CarrierAddressTruck NumberOdometer ReadingDriverDate MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM TruckAir Compressor Pass Fail Air Lines Pass Fail Battery Pass Fail Belts and Hoses Pass Fail Body Pass Fail Brake Accessories Pass Fail Brakes, Parking Pass Fail Brakes, Service Pass Fail Carburetor Pass Fail Clutch Pass Fail Coupling Devices Pass Fail Defroster / Heater Pass Fail Drive Lines Pass Fail Engine Pass Fail Exhaust Pass Fail Fifth Wheel Pass Fail Fluid Levels Pass Fail Frame and Assembly Pass Fail Front Axle Pass Fail Fuel Tanks Pass Fail Heater Pass Fail Horn Pass Fail Lights - Head / Stop Pass Fail Lights - Tail / Dash Pass Fail Lights - Turn Indicators Pass Fail Lights - Clearance / Marker Pass Fail Mirrors Pass Fail Muffler Pass Fail Oil Pressure Pass Fail Radiator Pass Fail Rear End Pass Fail Reflectors Pass Fail Safety Equipment - Fire Extinguisher Pass Fail Safety Eqiupment - Flags / Flares / Fuses Pass Fail Safety Equipment - Reflective Triangles Pass Fail Safety Equipment - Spare Bulbs and Fuses Pass Fail Safety Equipment - Spare Seal Beam Pass Fail Starter Pass Fail Steering Pass Fail Suspension System Pass Fail Tachograph Pass Fail Tire Chains Pass Fail Transmission Pass Fail Trip Recorder Pass Fail Wheels and Rims Pass Fail Windows Pass Fail Windshield Wipers Pass Fail Other Pass Fail TrailersChoose the Trailer-- Please choose an option --11 - Old Dump Trailer12 - Spartan 75813 - Carry on Flatbed14 - Vac Trailer15 - Drill Trailer16 - Bursting Trailing17 - New Dump Trailer18 - Fuel TrailerTrailer(s) Number(s) Pass Fail Brake Connection Pass Fail Brakes Pass Fail Coupling Devices Pass Fail Coupling (King) Pin Pass Fail Doors Pass Fail Hitch Pass Fail Landing Gear Pass Fail Lights - All Pass Fail Reflectors / Reflective Tape Pass Fail Roof Pass Fail Suspension System Pass Fail Tarpaulin Pass Fail Tires Pass Fail Wheels Pass Fail Other Pass Fail The condition of the above vehicle is satisfactory Yes No Driver's SignatureCorrectionsAbove Defects Corrected Yes No Above Defects Need Not Be Corrected For Safe Operation Of Vehicle Yes No Mechanic's SignatureDate MM slash DD slash YYYY Driver's SignatureDate MM slash DD slash YYYY Δ