The DOT Vehicle Inspection form is a crucial document used to ensure that commercial vehicles meet safety standards. This form records the results of an annual inspection conducted by a certified technician. It helps maintain the safety and reliability of vehicles on the road, protecting both drivers and the public.
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Annual Periodic Vehicle Inspection Report
Name and Address of Inspecting Company or Agency
Registered Owner’s Name
Date
Time
Street
Certified Inspector’s Name (Print or Type)
City, State, Zip Code
The signing of this inspection report certifies that the technician
meets and exceeds all requirements of 49 CFR §396.17 and
Motor Carrier Operating Vehicle (If different from Owner)
compatible state regulations and that the technician has the
necessary tools, and is skilled in completion of the annual
inspection, as listed in 49 CFR §396.17
Technician’s Signature______________________________
License Plate Number/State
Vehicle Identification Number
Vehicle Make
Vehicle Model
Model Year
Vehicle Components Inspected
OK
Need
Repair
Item
1. BRAKE SYSTEM
5. FUEL SYSTEM
10. SUSPENSION
Adjustment
Visible Leaks
Springs (cracked/broken/shifted)
Drums or Rotors
Fill Caps in place/intact
U-bolts. Hangers, etc.
Hoses and/or Tubing
Tank(s) securely attached
Torque, Radius, Tracking Arms
Lining
6. LIGHTING DEVICES
11. FRAME
Warning (Low Pressure)
Headlamps
Frame Members
Tractor Protection Valve
Front Turn Signals
Tire & Wheel Clearance
Air Compressor
Front ID/Clearance Lamps
Sliding Subframe (adj. axle)
Service Brakes
Side Marker Lamps – Left
12. TIRES
Parking Brakes
Side Marker Lamps -Right
Steering Axle Tires -Condition
Electric Brakes
Rear Turn Signals
Steering Tires - over 4/32” tread
Hydraulic Brakes
Stop Lamps
Other Tires – Condition
Vacuum Brakes
Tail Lamps
Other Tires – over 2/32” tread
Warning (Sys Failure)
Rear ID/Clearance Lamps
13. WHEELS & RIMS
Reflectors / Ref Tape
Lock/Slide Ring
2. STEERING SYSTEM
Free Play (Lash)
Fasteners
7. COUPLING DEVICES
Steering Column
5T H Wheel
Disk/Spoke Condition
Front Axle Beam
Pintle Hooks
Welds
Steering Gear Box
Drawbar Eye
List any other condition
which may affect safe
Pittman Arm
Drawbar Tongue
vehicle operation
Ball & Socket Joints
Safety Devices
Tie Rods & Drag Links
8. EXHAUST SYSTEM
Nuts, Bolts, Fasteners
Leaks
Power Steering Fluid
Placement
3. WINDSHIELDS
9. SAFE LOADING
Securement Devices
4. WIPERS
MARK COLUMNS AS FOLLOWS: x = OK; o = Needs repair; NA = Does not apply; Fill in Repair date as appropriate
I CERTIFY THE ANNUAL VEHICLE INSPECTION HAS BEEN DONE ACCURATELY AND COMPLETELY. I FURTHER CERTIFY THAT THIS INSPECTION COMPLIES WITH THE REQUIREMENTS OF 49 CFR §396.21.
This information must be available on board the vehicle, either as a copy of this report, or on a decal that complies with 49 CFR §396.17(c)(2). This report must be kept a minimum of fourteen months from date of completion
Certified Inspector’s Signature:
Date:
INSPECTOR QUALIFICATIONS
Certification — 49 CFR §396.19
Motor carriers are responsible for ensuring that individual(s) performing an annual inspection under §396.17 are qualified as follows:
•Understands the inspection criteria set forth in Part 393 and Appendix G and can identify defective components
•Is knowledgeable of and has mastered the methods, procedures, tools and equipment used when performing an inspection
•Is capable of performing an inspection by reason of experience, training, or both, and qualifies in one of the following categories (check all that apply):
I.___ Successfully completed a State or Federal training program or has certificate from a State or Canadian Province which qualifies the person to perform commercial vehicle safety inspections.
Specify: _______________________________________
II.___ Have a combination of training or experience totaling at least one year as follows (check all that apply):
a.___ Participation in a truck manufacturer-sponsored training program or similar commercial training program designed to train students in truck operation and maintenance.
Where and Date: _____________________________________________________
b.___ (years) experience as a mechanic or inspector in a motor carrier maintenance program.
Name and Date: _____________________________________________________
c.___ (years) experience as a mechanic or inspector in truck maintenance at a commercial garage, fleet leasing company, or similar facility.
Name of Facility and Dates: ____________________________________________
d.___ (years) experience as a commercial vehicle inspector for a State, Provincial, or Federal Government.
Where and Dates: ____________________________________________________
I certify the above information is true and accurate to the best of my knowledge.
Employee ______________________________________
________________
Signature of Mechanic/Inspector
Motor Carrier/Company ____________________________________
Signature of Employer/Supervisor
Evidence of Inspector Qualification is on file at:
_______________________________
BRAKE INSPECTOR QUALIFICATIONS
Certification — 49 CPR §396.25
“Brake Inspector” means any employee of a motor carrier who is responsible for ensuring all brake inspections, maintenance, service, or repairs to any commercial motor vehicle, subject to the motor carrier’s control, meet the applicable Federal standards.
No motor carrier shall require or permit any employee who does not meet minimum brake inspector qualifications to be responsible for the inspection, maintenance, service or repairs of any brakes on its commercial motor vehicles.
Minimum Qualifications
•Understands and can perform brake service and inspection
•Is knowledgeable of and has mastered the methods, procedures, tools and equipment necessary to perform brake service and inspection
•Is capable of performing brake service or inspection by reason of experience, training, or both, and qualifies in one of the following categories (check all that apply):
I.___Has successfully completed an apprenticeship program sponsored or approved
by a State, Canadian Province, a Federal agency or labor union, or has a certificate from a State or Canadian Province which qualifies the person to perform brake service or inspections.
Specify: ________________________________________________________________
II.___ Has brake-related training or experience or a combination thereof totaling at least one year as follows (check all that apply):
a.___Participation in a brake maintenance or inspection training program sponsored by a brake or vehicle manufacturer or similar commercial training program.
Where and Date:_______________________________________________
b.___ (years) experience performing brake maintenance or inspection in a motor carrier maintenance program.
Name and Date:_______________________________________________
c.___ (years) experience performing brake maintenance or inspection at a commercial garage, fleet leasing company, or similar facility.
Name of Facility and Dates:______________________________________
The DOT Vehicle Inspection form is a critical document used to ensure that commercial vehicles are safe and compliant with federal regulations. In addition to this form, there are several other documents and forms that are commonly utilized in conjunction with vehicle inspections. Each of these documents plays a vital role in maintaining safety standards and regulatory compliance within the transportation industry.
Each of these documents complements the DOT Vehicle Inspection form by providing additional layers of accountability and compliance. Together, they help maintain high safety standards in the transportation industry, ensuring that vehicles are safe for both drivers and the public.