DATE: ________________________ TRAILER #: ________________________

ACTION SHUTTLE TRIP COMMENT(S)

1 2 3 4
Fifth wheel locked

Landing gear retracted

Air brake and power lines connected

Trailer tail, brake, signal and plate lights are

functional
Truck tires in good condition (No canvas/wire
showing, no visible tread, no visible under-
inflation)
Cargo doors locked

NAME OF DRIVER: ______________________ SIGNATURE OF DRIVER: __________________

(Block Letters)

SIGNATURE OF DISPATCH SUPERVISOR: _____________________________________________

REVIEWED BY: __________________________________________________________________