LEG Commercial Motor Vehicle_Truck-Trailer Tandem

• Bussiness Unit/Department:

• Location/Site

• Location
  Address

• Prepared by

• Conducted on

  Date

Truck

Under the Hood

• Battery

  Good

  Repair

  Replace

  N/A

• Fluid Levels - Coolant, Power Steering, oil, wind shield wash fluid.

  Good

  Repair

  Replace

  N/A

• Comments:

• Add media

  Media

• Headlamps

  Yes

  No

  N/A

• Turn Signals, Front & Rear (Tail lamps, Stop lamps, Hazard lamps, Back up lamps, License Plate lamp)

  Good

  Repair

  Replace

  N/A

• Windshield - Front / Rear

  Good

  Repair

  Replace

  N/A

• Windshield Wipers - Front

  Good

  Repair

  Replace

  N/A

• Lug nuts- Complete set (not loose or missing)

  Yes

  No

  N/A

• Tires and Rims in good condition -All

  Yes

  No

  N/A

• Brakes

  Yes

  No

  N/A

• Fire extinguisher (Note: 10 B:C or more if hauling Haz Mat)

  Yes

  No

  N/A

• Extra fuses and bulbs

  Yes

  No

  N/A

• Rear-vision mirrors

  Yes

  No

  N/A

• Defroster

  Yes

  No

  N/A

• Emergency Equipment

  Yes

  No

  N/A

Trailer

• Breakaway and emergency breaking ( Note: Check cables for damage, battery functional and properly hooked up to power unit if in use)

  Yes

  No

  N/A

• Electrical connections: Properly attached and secured.

  Yes

  No

  N/A

• Hitch/Safety Chains/Safety Pin

  Yes

  No

  N/A

• Lights (Tail lamps, Stop Lamps, Hazard Lamps, Backup Lamp, License Plate Lamp, Turn Signals, Side Marker Lamps)

  Yes

  No

  N/A

• Brakes

  Yes

  No

  N/A

• Rear Reflex Reflectors

  Yes

  No

  N/A

• Rear Side Reflex Reflectors

  Yes

  No

  N/A

• Retro flextime Sheeting-Sides and Rear of Trailer<br>(Note: Required on trailers 80' or more and gross vehicle weight of 10,001 lbs. or more)

  Yes

  No

  N/A

• Tires/lugs nuts-missing or loose

  Yes

  No

  N/A

• Copy of required paperwork for trailer.

  Yes

  No

  N/A

• Copy of DOT inspection certificate.

  Yes

  No

  N/A

• Copy of trailer license receipt.

  Yes

  No

  N/A

Vehicle Documents

• Bill of Lading /Shipping Papers

  Good

  Repair

  Replace

  N/A

• SDS Available (if applicable)

  Yes

  No

  N/A

• Insurance Card

  Good

  Repair

  Replace

  N/A

• Insurance Cab Card

  Good

  Repair

  Replace

  N/A

• Inspection book (DVIR)

  Good

  Repair

  Replace

  N/A

• Accident Report Envelope

  Good

  Repair

  Replace

  N/A

• Permits Oversize / Weight (if applicable)

  Good

  Repair

  Replace

  N/A

• HAZMAT Guidebook

  Good

  Repair

  Replace

  N/A

• Emergency Response Guidebook

  Good

  Repair

  Replace

  N/A

• Comments:

Sign Off

• Truck No.:

• Trailer No.:

• Driver's Name:

• Driver's signature:

  Sign

• Safety/DOT Inspector Name:

• PRE-TRIP INSPECTION

  Off

  On

• POST-TRIP INSPECTION

  Off

  On