Chaparral Energy DOT Inspection

• Vehicle Inspection Form

• Client / Site

• Conducted on

  Date

• Prepared by

• TRUCK # / TRAILER #

• ODOMETER READING

• LOCATION

Inside

• Parking Brake (Apply) 393.41

  Yes

  No

  N/A

• Company Name and USDOT number on door(s). 390.21

  Yes

  No

  N/A

• Secured and Charged Fire Extinguisher (5lb Non-haz;10lb Haz-mat). 393.95

  Yes

  No

  N/A

• Paperwork (Private Motor Carrier License, Haz-Mat Registration, Vehicle Registration(s), Insurance Certificate, IFTA License & Stickers, Annual Inspections(s). 392.2-396.17

  Yes

  No

  N/A

• Horn -393.81

  Yes

  No

  N/A

• Seat Belt -393.93

  Yes

  No

  N/A

• Emergency Triangles, First Aid Kit, Accident Kit, Emergency Kit (fuses & spare light bulbs). 393.95

  Yes

  No

  N/A

Start Engine

• Instrument Panel (Speedometer, Oil Pressure, Air Pressure, Ammeter, Lights).-393.82

  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). 393.51

  Yes

  No

  N/A

• Windshield Wipers and Washer Fluid -393.78

  Yes

  No

  N/A

• Heater-Defroster-393.79

  Yes

  No

  N/A

• Steering Wheel (Excess play-Manual steering movement should not exceed 30 degrees. Power steering movement should not exceed 45 degrees). 393.209

  Yes

  No

  N/A

• Apply Trailer Brakes in EMERGENCY-393.40

  Yes

  No

  N/A

• Service Brakes (Apply-air loss should not exceed-3 psi / min on single vehicles / 4 psi / min on combination).<br>393.45

  Yes

  No

  N/A

Outside

• Front Lights (headlights, clearance & marker, turn signal, 4-way flashers).393.24-393.11

  Yes

  No

  N/A

• Windshield-393.60

  Yes

  No

  N/A

• Mirrors-393.80

  Yes

  No

  N/A

• Steering Axle Tires, Rims, and Lugs (Tire tread shall be at least 4/32 of an inch). 393.75

  Yes

  No

  N/A

• Fuel System-393.65

  Yes

  No

  N/A

• Brake/Electric Lines and connections to trailer. 393.43-393.45

  Yes

  No

  N/A

• Coupling (Fifth wheel, tow bar safety chains, locking devices). 393.70

  Yes

  No

  N/A

• Body, Frame and Assembly-393.203

  Yes

  No

  N/A

• Engine, Exhaust-393.83

  Yes

  No

  N/A

• Tail Lights (tail, brake, turn signal, 4-way, clearance & marker). 393.11

  Yes

  No

  N/A

• Suspension System-393.207

  Yes

  No

  N/A

• Drive Axle(s) / Other tires, Rims and Lugs (Tire tread shall be at least 2/32 of an inch). 393.75

  Yes

  No

  N/A

• Conspicuity Tape/Reflectors-393.13

  Yes

  No

  N/A

• Tag-392.2

  Yes

  No

  N/A

Trailer

• Brakes, Brake Connections and Breakaway Systems-393.43

  Yes

  No

  N/A

• Coupling Devices; King Pin; Hitch-393.70

  Yes

  No

  N/A

• Lights (tail, brake, turn signal, 4-way, clearance & marker). 393.11

  Yes

  No

  N/A

• Landing Gear -393.201

  Yes

  No

  N/A

• Suspension System -393.207

  Yes

  No

  N/A

• Tires, Rims and Lugs (Tire tread shall be at least 2/32 of an inch). 393.75

  Yes

  No

  N/A

• Conspicuity Tape / Reflectors-393.13

  Yes

  No

  N/A

• Tag-392.2

  Yes

  No

  N/A

• Comments

• Inspector Signature

  Sign