Skip to main content
Annual Vehicle Inspection Form
Share
Save
Annual Vehicles Inspection Form (#67)
Annual Vehicles Inspection Form Â
Â
Today's Date:
Report Number:
Fleet Unit Number:
Motor Carrier Operator:
Address
Address Line 1
Address Line 2
City
State
Zip Code
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belau
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo (Kinshasa)
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao S.A.R., China
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo (Brazzaville)
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (Dutch part)
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia/Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom (UK)
United States (US)
United States (US) Minor Outlying Islands
United States (US) Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Vehicle Type:
Tractor
Trailer
Truck
Other
others
Vehicle Identification Number:
License Plate Number:
Inspector's First Name
Inspector's Last Name
Inspector Meets Requirements of Section 396.19.
Yes
No
Vehicle Inspected Components
Brake System
Passed Inspection
Needs Repair
N/A
Service Brakes
Parking Brake
Brake Drums/Rotors
Brake Hose
Tubing
Low Pressure Warning Device
Air Compressor
Tractor Protection Valve
Electric Brakes
Hydraulic Brakes
Vacuum Systems
Brake Repair:
Brake Repair:
Brake Repair:
Brake Repair Date:
Coupling Devices
Check All That Apply:
Passed Inspection
Needs Repair
N/A
Fifth Wheels
Saddle-Mounts
Drawbar/Towbar Tongue
Drawbar/Towbar Eye
Pintle Hooks
Repair
Repair Date:
Repair
Repair Date:
Steering Mechanism
Checkbox Grid
Passed Inspection
Needs Repair
N/A
Steering Column
Steering System
Steering Gear Box
Pitman Arm
Power Steering
Steering Wheel Free Play
Front Axle Beam + Related Components
Tie Rods and Drag Links
Ball and Socket Joints
Repair
Repair Date:
Suspension
Check All That Apply:
Passed Inspection
Needs Repair
N/A
U-bolts, Springs, Etc. Cracked or Broken
Torque, Radius or Tracking Components
Spring Assembly
Repair
Repair Date:
Exhaust System
Check All That Apply:
Passed Inspection
Needs Repair
N/A
Leaks found at a point forward of or directly below the driver/sleeper compartment
Found burning, charring, or damage to the electrical wiring
Repair
Repair Date:
Fuel System
Check All That Apply:
Passed Inspection
Needs Repair
N/A
Visible Leak
Fuel Tank Filler Cap Missing
Repair
Repair Date:
Frame
Check All That Apply:
Passed Inspection
Needs Repair
N/A
Adjustable Axle Assemblies
Tire and Wheel Clearance
Frame Members
Repair
Repair Date:
Tires, Wheels and Rims
Check All That Apply:
Passed Inspection
Needs Repair
N/A
Tire Tread
Lock or Side Ring
Wheels and Rims Not Bent
Fasteners
Welds
Repair
Repair Date:
Windshield and Wipers
Check All That Apply:
Passed Inspection
Needs Repair
N/A
Cracks or Holes That Impede Vision
Wiper Missing Parts
Wipers Fully Functional
Repair
Repair Date:
Other Misc:
Other Observations/Issues to Address:
I have read and agree to the
Terms and Conditions
and
Privacy Policy
Submit Form
Sana Ullah
sana.ullah
Tags
Government
