DOT Inspection Report Form

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Annual Inspection Form

Today's Date:

Report Number:*

Fleet Unit Number:

Motor Carrier Operator:

Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Vehicle Type:

Tractor Trailer Truck

Other:

Vehicle Identification Number:

License Plate Number:

Inspector's Name:

First Name

Last Name

Inspector Meets Requirements of Section 396.19.

Yes No

Vehicle Inspected Components

Brake System

Brake System
	Passed Inspection	Needs Repair	N/A
Service Brakes	Brake System: Service Brakes (Passed Inspection)	Service Brakes (Needs Repair)	Service Brakes (N/A)
Parking Brake	Parking Brake (Passed Inspection)	Parking Brake (Needs Repair)	Parking Brake (N/A)
Brake Drums/Rotors	Brake Drums/Rotors (Passed Inspection)	Brake Drums/Rotors (Needs Repair)	Brake Drums/Rotors (N/A)
Brake Hose	Brake Hose (Passed Inspection)	Brake Hose (Needs Repair)	Brake Hose (N/A)
Tubing	Tubing (Passed Inspection)	Tubing (Needs Repair)	Tubing (N/A)
Low Pressure Warning Device	Low Pressure Warning Device (Passed Inspection)	Low Pressure Warning Device (Needs Repair)	Low Pressure Warning Device (N/A)
Air Compressor	Air Compressor (Passed Inspection)	Air Compressor (Needs Repair)	Air Compressor (N/A)
Tractor Protection Valve	Tractor Protection Valve (Passed Inspection)	Tractor Protection Valve (Needs Repair)	Tractor Protection Valve (N/A)
Electric Brakes	Electric Brakes (Passed Inspection)	Electric Brakes (Needs Repair)	Electric Brakes (N/A)
Hydraulic Brakes	Hydraulic Brakes (Passed Inspection)	Hydraulic Brakes (Needs Repair)	Hydraulic Brakes (N/A)
Vacuum Systems	Vacuum Systems (Passed Inspection)	Vacuum Systems (Needs Repair)	Vacuum Systems (N/A)

Brake Repair:

Brake Repair Date:

Brake Repair:

Brake Repair Date:

Coupling Devices

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
Fifth Wheels	Check All That Apply:: Fifth Wheels (Passed Inspection)	Fifth Wheels (Needs Repair)	Fifth Wheels (N/A)
Saddle-Mounts	Saddle-Mounts (Passed Inspection)	Saddle-Mounts (Needs Repair)	Saddle-Mounts (N/A)
Drawbar/Towbar Tongue	Drawbar/Towbar Tongue (Passed Inspection)	Drawbar/Towbar Tongue (Needs Repair)	Drawbar/Towbar Tongue (N/A)
Drawbar/Towbar Eye	Drawbar/Towbar Eye (Passed Inspection)	Drawbar/Towbar Eye (Needs Repair)	Drawbar/Towbar Eye (N/A)
Pintle Hooks	Pintle Hooks (Passed Inspection)	Pintle Hooks (Needs Repair)	Pintle Hooks (N/A)

Repair:

Repair Date:

Repair:

Repair Date:

Steering Mechanism

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
Steering Column	Check All That Apply:: Steering Column (Passed Inspection)	Steering Column (Needs Repair)	Steering Column (N/A)
Steering System	Steering System (Passed Inspection)	Steering System (Needs Repair)	Steering System (N/A)
Steering Gear Box	Steering Gear Box (Passed Inspection)	Steering Gear Box (Needs Repair)	Steering Gear Box (N/A)
Pitman Arm	Pitman Arm (Passed Inspection)	Pitman Arm (Needs Repair)	Pitman Arm (N/A)
Power Steering	Power Steering (Passed Inspection)	Power Steering (Needs Repair)	Power Steering (N/A)
Steering Wheel Free Play	Steering Wheel Free Play (Passed Inspection)	Steering Wheel Free Play (Needs Repair)	Steering Wheel Free Play (N/A)
Front Axle Beam + Related Components	Front Axle Beam + Related Components (Passed Inspection)	Front Axle Beam + Related Components (Needs Repair)	Front Axle Beam + Related Components (N/A)
Tie Rods and Drag Links	Tie Rods and Drag Links (Passed Inspection)	Tie Rods and Drag Links (Needs Repair)	Tie Rods and Drag Links (N/A)
Ball and Socket Joints	Ball and Socket Joints (Passed Inspection)	Ball and Socket Joints (Needs Repair)	Ball and Socket Joints (N/A)

Repair:

Repair Date:

Repair:*

Repair Date:

Suspension

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
U-bolts, Springs, Etc. Cracked or Broken	Check All That Apply:: U-bolts, Springs, Etc. Cracked or Broken (Passed Inspection)	U-bolts, Springs, Etc. Cracked or Broken (Needs Repair)	U-bolts, Springs, Etc. Cracked or Broken (N/A)
Torque, Radius or Tracking Components	Torque, Radius or Tracking Components (Passed Inspection)	Torque, Radius or Tracking Components (Needs Repair)	Torque, Radius or Tracking Components (N/A)
Spring Assembly	Spring Assembly (Passed Inspection)	Spring Assembly (Needs Repair)	Spring Assembly (N/A)

Repair:

Repair Date:

Exhaust System

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
Leaks found at a point forward of or directly below the driver/sleeper compartment	Check All That Apply:: Leaks found at a point forward of or directly below the driver/sleeper compartment (Passed Inspection)	Leaks found at a point forward of or directly below the driver/sleeper compartment (Needs Repair)	Leaks found at a point forward of or directly below the driver/sleeper compartment (N/A)
Found burning, charring, or damage to the electrical wiring	Found burning, charring, or damage to the electrical wiring (Passed Inspection)	Found burning, charring, or damage to the electrical wiring (Needs Repair)	Found burning, charring, or damage to the electrical wiring (N/A)

Repair:

Repair Date:

Fuel System

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
Visible Leak	Check All That Apply:: Visible Leak (Passed Inspection)	Visible Leak (Needs Repair)	Visible Leak (N/A)
Fuel Tank Filler Cap Missing	Fuel Tank Filler Cap Missing (Passed Inspection)	Fuel Tank Filler Cap Missing (Needs Repair)	Fuel Tank Filler Cap Missing (N/A)

Repair:

Repair Date:

Frame

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
Adjustable Axle Assemblies	Check All That Apply:: Adjustable Axle Assemblies (Passed Inspection)	Adjustable Axle Assemblies (Needs Repair)	Adjustable Axle Assemblies (N/A)
Tire and Wheel Clearance	Tire and Wheel Clearance (Passed Inspection)	Tire and Wheel Clearance (Needs Repair)	Tire and Wheel Clearance (N/A)
Frame Members	Frame Members (Passed Inspection)	Frame Members (Needs Repair)	Frame Members (N/A)

Repair:

Repair Date:

Tires, Wheels and Rims

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
Tire Tread	Check All That Apply:: Tire Tread (Passed Inspection)	Tire Tread (Needs Repair)	Tire Tread (N/A)
Lock or Side Ring	Lock or Side Ring (Passed Inspection)	Lock or Side Ring (Needs Repair)	Lock or Side Ring (N/A)
Wheels and Rims Not Bent	Wheels and Rims Not Bent (Passed Inspection)	Wheels and Rims Not Bent (Needs Repair)	Wheels and Rims Not Bent (N/A)
Fasteners	Fasteners (Passed Inspection)	Fasteners (Needs Repair)	Fasteners (N/A)
Welds	Welds (Passed Inspection)	Welds (Needs Repair)	Welds (N/A)

Repair:

Repair Date:

Windshield and Wipers

Check All That Apply:

Check All That Apply:
	Passed Inspection	Needs Repair	N/A
Cracks or Holes That Impede Vision	Check All That Apply:: Cracks or Holes That Impede Vision (Passed Inspection)	Cracks or Holes That Impede Vision (Needs Repair)	Cracks or Holes That Impede Vision (N/A)
Wiper Missing Parts	Wiper Missing Parts (Passed Inspection)	Wiper Missing Parts (Needs Repair)	Wiper Missing Parts (N/A)
Wipers Fully Functional	Wipers Fully Functional (Passed Inspection)	Wipers Fully Functional (Needs Repair)	Wipers Fully Functional (N/A)

Repair:

Repair Date:

Other Misc.

Other Observations/Issues to Address:

Inspector's Signature

[clear]

Use your mouse or finger to draw your signature above