Vehicle History Record
Report
FLEET UNIT NUMBER
Number
Annual Vehicle Inspection Report
DATE
MOTOR CARRIER OPERATOR INSPECTOR’S NAME (PRINT OR TYPE)
ADDRESS THIS INSPECTOR MEETS THE QUALIFICATION REQUIREMENTS
IN SECTION 396.19.
o YES
CITY, STATE, ZIP CODE VEHICLE IDENTIFICATION (3) AND COMPLETE o LIC. PLATE NO.
o VIN o OTHER
VEHICLE TYPE o TRACTOR o TRAILER o TRUCK INSPECTION AGENCY/LOCATION (OPTIONAL)
o (OTHER)
VEHICLE COMPONENTS INSPECTED
NEEDS REPAIRED NEEDS REPAIRED
ITEM OK REPAIR DATE ITEM OK REPAIR DATE
1. BRAKE SYSTEM 7. STEERING MECHANISM
a. Service Brakes a. Steering Wheel Free Play
b. Parking Brake System b. Steering Column
c. Brake Drums or Rotors c. Front axle beam and ALL steering components other
than steering column
d. Brake Hose
d. Steering Gear Box
e. Brake Tubing
e. Pitman Arm
f. Low Pressure Warning Device
f. Power Steering
g. Tractor Protection Valve
g. Ball and Socket Joints
h. Air Compressor
h. Tie Rods and Drag Links
i. Electric Brakes
i. Nuts
j. Hydraulic Brakes
j. Steering System
k. Vacuum Systems
8. SUSPENSION
2. COUPLING DEVICES
a. Any U-bolt(s), spring hanger(s), or other axle
a. Fifth Wheels positioning part(s) cracked, broken, loose or missing
resulting in shifting of an axle from its normal position.
b. Pintle Hooks
b. Spring Assembly
c. Drawbar/Towbar Eye
c. Torque, Radius, or Tracking Components
d. Drawbar/Towbar Tongue
9. FRAME
e. Safety Devices
a. Frame Members
f. Saddle-Mounts
b. Tire and Wheel Clearance
3. EXHAUST SYSTEM
c. Adjustable Axle Assemblies (Sliding Subframes)
a. Any exhaust system determined to be leaking ot a point
forward of or directly below the driver/sleeper compartment. 10. TIRES
b. A bus exhaust system leaking or discharging to the a. Tires on any steering axle of a power unit.
atmosphere in violation of standards (1), (2), or (3).
c. No part of the exhaust system of any motor vehicle b. All other tires.
shall be so located as would be likely to result in burning, 11. WHEELS AND RIMS
charring, or damaging the electrical wiring, the fuel
supply, or any combustible part of the motor vehicle. a. Lock or Side Ring
4. FUEL SYSTEM b. Wheels and Rims
a. Visible leak c. Fasteners
b. Fuel tank filler cap missing d. Welds
c. Fuel tank securely attached 12. WINDSHIELD GLAZING
5. LIGHTING DEVICES Requirements and exceptions as stated pertaining to any
All lighting devices and reflectors required by Section crack, discoloration or vision reducing matter (reference
393 shall be operable. 393.60 for exceptions).
13. WINDSHIELD WIPERS
6. SAFE LOADING
a. Part(s) of vehicle or condition of loading such that the Any power unit that has an inoperative wiper, or missing
spare tire or any part of the load or dunnage can fall or damaged parts that render it ineffective.
onto the roadway. List any other condition which may prevent safe operation
b. Protection against shifting cargo of this vehicle.
______________________________________________
______________________________________________
Instructions: Mark column entries to verify inspection: X OK, X NEEDS REPAIR, NA IF ITEMS DO NOT APPLY, REPAIRED DATE.
CERTIFICATION: THIS VEHICLE HAS PASSED ALL THE INPECTION ITEMS FOR THE ANNUAL VEHICLE INSPECTION REPORT IN ACCORDANCE WITH 49 CFR 396.
