DOT Daily Inspection Form
Completion of this report required by Federal Law 49 CFR 396.11 & 396.13
Your Name
Your Email
Truck Area
Dixie
Beryl
Flowell
Truck / Trailer Number
Odometer Reading
Number of Items That Need Correction
Email to:
Engine
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Engine
Correction Needed:
Transmission
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Transmission Correction Needed
Clutch
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Clutch
Correction Needed
Steering Mechanism
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Steering Mechanism
Correction Needed
Horn
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Horn
Correction Needed
Windshield Wipers/Washer
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Windshield Wipers/Washer
Correction Needed
Rear Vision Mirrors
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Rear Vision Mirrors
Correction Needed
Lighting Devices and Reflectors
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Lighting Devices and Reflectors
Correction Needed
Parking Brakes
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Parking Brakes
Correction Needed
Service Brakes
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Service Brakes Correction Needed
Air Lines/Light Lines
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Air Lines/Light Lines
Correction Needed
Coupling Devices
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Coupling Devices
Correction Needed
Tires
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Tires
Correction Needed
Wheels and Rims
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Wheels and Rims
Correction Needed
Emergency Equipment
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Emergency Equipment
Correction Needed
Other
OK, Good
Not Applicable
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Other
Correction Needed
Vehicle condition
OK (This must be checked if there are no defects)
Defects do not need to be corrected for safe operation
Correction Needed Self Repair
Correction Needed Fleet Purchasing Coordinated Repair
Mechanic's Name:
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Contact Information