EFS Commercial Motor Vehicle Inspection, Combination Units. Rev 5

• Tractor/Truck and Trailer Number. Registration State and #.

• Vehicle type

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Vehicle Mileage

• Tire size

Driver Information if the Driver is present

• Drivers Name

• Drivers Date of Birth

  Date

• Drivers License Number and State

• Does the driver have a Current Drivers License and the Proper Endorsements to operate the vehicle?

  Yes

  No

  N/A

• Driver License Endorsements

  Select tanker hazmat doubles/triples Trailer Tank/Hazmat Passenger

  • tanker
  • hazmat
  • doubles/triples Trailer
  • Tank/Hazmat
  • Passenger

• Does the Driver have any Restrictions on his license and are they being followed?

  Yes

  No

  N/A

• Does the driver have a Current Medical Card?

  Yes

  No

  N/A

• When does the Medical Card Expire?

  Date

• Is the driver in possession of a Log Book?

  Yes

  No

  N/A

• Does the Log Book conform to the Federal Regulation?

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

Inside the Truck Cab

• Is the Truck Cab Clean and Free of Trash?

  Yes

  No

  N/A

• Is there a copy of the previous days DVIR inside the truck?

  Yes

  No

  N/A

• Are the Windows Clean and free of Cracks that might impair the drivers ability to see?

  Yes

  No

  N/A

• Are the Mirrors Clean and free of Cracks that might impair the drivers ability to see?

  Yes

  No

  N/A

• Are the Windshield Wipers clean with no dry rotting or cracks that would impair their functionality?

  Yes

  No

  N/A

• Do the Windshield Wipers work?

  Yes

  No

  N/A

• Is the Fire Extinguisher Accessible, Fully Charged and Secured?

  Yes

  No

  N/A

• Has the Fire Extinguisher been Inspected Annually and within the Last Month?

  Yes

  No

  N/A

• Are the Emergency Triangles present and stored correctly? (3)

  Yes

  No

  N/A

• Is the Horn working properly?

  Yes

  No

  N/A

• Turning on the Ignition, are all of the Gauges functioning properly?

  Yes

  No

  N/A

• Turn Signals, 4-way Emergency Flashers and High Beam Indicator lamps are all working properly?

  Yes

  No

  N/A

• Is the Steering Wheel free from excessive play when turned side to side?

  Yes

  No

  N/A

• Is there a copy of the Vehicle Registration and Company Insurance Card in the glove box?

  Yes

  No

  N/A

• Does the Vin Number on the truck match the Vin Number on the registration card?

  Yes

  No

  N/A

• Does the Registration Plate on the truck match the Registration Number on the registration card?

  Yes

  No

  N/A

• When does the Vehicle Registration Card Expire?

  Date

• When does the Insurance Card Expire?

  Date

• Is there a copy of the Federal Motor Carrier Safety Regulation (green book) in the cab?

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

Brake Check

• Apply the Parking Brake. Does it hold when putting the vehicle in drive and pulling against it?

  Yes

  No

  N/A

• Move the vehicle forward and apply the brake. Does it grab firmly with no slipping?

  Yes

  No

  N/A

• Does the Brake Modulator Activate ALL Electric Trailer Brakes when applied?

  Yes

  No

  N/A

• Is the Emergency Break Away Cable in good condition and properly attached to the towing unit?

  Yes

  No

  N/A

• Does the Emergency Break Away Device on the trailer work when the pin is pulled?

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

Engine compartment

• Is The area under the Engine free of Leaks ( oil, water, other fluids)?

  Yes

  No

  N/A

• Check the Oil, Coolant, Brake and Washer Fluid levels. Are they all within manufacturers parameters?

  Yes

  No

  N/A

• Is the Serpentine Belt snug and free from cracks or fraying?

  Yes

  No

  N/A

• Are all of the Hoses free from cracks, fraying or wear?

  Yes

  No

  N/A

• On the Battery, are the posts tight and free of corrosion?

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

Outside the vehicle Inspection

• Vehicle picture.

  Media

• Is there an Annual Inspection Decal on the Truck, is it Legible? If not there must be a Hard copy available in the truck.

  Yes

  No

  N/A

• When does the Annual Inspection on the Truck Expire?

  Date

• Is there an Annual Inspection Decal on the Trailer, is it Legible? If not there must be a Hard copy available on the Trailer.

  Yes

  No

  N/A

• When does the Annual Inspection on the Trailer Expire?

  Date

• Is there a copy of the Trailer Registration Document on the Trailer?

  Yes

  No

  N/A

• Does the Vin Number on the trailer match the Vin Number on the registration card?

  Yes

  No

  N/A

• Does the Registration Plate on the trailer match the Registration Number on the registration card?

  Yes

  No

  N/A

• When does the Registration on the Trailer Expire?

  Date

• Are the License Plates on the Truck properly Mounted and Legible?

  Yes

  No

  N/A

• Are the License Plates on the Trailer properly Mounted and Legible?

  Yes

  No

  N/A

• Is the Company Name and DOT number in legible condition on both the driver and passenger sides of the truck?

  Yes

  No

  N/A

• Is the current IFTA decal visible on both sides of the truck?

  Yes

  No

  N/A

• Is the Truck and Trailer Numbers on the vehicles and are they Legible?

  Yes

  No

  N/A

• Is the Electrical Connection between the Truck and Trailer in good working condition?

  Yes

  No

  N/A

• Are the Electrical Wires are in good condition with no cuts or frays?

  Yes

  No

  N/A

• Are all Truck and Trailer Lights functioning properly, including but not limited to the license plate lamps?

  Yes

  No

  N/A

• Are all Lighting Device Lenses in good condition?

  Yes

  No

  N/A

• Is there a 20lb Fire Extinguisher on the Trailer and is it in proper operating condition?

  Yes

  No

  N/A

• Are there Mud Flaps on the Truck and Trailer if Required?

  Yes

  No

  N/A

• Using a Tire Gauge, check the Tires for proper Inflation. Are they within specifications?

  Yes

  No

  N/A

• Are the Tires free of Excessive Wear and Damage, is the Tread Depth within allowable limits (4/32 Steer Axle, 2/32 others)?

  Yes

  No

  N/A

• Do the Lug Nuts Appear to be Tight on all of the wheels?

  Yes

  No

  N/A

• Are the Rims in good condition with no Bends or Cracks?

  Yes

  No

  N/A

• Does the vehicle have a set of Wheel Chocks?

  Yes

  No

  N/A

• If Required are the Wheel Chocks being Used?

  Yes

  No

  N/A

• Is there a Spare Tire for the Truck?

  Yes

  No

  N/A

• is there a Spare Tire for the Trailer?

  Yes

  No

  N/A

• Do the Frames of both the Truck and Trailer appear to be free of defects and in good operating condition?

  Yes

  No

  N/A

• If using a Ball Hitch, is it the proper Size Ball for the trailer? ( if trailer is being utilized)

  Yes

  No

  N/A

• Are the Safety Chains Crossed, in good condition and Properly Attached to the towing unit?

  Yes

  No

  N/A

• Is the a truck Bed and Trailer free of Trash and Debris?

  Yes

  No

  N/A

• Are all items on the Truck and Trailer Properly Secured?

  Yes

  No

  N/A

• Are all Securement Devices in good condition?

  Yes

  No

  N/A

• If Rods are being used to Secure Iron in the Racks, do the Rods have R-Clips in them?

  Yes

  No

  N/A

• Is the DOT reflective tape on the trailer?

  Yes

  No

  N/A

• Is the Paint on the trailer, the iron and on the equipment in good condition?

  Yes

  No

  N/A

• Is the Iron Certification Current and are the certification bands in good, readable condition?

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Other Deficiencies

  Yes

  No

  N/A

• Is the Vehicle Safe to Operate?

  Safe

  At Risk

  N/A

Audit Certification

• Auditor signature

  Sign

• Auditor comments

• Driver signature

  Sign

• Driver comments.

• Mechanics signature after repairs have been completed. Date repairs have been completed.

  Sign

• Mechanics comments / notes.