Carrier:
Address:
Truck Number:
Odometer Reading:
Driver:
Date:
Air Compressor: PassFail
Battery: PassFail
Body: PassFail
Brakes, Parking: PassFail
Carburetor: PassFail
Coupling Devices: PassFail
Drive Lines: PassFail
Exhaust: PassFail
Fluid Levels: PassFail
Front Axle: PassFail
Heater: PassFail
Lights - Head/Stop: PassFail
Lights - Turn Indicators: PassFail
Mirrors: PassFail
Oil Pressure: PassFail
Rear End: PassFail
Safety Equipment - Fire Extinguisher: PassFail
Safety Equipment - Reflective Triangles: PassFail
Safety Equipment - Spare Seal Beam: PassFail
Steering: PassFail
Tachograph: PassFail
Transmission: PassFail
Wheels and Rims: PassFail
Windshield Wipers: PassFail
Air Lines: PassFail
Belts and Hoses: PassFail
Brake Accessories: PassFail
Brakes, Service: PassFail
Clutch: PassFail
Defroster / Heater: PassFail
Engine: PassFail
Fifth Wheel: PassFail
Frame and Assembly: PassFail
Fuel Tanks: PassFail
Horn: PassFail
Lights - Tail / Dash: PassFail
Lights - Clearance / Marker: PassFail
Muffler: PassFail
Radiator: PassFail
Reflectors: PassFail
Safety Equipment - Flags / Flares / Fuses: PassFail
Safety Equipment - Spare Bulbs and Fuses: PassFail
Starter: PassFail
Suspension System: PassFail
Tire Chains: PassFail
Trip Recorder: PassFail
Windows: PassFail
Other: PassFail
Choose the Trailer: —Please choose an option—11 - Old Dump Trailer12 - Spartan 75813 - Carry on Trailer14 - Vac Trailer15 - Drill Trailer16 - Bursting Trailing17 - New Dump Trailer18 - Fuel Trailer19 - White Equipment Trailer
Trailer(s) Number(s): PassFail
Brakes: PassFail
Coupling (King) Pin: PassFail
Hitch: PassFail
Lights - All: PassFail
Roof: PassFail
Tarpaulin: PassFail
Wheels: PassFail
The condition of the above vehicle is satisfactory: YesNo
Brake Connection: PassFail
Doors: PassFail
Landing Gear: PassFail
Reflectors / Reflective Tape: PassFail
Tires: PassFail
Driver's Signature:
Above Defects Corrected: YesNo
Above Defects Need Not Be Corrected For Safe Operation Of Vehicle: YesNo
Mechanic's Signature:
