BOUND EDGE

Ply 1 - Original
Ply 2 -Vehicle Copy

DRIVERS CONCRETE VEHICLE INSPECTION REPORT

As required by the D.O.T. Federal Motor Carrier Safety Regulations 49 CFR 396.11 & 396.13
Company Date
Location

Vehicle No.
HOUR READINGS

ODOMETER READINGS
Total Miles Today Ending

Mileage Ending
Mileage Begin

Total Hours Today

Begin
Driver: check (3) item that needs repair. Mechanic: check (3) when repaired.
Prt = Pre-Trip, Pot = Post-Trip, Rep = Repaired

POWER UNIT
GENERAL CONDITION

Prt Pot Rep

Cab/Doors/Windows

Body/Doors

Oil Leak

Grease Leak

Coolant Leak

Fuel Leak

Other

(IDENTIFY)

ENGINE COMPARTMENT

Oil Level
Coolant Level
Belts/Hoses
Other

(IDENTIFY)

INTERIOR CAB

Defects:

A
S

Prt Pot Rep

All Chutes Secure

Latches

Safety Hooks

Hydraulic System

Hoses, Motor, Pumps

Tank, Cooler

Water System

Hoses, Line, Tanks

Valves and Drum

EXTERIOR

Prt Pot Rep

Prt Pot Rep

Gauges/Warning Indicators

Lights

Windshield Wiper(s)/Washer(s)
Reflectors

Horn(s)

Suspension

Heater/Defroster

Tires

Mirrors

Wheels/Rims/Lugs

Steering

Battery

Clutch

Exhaust

Service Brakes

Brakes

Parking Brakes

Air Lines

Emergency Brakes

Light Line

Triangles/Flares

Fifth Wheel

Fire Extinguisher

Other Coupling

Other Safety Equipment

Tie-Downs

Spare Fuses

Rear-End Protection

Seat Belts

Other

E
L
P
M
None

Mechanic Repaired

(IDENTIFY)

MIXER UNIT(S)

Prt Pot Rep

Check for Leaks

Air

Hydraulic

Oil

Hopper

Control Cables

Ladders

Water Tank Glass Clean

Defects:

None

Prt Pot Rep

Hold Downs

Chain Adjusted, Oiled

Control Levers

Counter Working

Roller & Drum

Other

Mechanic Repaired

(IDENTIFY)

WINTER MONTHS (POST-TRIP ONLY WHEN APPLICABLE)

Drain Water Tanks (Open Water & Drain Valves)

Mixer Controls in Neutral

Remarks
CONDITION OF THE ABOVE VEHICLE IS SATISFACTORY
DRIVERS SIGNATURE
ABOVE DEFECTS CORRECTED
ABOVE DEFECTS NEED NOT BE CORRECTED FOR SAFE OPERATION OF VEHICLE
MECHANICS SIGNATURE

DATE

DRIVERS SIGNATURE

DATE

Copyright 2012 J. J. KELLER &ASSOCIATES, INC., Neenah, WI USA (800) 327-6868 jjkeller.com Printed in the United States

10605 (Rev. 9/12)