DOT Mock Inspection Form

• Prepared by. Troy Covington

• Location

• Vehicle #

• Driver Name

• Instructions:
  
  1. Fill out the fields below.
  2. Answer "Compliant", "Non-Compliant", "N/A" for the questions provided.
  3. Add photos and notes by clicking on the paperclip icon.
  4. To add a Corrective Measure, click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  5. Complete audit by providing digital signature.
  6. Share your report by exporting as PDF, Word, Excel or Web Link.

Truck and Driver information

• DOT Annual Inspection Date

  Compliant

  Non-Compliant

  N/A

• Insurance Card

  Compliant

  Non-Compliant

  N/A

• DOT Medical Card

  Compliant

  Non-Compliant

  N/A

• Logbook HOS

  Compliant

  Non-Compliant

  N/A

• Copy of Drivers License ( current not expired)

  Compliant

  Non-Compliant

  N/A

General Conditions

• Cab, doors, windows (any dents, dings, can the driver see out the windows, cleanliness)

  Compliant

  Non-Compliant

  N/A

• Body (any dents or dings not known about, any cracks in the body)

  Compliant

  Non-Compliant

  N/A

• All lightbulbs operable (if there is a light on the truck, it must be operable)

  Compliant

  Non-Compliant

  N/A

• All locks and latches operable (check the hood latches and the back chute Latch (if there is one))

  Compliant

  Non-Compliant

  N/A

Engine Compartment

• Oil level

  Compliant

  Non-Compliant

  N/A

• Coolant level

  Compliant

  Non-Compliant

  N/A

• Belts

  Compliant

  Non-Compliant

  N/A

• Windshield Wiper Fluid

  Compliant

  Non-Compliant

  N/A

• Transmission Fluid Level

  Compliant

  Non-Compliant

  N/A

In-Cab

• Gauges/warning indicators

  Compliant

  Non-Compliant

  N/A

• Windshield wipers/washers (are they operable, this is one of our top DOT violations)

  Compliant

  Non-Compliant

  N/A

• Horn(s)

  Compliant

  Non-Compliant

  N/A

• Heater/defroster

  Compliant

  Non-Compliant

  N/A

• Mirrors

  Compliant

  Non-Compliant

  N/A

• Steering

  Compliant

  Non-Compliant

  N/A

• Parking brakes

  Compliant

  Non-Compliant

  N/A

• Emergency brakes

  Compliant

  Non-Compliant

  N/A

• Triangles

  Compliant

  Non-Compliant

  N/A

• Fire extinguisher

  Compliant

  Non-Compliant

  N/A

• Hard hat

  Compliant

  Non-Compliant

  N/A

• Seat belts

  Compliant

  Non-Compliant

  N/A

• Radio

  Compliant

  Non-Compliant

  N/A

Exterior

• Lights/turn signals

  Compliant

  Non-Compliant

  N/A

• Reflectors

  Compliant

  Non-Compliant

  N/A

• Tires

  Compliant

  Non-Compliant

  N/A

• Wheels/rims/lugs

  Compliant

  Non-Compliant

  N/A

• Battery

  Compliant

  Non-Compliant

  N/A

• Brakes

  Compliant

  Non-Compliant

  N/A

• Air lines

  Compliant

  Non-Compliant

  N/A

• Mudflaps

  Compliant

  Non-Compliant

  N/A

• Did the driver pass or fail the assessment?

  Pass

  Fail

  N/A

• Inspector

  Sign

• Driver Signature

  Sign