SAFETY EMPHASIS CMV - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Vehicle Unit Number

• Vehicle Description (Year, Make, Type)

Asset

Driver Information

• Driver Name

• Driver has on him/her a proper Driver's License for the vehicle being operated?

  Yes

  No

  Y-notes

  N/A

• Driver has current Medical Card on him/her at time of inspection?

  Yes

  No

  Y-notes

  N/A

• (X2) The driver was observed wearing a seat belt while operating the vehicle?

  Yes

  No

  Y-notes

  N/A

• (X5) Driver has a current DQ file and in drug pool?

  Yes

  No

  Y-notes

  N/A

Vehicle Documenation

• Current Registration Certificate and Insurance Card in Vehicle

  Yes

  No

  Y-notes

  N/A

• (X3) Current Annual Inspection Sticker Properly Displayed on the vehicle (both a sticker and certificate required)?

  Yes

  No

  Y-notes

  N/A

• (X3) Current Annual Inspection Certificate Maintained in Vehicle (both a sticker and certificate required)?

  Yes

  No

  Y-notes

  N/A

• Current DOT Hazmat Registration Certificate Maintained in all Agronomy and Energy Trucks/Pickups?

  Yes

  No

  Y-notes

  N/A

• Daily Inspection Reports Being Performed and Copies Given to Supervisor?

  Yes

  No

  Y-notes

  N/A

• Emergency Response Guide Book properly maintained in the vehicle for all Agronomy and Energy Trucks/Pickups?

  Yes

  No

  Y-notes

  N/A

• Blank Copy of CVA's vehicle accident report form available in the vehicle?

  Yes

  No

  Y-notes

  N/A

• DOT Hazmat Shipping Paper Properly Stored in the Vehicle (If Applicable)

  Yes

  No

  Y-notes

  N/A

• (X3) CVA Vehicle Maintenance Log is maintained in the vehicle with proper documentation of all maintenance, lubrication, and repairs performed?

  Yes

  No

  Y-notes

  N/A

Vehicle Inspection

• (X2) Driver's Compartment Clean and Free Clutter/Rubbish

  Yes

  No

  Y-notes

  N/A

• Fire Extinguisher / Emergency Reflective Triangles Compliant

  Yes

  No

  Y-notes

  N/A

• Steps, Ladders, and Grab Bars are in safe condition?

  Yes

  No

  Y-notes

  N/A

• Seat and Seatbelt in proper working order?

  Yes

  No

  Y-notes

  N/A

• Gauges and Controls in proper working order?

  Yes

  No

  Y-notes

  N/A

• Horn in proper working order?

  Yes

  No

  Y-notes

  N/A

• Lights are in safe condition/FMCSA compliant?

  Yes

  No

  Y-notes

  N/A

• Windshield Wiper and Washer are in safe condition/FMCSA compliant?

  Yes

  No

  Y-notes

  N/A

• Windshield and Side Windows compliant?

  Yes

  No

  Y-notes

  N/A

• Wheels and Tires are safe condition/FMCSA compliant?

  Yes

  No

  Y-notes

  N/A

• Frame / Rear End Protection / Component Anchor bolts are safe condition/FMCSA compliant?

  Yes

  No

  Y-notes

  N/A

• Suspension Components are safe condition?

  Yes

  No

  Y-notes

  N/A

• Fuel System properly secured and free of leaks?

  Yes

  No

  Y-notes

  N/A

• Coupling Devices in proper working order including safety chains?

  Yes

  No

  Y-notes

  N/A

• Steering Components are in safe condition/FMCSA compliant?

  Yes

  No

  Y-notes

  N/A

• (X2) Brake Components are in safe condition/FMCSA compliant?

  Yes

  No

  Y-notes

  N/A

• TRAM Fall Protection Systems if equipped are maintained in safe condition (Feed Trucks Only)

  Yes

  No

  Y-notes

  N/A

• All other vehicle components are in safe condition/FMCSA compliant?

  Yes

  No

  Y-notes

  N/A

Safe Loading

• Cargo is properly secured?

  Yes

  No

  Y-notes

  N/A

• Tie-down straps, chains, load binders, all in safe condition?

  Yes

  No

  Y-notes

  N/A

Hazmat Cargo Tank Questions

• Hazmat Tanker Questions

• (X3) Monthly propane discharge inspection testing & forms completed for past 12 months?

  Yes

  No

  Y-notes

  N/A

• LP - Remote Shut-off is tested daily and is operational during the inspection?

  Yes

  No

  Y-notes

  N/A

• Cargo Tank, Piping, and Hoses free of leaks or defects?

  Yes

  No

  Y-notes

  N/A

• Placards, Tank Inspections, and all required markings compliant with DOT requirements?

  Yes

  No

  Y-notes

  N/A

• Proper PPE in-vehicle for handling fuels/LP Gas

  Yes

  No

  Y-notes

  N/A

• All other cargo tank truck/equipment in safe condition?

  Yes

  No

  Y-notes

  N/A

• Signature of Inspector

  Sign

• Signature of Vehicle Operator

  Sign

• Check box to place vehicle Out-of-Service for Unsafe Conditions.

• This vehicle must be placed out-of-service until necessary repairs have been completed.

  

• The following defects require immediate repair before continued operation. All other vehicle defectives must be corrected before the next date the vehicle is used.