ANNUAL VEHICLE INSPECTION REPORT
VEHICLE HISTORY RECORD
REPORT
HUMBER FLEET UNIT NUMBER
DATE
MOTOR CARRIER OPERATOR INSPECTOR 'S NAME (PRINT OR TYPE)
ADDRESS THIS INSPECTOR MEETS THE QUALIFICATION REQUIREMENTS IN SECTION 396 19
YES
CITY. STATE. ZIP CODE VEHICLE IDENTIFICATION AND COMPLETE) Q L|C pLATE N0 VIN OTHER
VEHICLE TYPE TRACTOR TRAILER TRUCK BUS INSPECTION AGENCY /LOCATION ( OPTIONAL )
( OTHER )
E33EHES3
1. BRAKE SYSTEM
ITEM |OKM str |-
VEHICLE COMPONENTS INSPECTED
ITEM
6. SAFE LOADING
OK ; HE?MaED
0 Tt
*
10. TIRES
ITEM
a. Service Brakes a. Part(s) of vehicle or a. Tires on any steering axle
b . Parking Brake System condition of loading such of a power unit.
c . Brake Drums or Rotors that the spare tire or any b. All other tires.
d. Brake Hose part of the load or dunnage 11. WHEELS AND RIMS
e. Brake Tubing can fall onto the roadway. a. Lock or Side Ring
f. Low Pressure Warning b. Protection against shifting b. Wheels and Rims
Device cargo. c . Fasteners
g. Tractor Protection Valve c. Container securement d. Welds
h. Air Compressor devices on intermodal 12. WINDSHIELD GLAZING
.
i Electric Brakes equipment. Requirements and exceptions
.
j Hydraulic Brakes 7. STEERING MECHANISM as stated pertaining to any
k. Vacuum Systems a. Steering Wheel Free Play crack , discoloration or vision
2. COUPLING DEVICES .
b Steering Column reducing matter (reference
a. Fifth Wheels c. Front Axle Beam and All 393.60 for exceptions).
b. Pintle Hooks Steering Components 13. WINDSHIELD WIPERS
c. Drawbar/Towbar Eye Other Than Steering Any power unit that has an
S! '
d. Drawbar/Towbar Tongue Column inoperative wiper, or missing
.
e Safety Devices d. Steering Gear Box or damaged parts that render
f. Saddle-Mounts e. Pitman Arm it ineffective.
3. EXHAUST SYSTEM .
f Power Steering 14. OTHER
a. Exhaust system leaking g. Ball and Socket Joints List any other condition(s )
forward of or directly below h. Tie Rods and Drag Links which may prevent safe
the driver/sleeper .
i Nuts operation of this vehicle.
compartment . j. Steering System
b. Bus exhaust system 8. SUSPENSION
leaking or discharging in a. Any U-bolt(s), spring
violation of standard. hanger (s) , or other axle
c. Exhaust system likely to positioning part (s) cracked,
.
bum char , or damage the I broken, loose or missing
electrical wiring, fuel supply, resulting in shifting of an
or any combustible part of axle from its normal position.
the motor vehicle. b. Spring Assembly
4. FUEL SYSTEM c. Torque, Radius or Tracking
a. Visible leak . Components
.
b Fuel tank filler cap missing . 9. FRAME
.
c Fuel tank securely attached.! a. Frame Members
5. LIGHTING DEVICES b. Tire and Wheel Clearance
All lighting devices and c. Adjustable Axle
reflectors required by Part 393 Assemblies (Sliding
shall be operable. Subframes)
INSTRUCTIONS. MARK COLUMN ENTRIES TO VERIFY INSPECTION OK, X NEEDS REPAIR , NA |F ITEMS DO NOT APPLY , REPAIRED DATE
CERTIFICATION: THIS VEHICLE HAS PASSED ALL THE INSPECTION ITEMS FOR THE ANNUAL VEHICLE INSPECTION Ih
ACCORDANCE WITH 49 CFR PART 396.
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