Chaparral Energy DOT Inspection

• Vehicle Inspection Form

• Client / Site

• Conducted on

  Date

• Prepared by

• TRUCK # / TRAILER #

• ODOMETER READING

• LOCATION

Inside

• Parking Brake (Apply)

  Yes

  No

  N/A

• Company Name and USDOT number on door(s)

  Yes

  No

  N/A

• Secured and Charged Fire Extinguisher (5lb Non-haz;10lb Haz-mat)

  Yes

  No

  N/A

• Paperwork (Private Motor Carrier License, Haz-Mat Registration, Vehicle Registration(s), Insurance Certificate, IFTA License & Stickers, Annual Inspections(s)

  Yes

  No

  N/A

• Horn

  Yes

  No

  N/A

• Seat Belt

  Yes

  No

  N/A

• Emergency Triangles, First Aid Kit, Accident Kit, Emergency Kit (fuses & spare light bulbs)

  Yes

  No

  N/A

Start Engine

• Instrument Panel (Speedometer, Oil Pressure, Air Pressure, Ammeter, Lights)

  Yes

  No

  N/A

• Low Air Warning Device (Air pressure below 40 psi check on pressure build-up Air pressure above 60 psi deplete air until warning device works)

  Yes

  No

  N/A

• Windshield Wipers and Washer Fluid

  Yes

  No

  N/A

• Heater-Defroster

  Yes

  No

  N/A

• Steering Wheel (Excess play-Manual steering movement should not exceed 30 degrees. Power steering movement should not exceed 45 degrees)

  Yes

  No

  N/A

• Apply Trailer Brakes in EMERGENCY

  Yes

  No

  N/A

• Service Brakes (Apply-air loss should not exceed-3 psi / min on single vehicles / 4 psi / min on combination)

  Yes

  No

  N/A

Outside

• Front Lights (headlights, clearance & marker, turn signal, 4-way flashers)

  Yes

  No

  N/A

• Windshield

  Yes

  No

  N/A

• Mirrors

  Yes

  No

  N/A

• Steering Axle Tires, Rims, and Lugs (Tire tread shall be at least 4/32 of an inch)

  Yes

  No

  N/A

• Fuel System

  Yes

  No

  N/A

• Brake/Electric Lines and connections to trailer

  Yes

  No

  N/A

• Coupling (Fifth wheel, tow bar safety chains, locking devices)

  Yes

  No

  N/A

• Body, Frame and Assembly

  Yes

  No

  N/A

• Engine, Exhaust

  Yes

  No

  N/A

• Tail Lights (tail, brake, turn signal, 4-way, clearance & marker)

  Yes

  No

  N/A

• Suspension System

  Yes

  No

  N/A

• Drive Axle(s) / Other tires, Rims and Lugs (Tire tread shall be at least 2/32 of an inch)

  Yes

  No

  N/A

• Conspicuity Tape/Reflectors

  Yes

  No

  N/A

• Tag

  Yes

  No

  N/A

Trailer

• Brakes, Brake Connections and Breakaway Systems

  Yes

  No

  N/A

• Coupling Devices; King Pin; Hitch

  Yes

  No

  N/A

• Lights (tail, brake, turn signal, 4-way, clearance & marker)

  Yes

  No

  N/A

• Landing Gear

  Yes

  No

  N/A

• Suspension System

  Yes

  No

  N/A

• Tires, Rims and Lugs (Tire tread shall be at least 2/32 of an inch)

  Yes

  No

  N/A

• Conspicuity Tape / Reflectors

  Yes

  No

  N/A

• Tag

  Yes

  No

  N/A

• Comments

• Inspector Signature

  Sign

• Date & Time

  Date

• Driver Signature

  Sign

• Date & Time

  Date