Annual Vehicle Assessment

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Annual Vehicle Assessment

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Annual Vehicles Inspection Form

Today's Date * Report Number * Fleet Unit Number * Motor Carrier Operator Address

Address Line 1 *

Address Line 2

City *

State *

Zip *

Country *

Vehicle Type Others

Vehicle Identification Number

License Plate Number

Inspector's First Name

Inspector's Last Name

Inspector Meets Requirements of Section 396.19.

Vehicle Inspected Components

Brake System

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 Date

Coupling Devices

Fifth Wheels

Saddle Mounts

Drawbar/Towbar Tongue

Drawbar/Towbar Eye

Pintle Hooks

Repair Repair Date

Steering Mechanism

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

U-bolts, Springs, Etc. Cracked or Broken

Torque, Radius or Tracking Components

Spring Assembly

Repair Repair Date

Exhaust System

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

Visible Leak

Fuel Tank Filler Cap Missing

Repair Repair Date

Frame

Adjustable Axle Assemblies

Tire and Wheel Clearance

Frame Members

Repair Repair Date

Tires, Wheels and Rims

Tire Tread

Lock or Side Ring

Wheels and Rims Not Bent

Fasteners

Welds

Repair Repair Date

Windshield and Wipers

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

Annual Vehicles Inspection Form

<label> Today's Date *
    [date_time* today-date "m/d/Y"] </label>

<label> Report Number *
    [text* report-number] </label>

<label> Fleet Unit Number *
    [text* fleet-unit-number] </label>

<label> Motor Carrier Operator
    [text* motor-carrier-operator] </label>

<label> Address </label>
[address address-344 format:international required_fields:line1|city|state|zip|country]

<label> Vehicle Type
    [select select-307 first_as_label "- select -" "Tractor" "Trailer" "Truck" "Other"] </label>

<label> Others
    [textarea others x3] </label>


    
    <label> Vehicle Identification Number
        [text* vehicle-identification-number] </label>
    
    
    <label> License Plate Number
        [text* license-plate-number] </label>
    



    
    <label> Inspector's First Name
        [text* inspector-first-name] </label>
    
    
    <label> Inspector's Last Name
        [text* inspector-last-name] </label>
    


<label> Inspector Meets Requirements of Section 396.19.
    [select select-735 first_as_label "- select -" "Yes" "No"] </label>

[section_break section_break-330 "Vehicle Inspected Components"]

Brake System


    
    <label> Service Brakes
        [select service-brakes first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Parking Brake
        [select parking-brake first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Brake Drums/Rotors
        [select brake-drums first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Brake Hose
        [select* brake-hose first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Tubing
        [select tubing first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Low Pressure Warning Device
        [select* low-pressure-warning-device first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Air Compressor
        [select air-compressor first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Tractor Protection Valve
        [select* tractor-protection-value first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Electric Brakes
        [select electric-brakes first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Hydraulic Brakes
        [select* hydraulic-brakes first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Vacuum Systems
        [select vacuum-systems first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    


<label> Brake Repair
    [text brake-repair] </label>

<label> Brake Repair Date
    [date_time date_time-858 "m/d/Y"] </label>

[section_break section_break-89 "Coupling Devices"]


    
    <label> Fifth Wheels
        [select fifth-wheels first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Saddle Mounts
        [select* saddle-mounts first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Drawbar/Towbar Tongue
        [select drawbar-tongue first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Drawbar/Towbar Eye
        [select* drawbar-eye first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Pintle Hooks
        [select pintle-hooks first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    


<label> Repair
    [text brake-repair] </label>

<label> Repair Date
    [date_time brake-repair-date "m/d/Y"] </label>

[section_break section_break-113 "Steering Mechanism"]


    
    <label> Steering Column
        [select steering-column first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Steering System
        [select steering-system  first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Steering Gear Box
        [select steering-gear-box first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Pitman Arm
        [select* pitman-arm first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Power Steering
        [select power-steering first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Steering Wheel Free Play
        [select* steering-wheel-free-play first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Front Axle Beam + Related Components
        [select front-axle-beam-components first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Tie Rods and Drag Links
        [select tie-rods-drag-links  first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Ball and Socket Joints
        [select ball-socket-joint first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    


<label> Repair
    [text steering-repair] </label>

<label> Repair Date
    [date_time steering-repair-date "m/d/Y"] </label>

[section_break section_break-263 "Suspension"]


    
    <label> U-bolts, Springs, Etc. Cracked or Broken
        [select bolts-spring-broken first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Torque, Radius or Tracking Components
        [select torque-radius-comp  first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Spring Assembly
        [select spring-assembly first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    


<label> Repair
    [text suspension-repair] </label>

<label> Repair Date
    [date_time suspension-repair-date "m/d/Y"] </label>

[section_break section_break-892 "Exhaust System"]


    
    <label> Leaks found at a point forward of or directly below the driver/sleeper compartment
        [select leaks-found-exhaust first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Found burning, charring, or damage to the electrical wiring
        [select  found-burning-exhaust first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    


<label> Repair
    [text exhaust-repair] </label>

<label> Repair Date
    [date_time exhaust-repair-date "m/d/Y"] </label>

[section_break section_break-691 "Fuel System"]


    
    <label> Visible Leak
        [select visible-leak-fuel first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Fuel Tank Filler Cap Missing
        [select  fuel-tank first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    


<label> Repair
    [text fuel-repair] </label>

<label> Repair Date
    [date_time fuel-repair-date "m/d/Y"] </label>

[section_break section_break-958 "Frame"]


    
    <label> Adjustable Axle Assemblies
        [select adjustable-axle-frame first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Tire and Wheel Clearance
        [select tire-wheel-frame  first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Frame Members
        [select frame-members first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    


<label> Repair
    [text frame-repair] </label>

<label> Repair Date
    [date_time frame-repair-date "m/d/Y"] </label>

[section_break section_break-912 "Tires, Wheels and Rims"]


    
    <label> Tire Tread
        [select tire-tread first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Lock or Side Ring
        [select lock-side-ring  first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Wheels and Rims Not Bent
        [select wheels-rims-not-bent first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Fasteners
        [select  fasteners first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Welds
        [select welds first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    


<label> Repair
    [text tire-rims-repair] </label>

<label> Repair Date
    [date_time tire-rims-repair-date "m/d/Y"] </label>

[section_break section_break-636 "Windshield and Wipers"]


    
    <label> Cracks or Holes That Impede Vision
        [select cracks-impede-vision first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    <label> Wiper Missing Parts
        [select wiper-missing-parts first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    



    
    <label> Wipers Fully Functional
        [select wipers-fully-functional first_as_label "- select -" "Passed Inspection" "Needs Repair" "N/A"] </label>
    
    
    


<label> Repair
    [text wipers-repair] </label>

<label> Repair Date
    [date_time wipers-repair-date "m/d/Y"] </label>

[section_break section_break-645 "Other Misc"]

<label> Other Observations/Issues to Address
    [textarea other-observations x3] </label>


[acceptance acceptance-91 optional] I have read and agree to the Terms and Conditions and Privacy Policy [/acceptance]


[submit "Submit"]

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Address Field

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Textarea field

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Feature of this Template

Here is a quick overview of the features of this template, highlighting its key functions and how they can help you automate your process.

Vehicle Information: Collects details like make, model, year, and Vehicle Identification Number (VIN).
Mileage Update: Records the current mileage of the vehicle for tracking purposes.
Exterior Condition: Assesses the condition of the vehicle's body, including paint, dents, and rust.
Interior Condition: Evaluates the state of the vehicle's interior, including seats, flooring, and controls.
Tire Condition: Reviews tire wear, tread depth, and overall condition.
Fluid Levels and Maintenance: Checks the levels of essential fluids (oil, coolant, brake fluid) and records any maintenance done.