DOT Annual Vehicle Inspection Report
Carrier & Vehicle Information
Carrier Name
Address
City
State
ZIP Code
Vehicle ID No.
License Plate No.
Make
Year
Model
Inspection Information
Date of Inspection
Odometer Reading
Inspector Name
Inspector Certification
Inspection Items
Component
Pass
Fail
Comments
Brake System
Steering Mechanism
Lights/Reflectors
Tires/Wheels
Horn
Windshield Wipers
Rear Vision Mirrors
Emergency Equipment
Remarks/Notes
Certification
Inspector Signature
Date
Carrier Representative Signature
Date