and can identify defective components, and is knowledgeable of and has mastered the methods, procedures, tools and equipment used when performing an inspection.

The inspector 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.

Fill in Specify under I. 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." Sign and date as Employee (Signature of Mechanic/Inspector), sign and date as Motor Carrier/Company (Signature of Employer/Supervisor), and fill in where Evidence of Inspector Qualification is on file at.

Under Brake Inspector Qualifications Certification - 49 CFR §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: the inspector understands and can perform brake service and inspection, and is knowledgeable of and has mastered the methods, procedures, tools and equipment necessary to perform brake service and inspection.

The inspector 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.

Fill in Specify under I. 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).

Employee Signature of Mechanic/Inspector and Date, Motor Carrier/Company Signature of Employer/Supervisor and Date, then fill in where Evidence of Inspector Qualification is on file at.