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COLORADO PUBLIC UTILITIES COMMISSION
ANNUAL VEHICLE INSPECTION REPORT VEHICLE HISTORY RECORD
REPORT NUMBER
Date
Time
UNIT NO. Inspection Agency/Location
Carrier's Company Name Address
Inspector's Name (Print or Type) This Inspector Meets the qualification requirements in Section 396.19 ( ) Yes
City
State
Zip Code
Plate
Make
VIN
Year
Vehicle Type (Circle One)
Taxi
Van/People Mover
Bus
Limousine
Truck
Trailer
State Tow Truck
Other
VEHICLE COMPONENTS INSPECTED OK
Needs Repaired Repair Date
Item
OK
Needs Repaired Repair Date
Item
OK
Needs Repaired Repair Date
Item
1. BRAKE SYSTEM
4. FUEL SYSTEM
a. Service Brakes
a. Visible Leak
a. Frame members
b. Parking Brake System
b. Fuel Tank Filler Cap Missing
b. Tire and Wheel Clearance
c. Brake Drums or Rotors
c. Fuel Tank Securely Attached
c. Adjustable Axle
d. Brake Hose
5. LIGHTING DEVICES
e. Brake Tubing
All lighting devices and reflectors
f. Low Pressure Warning
required by Section 393 shall be
Device g. Tractor Protection Valve
operable. 6. SAFE LOADING
9. FRAME
Assemblies (Sliding Subframes) 10. TIRES a. Tires on any steering axle of a power unit.
h. Air Compressor
a. Part(s) of vehicle or condition
i. Electric Brakes
of loading such that the spare
j. Hydraulic Brakes
tire or any part of the load or
k. Vacuum Systems
dunnage can fall onto the
b. Wheels and Rims
roadway.
c. Fasteners
2. COUPLING DEVICES a. Fifth Wheels
b. Protection against shifting
b. Pintle Hooks
cargo.
c. Drawbar/Towbar Eye
7. STEERING MECHANISM
b. All other tires. 11. WHEELS AND RIMS a. Lock or Side Ring
d. Welds 12. WINDSHIELD GLAZING Requirements and exceptions
d. Drawbar/Towbar Tongue
a. Steering Wheel Free Play
as stated pertaining to any
e. Safety Devices
b. Steering Column
crack, discoloration or vision
f. Saddle Mounts
c. Front Axle Beam and All
reducing matter (reference
3. EXHAUST SYSTEM
Steering Components Other
a. Any exhaust system determined to be leaking
Than Steering Column d. Steering Gear Box
393.60 for exceptions) 13. WINDSHIELD WIPERS Any power unit that has an
at a point forward of or
e. Pitman Arm
inoperative wiper, or missing
directly below the driver/
f. Power Steering
or damaged parts that render
sleeper compartment
g. Ball and Socket Joints
b. A bus exhaust system leaking or discharging to the atmosphere in violation of standards (1), (2) or (3). c. No part of the exhaust
List any other condition that
i.
may prevent safe operation of
Nuts
j. Steering System 8. SUSPENSION
or other axle positioning
vehicle shall be so located
part(s) cracked, broken, loose
as would be likely to result
or missing resulting in shifting
in burning, charring, or
of an axle from its normal
wiring, the fuel supply, or any combustible part of the motor vehicle.
this motor vehicle.
a. Any U-bolt(s), spring hanger(s)
system of any motor
damaging the electrical
it ineffective.
h. Tie Rods and Drag Links
position. b. Spring Assembly c. Torque, Radius or Tracking Components
Mark column entries to verify inspection: __X___ OK __X__ Need Repair __NA__ If Items Do Not Apply _____ Repair Date, As Applicable CERTIFICATION: THIS VEHICLE HAS PASSED ALL THE INSPECTION ITEMS FOR THE ANNUAL VEHICLE INSPECTION REPORT IN ACCORDANCE WITH 49 CFR PARTS 396-17 THROUGH 396-23.
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* A copy of this report must be kept in the vehicle in accordance with 49 C.F.R. 396.17(c)
