AgVantage FS DOT Quick Check

• Audit Title

• Conducted on

  Date

• Prepared by

AgVantage FS DOT Quick Check

• Does this DOT Quick Check involve a driver?

  Yes

  No

Driver Information

• Identification--Front of License

  Media

• Endorsements--Back of License

  Media

• Observations or Concerns

• Does the Driver carry a medical card?

  Yes

  No

• Proof of Validity

  Media

• Reason for not carrying...

  Not required to carry.

  Not required to have one.

  No Excuse.

• Does this DOT Quick Check involve a vehicle?

  Yes

  No

Vehicle Information

• Vehicle being inspected.

  Media

• Vehicle Unit Number

  Media

Emergency Equipment

• Warning Triangles are available and appear to be in working condition.

• Add media

  Media

• Concern

• Fire Extinguisher is mounted, charged, and inspected.

• Add media

  Media

• Concern

• Responsible Ag First Aid Kit and Spare Fuses are available.

• Add media

  Media

• Concern

Vehicle Binder

• Shipping Papers are current and available.

• Add media

  Media

• Concern

• Vehicle registration is current and available.

• Add media

  Media

• Concern

• Vehicle proof of insurance is current and available.

• Add media

  Media

• Concern

• Vehicle's proof of annual inspection is current and available.

• Add media

  Media

• Concern

• DVIR appears to be completed in accordance to the Company Policy of "Every Driver...Every Day"

• Add media

  Media

• Concern

• Does this DOT Quick Check involve a trailer?

  Yes

  No

• Trailer being inspected.

  Media

• Trailer unit number.

  Media

• Trailer's proof of annual inspection is current and available.

• Add media

  Media

• Concern

• Trailer registration is current and available.

• Add media

  Media

• Concern

Walk Around Inspection

• Based on the information provided via DVIR and the judgement of the inspector is a thorough walk around inspection warranted at this juncture?

  Yes

  No

Front of Vehicle

• The following items are working properly at the time of inspection. Lights Signals Horn Windshield No leaks and drips

• Add media

  Media

• Concern

Side of Vehicle

• The following items are working properly at the time of inspection. Corporate Signage Marker Lights Mounting Bolts Attachments and Storage Mirrors

• Add media

  Media

• Concern

Rear of Vehicle

• The following items are working properly at the time of inspection. Marker Lights Signals Brake Lights Reverse Light License Plate Light Cluster of 3 Bumper Height <30" Reflective Striping Load Securement

• Add media

  Media

• Concern

Trailer

• Is a trailer involved in this walk around inspection?

  Yes

  No

• The following items are working properly at the time of inspection. Marker Lights Signals Brake Lights Reverse Light License Plate Light Cluster of 3 Bumper Height <30" Reflective Striping Load Securement Air Lines Chains & Brake Cable

• Add media

  Media

• Concern

Tires

• Tread depth is a minimum of 4/32" on the steer tires and 2/32" on the drive tires.

• Add media

  Media

• Concern

• Tire Inflation does not appear to be an issue.

• Add media

  Media

• Concern

• Wheels/Rims appear to be in good repair and functioning properly.

• Add media

  Media

• Concern

Findings and Recommendations

• Based on the information provided and gathered for this DOT Quick Check.

  Pass

  Fail

• Congratulations!!! At the time of this Quick Check you have proven to be DOT Compliant.

• Vehicle and/or Trailer are not allowed to resume normal business operations until the following expectations have been met.

Performed By

• Name

  Sign

• Name

  Sign