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(Long Form) DRIVER’S VEHICLE INSPECTION REPORT
Required by Federal Motor Carrier Safety Regulations (FMCSR) 396.11 Post-Trip, 396.13 Pre-Trip & 395.8 Interpretations
Warning: Laws are subject to change without notice Version 2010. Copyright© 1986-2010 United Safety Alliance, Inc.

CARRIER: ____________________________________    TRACTOR/TRUCK NO: ___________________

ADDRESS: ____________________________CITY: __________________ STATE & ZIP: _____________

DATE & TIME START: _____________ / ________________ ODOMETER READING START: _________________________

Circle and note all defective items under remarks.  Note: most are required by FMCSR

** [√] For each item that is Satisfactory. [X] For each item that is Unsatisfactory. **
Inside of Power Unit:
Before & After Driving
Outside of Power Unit:
Before & After Driving
[ ] [ ] All Warning Devices - (Low Air, Water & Oil) [ ] [ ] All Belts, All Hoses including Power Steering
[ ] [ ] Horn – (City & Air) [ ] [ ] Oil, Water & P/S Levels or Excessive Leaks
[ ] [ ] Windshield & Windshield Wipers [ ] [ ] Loose Bolts or Hood/Cab Mountings
[ ] [ ] Mirrors – (Clean, Adjusted & Mountings) [ ] [ ] Front Axle, Suspension, Frame & Steering
[ ] [ ] Air Leaks or Air Loss over 5 lbs. per min. [ ] [ ] Front Brake Adjustments, Hoses & Mountings
[ ] [ ] Steering, Turn Signal Lever & Indicator [ ] [ ] Front Tires, Wheels, Lug Nuts & Hub Oil
[ ] [ ] Heater, Defroster & Air Conditioner [ ] [ ] Lights: Head, Parking, ID, Marker, Turn & Stop Lamps
[ ] [ ] Parking Brake – (Power Unit & Trailer) [ ] [ ] Body including Cab, Steps, Boxes & Annual Inspection
[ ] [ ] All Gauges, Switches & Lights [ ] [ ] Muffler, Exhaust System & Drive Lines
[ ] [ ] Fire Extinguisher, Securement & Outside Sign [ ] [ ] Fuel Tanks, Mounts, Lines, Caps & Seals
[ ] [ ] 3 - Reflective Triangles & First Aid Kit [ ] [ ] Air & Electrical Lines, Securement & Glad Hands
[ ] [ ] Cab, Doors, Locks & Windows [ ] [ ] Coupler Device: Mounting, Bolts & Locking Device
[ ] [ ] Spare Head Lamp, Bulbs or Fuses? [ ] [ ] Rear Brake Adjustments, Hoses, Mountings
[ ] [ ] Other __________________________________ [ ] [ ] Rear Tires, Wheels & Lug Nuts
  [ ] [ ] Frame, Rear Suspension, Air Leaks & Axles
TRAILER(s) No. (s): __________/__________
[ ] [ ] Air, Electrical Lines & Glad Hand Connections [ ] [ ] Tires, Wheels, Lug Nuts & Hub Oil Level
[ ] [ ] Landing Gear & Handle in Cradle [ ] [ ] Lights – All & Current Annual Inspection Sticker
[ ] [ ] Frame & Cross Members [ ] [ ] Body, Floor/Deck, Roof, Doors & Door Locks
[ ] [ ] Suspension, Air Leaks & Axle Seals [ ] [ ] Load Securement and Securement Devices
[ ] [ ] Brake Adjustments, Hoses & Mountings [ ] [ ] Other __________________________________
If Required -                                                
HUB READING START: __________ /__________
   
HUB READING END: __________ /__________
Remarks: ________________________________________________________________________________
 
________________________________________________________________________________________
[ ] Condition of the above vehicles is satisfactory. [ ] Condition of the above vehicles is Unsatisfactory.
ODOMETER
READING END:______________________
TOTAL
MILES DRIVEN:_______________________
TOTAL HOURS
ON-DUTY: ___________________
Driver's
Signature:________________________________________
Date &
Time End: __________/__________
[ ] Above Defects Corrected. [ ] Above Defects NEED NOT be corrected for safe operation of vehicle.

Mechanic’s Signature:___________________________ Company ______________________ Date & Time: ____________

Driver’s Signature:________________________________             Date & Time: _________ / ____________

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Copyright© 1986-2016 United Safety Alliance, Inc. Version 2010


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