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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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CARRIER: ____________________________________ TRACTOR/TRUCK NO: ___________________

CARRIER: __________________ TRACTOR/TRUCK NO: _