DOT SAFETY AUDIT

• Document No.

• Legal Name

• Trade Name

• USDOT #

• Conducted on

  Date
• Address
  Address

• Assessor

Log files

• Log file for all commercial drivers

  Yes

  No

  N/A

• Previous 6 months plus current logs

  Yes

  No

  N/A

• Purged properly

  Yes

  No

  N/A

DVIR

• DVIR file for all cmv

  Yes

  No

  N/A

• 4 months plus current

  Yes

  No

  N/A

• Purged properly

  Yes

  No

  N/A

CMV

• Number of Delivery units

• Number of Service units

• Are Unit numbers displayed properly

  Yes

  No

  N/A

• Are DOT Numbers displayed properly

  Yes

  No

  N/A

DRIVER INFORMATION

• Total CDL Drivers

• Total Non-CDL Drivers

STRAIGHT TRUCKS

• Do you operate any straight trucks?

  Yes

  No

TRUCK TRACTORS

• Do you operate any truck tractors?

  Yes

  No

TRAILERS

• Do you utilize any trailers?

  Yes

  No

TOTAL INSPECTIONS (Roadside / Terminal)

• Have you had any roadside or terminal inspections within the previous 365 days?

  Yes

  No

• Total

• Were any inspections out-of-service?

  Yes

  No

  N/A

• Total

RECORDABLE ACCIDENTS (Fatalities, Injuries Requiring Immediate Medical Treatment, Towed Vehicles)

• Have you had any recordable accidents in the previous 3 years?

  Yes

  No

• List all recordable accidents.

LOCATION OF REVIEW

• Where was the review conducted?

  Select Principal Place of Business Terminal Location EA Office Other

  • Principal Place of Business
  • Terminal Location
  • EA Office
  • Other

• Other Location

GENERAL

• General # 2 Section # 387.7(d) - Critical<br>Does the carrier have required proof of financial responsibility (property carrier)?

  Yes

  No

  N/A

• General # 3 Section # 387.31(a) - Acute<br>Does the carrier have the required minimum level of financial responsibility in effect (passenger carrier)?

  Yes

  No

  N/A

• General # 8 Section # 390.3(e)<br>Is the carrier knowledgeable of the FMCSRs/HMRs?

  Yes

  No

  N/A

• General # 9 Section # 390.21<br>Does the carrier know the commercial motor vehicles marking requirements?

  Yes

  No

  N/A

DRIVER

• Driver # 2 Section # 391.11(b)(4) - Acute<br>Is the carrier using physically qualified drivers?

  Yes

  No

  N/A

• Driver # 3 Section # 391.45(a), 391.45(b) - Critical<br>Is the carrier using a driver without a medical certificate or with an expired medical certificate?

  Yes

  No

  N/A

• Driver # 4 Section # 391.15(a) - Acute<br>Is the carrier using any disqualified drivers?

  Yes

  No

  N/A

COMMERCIAL DRIVERS LICENSE (CDL)

• Are any drivers required to have a CDL?

  Yes

  No

• Driver # 21 Section # 383.23(a) - Critical<br>Has a driver operated a commercial motor vehicle without a current operating license, or a license, which hasn't been properly classed and endorsed?

  Yes

  No

• Driver # 22 Section # 383.37(a) - Acute<br>Has the motor carrier knowingly allowed its drivers whose CDLs have been suspended, revoked or canceled by a state, have lost the right to operate a CMV in a state, or have been disqualified from operating a CMV to operate a commercial motor vehicle?

  Yes

  No

• Driver # 23 Section # 383.51(a) - Acute<br>Has the motor carrier knowingly allowed, required, permitted, or authorized a driver to drive who is disqualified to drive a commercial motor vehicle?

  Yes

  No

OPERATIONS

• Do any drivers utilize a time sheet to record hours of service?

  Yes

  No

• Operations # 1 Section # 395.1(e)(1), 395.1(e)(2)<br>Does the carrier have a system for recording hours of duty status on 100/150 air-mile radius drivers, and are they properly utilizing the 100/150 air-mile radius exemption?

  Yes

  No

• Operations # 2 Section # 395.8(a) - Critical<br>Does the carrier require drivers to make a record of duty status?

  Yes

  No

  N/A

• Operations # 3 Section # 395.8(i) - Critical<br>Does the carrier require drivers to submit records of duty status within 13 days?

  Yes

  No

• Operations # 4 Section # 395.8(k)(1) - Critical<br>Can the carrier produce records of duty status and supporting documents for selected drivers?

  Yes

  No

• Operations # 5 Section # 395.3(a)(1) - Critical<br>Has the carrier allowed driver(s) to exceed the 11-hour rule? (Property)

  Yes

  No

• Operations # 6 Section # 395.3(a)(2) - Critical<br>Has the carrier allowed driver(s) to exceed the 14-hour rule? (Property)

  Yes

  No

• Operations # 8 Section # 395.3(b)(2) - Critical<br>Has the carrier allowed driver(s) to drive after having been on duty more than 70 hours in 8 consecutive days? (Property)

  Yes

  No

  N/A

• Operations # 13 Section # 395.8(e) - Critical<br>Does available evidence indicate a selected driver has prepared a false record of duty status?

  Yes

  No

• Operations # 14 Section # 392.2 - Critical<br>Does the motor carrier ensure that drivers operate commercial motor vehicles in accordance with the laws, ordinances, and regulations of the jurisdictions in which they are operating?

  Yes

  No

• Operation # 15 Section # 392.9(a)(1) - Critical<br>Does the carrier ensure that drivers are not permitted to drive a vehicle without the cargo properly distributed and adequately secured?

  Yes

  No

• Operations # 16 Section # 392.4(b) - Acute<br>Have any drivers operated a commercial motor vehicle while under the influence of, or in possession of, narcotic drugs, amphetamines, or any other substances capable of rendering the drivers incapable of safely operating motor vehicles?

  Yes

  No

• Operations # 17 Section # 392.5(b)(1) - Acute<br>Have any drivers operated a commercial motor vehicle while under the influence of, or in possession of, intoxicating beverages?

  Yes

  No

• Operations # 18 Section # 392.5(b)(2) - Acute<br>Have any drivers operated a commercial motor vehicle within 4 hours of having consumed intoxicating beverages?

  Yes

  No

MAINTENANCE

• Maintenance # 1 Section # 396.3(b) - Critical<br>Can the carrier produce maintenance files for requested vehicle(s)?

  Yes

  No

  N/A

• Maintenance # 2 Section # 396.17(a) - Critical<br>Can the carrier produce evidence of periodic (annual) inspections for selected vehicles?

  Yes

  No

  N/A

• Maintenance # 3 Section # 396.11(a) - Critical<br>Does the motor carrier require drivers to complete vehicle inspection reports daily?

  Yes

  No

  N/A

• Maintenance # 4 Section # 396.11(c) - Acute<br>Does the carrier ensure that out-of-service defects listed by the driver in the driver vehicle inspection reports are corrected before the vehicle is operated again?

  Yes

  No

  N/A

• Maintenance # 5 Section # 396.9(c)(2) - Acute<br>Does the carrier ensure vehicles that have been declared "out-of-service" do not operate before repairs have been made?

  Yes

  No

  N/A

• Maintenance # 6 Section 396.19<br>Is the carrier using qualified inspections (mechanic) and maintaining evidence of the inspector's qualifications?

  Yes

  No

  N/A

• Maintenance # 7 Section # 396.3<br>Can the carrier explain its systematic, periodic maintenance program?

  Yes

  No

  N/A

RECEIPT

• This audit is used to determine your compliance with the Federal Motor Carrier Safety Regulations (FMCSRs). Any violations discovered may be utilized to help determine the areas of concern that need addressing.
  
  Your signature for receipt of this report acknowledges your understanding that if any violations are discovered they will be corrected as earliest as possible. You also understand that by failing to correct any violations discovered, you will be held liable for any violations that may be discovered during a compliance review from FMCSA or your States Enforcement Agency.
  
  You also agree not to hold Employer Advantage and/or its representative liable for any violations discovered during a safety audit or compliance review conducted by any investigator or enforcement officer.
  
  Refusing to sign this report does not in any way release you from any liability.

• Assessor Signature

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• Company Official

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