Page 1
CHECK THE FOLLOWING INSPECTION ITEMS:
CVSA OOS CRITERIA FOR TRAILERS
Facility Registration #
National Board #
WO #
Facility:
Address:
Phone:
City:
Branch Code:
ST:
Zip:
Date:
Carrier:
Address:
C/S/Z/C:
VIN:
Fleet #
Cust ID:
MC/DOT:
Special Permit:
MAWP:
Mfgr:
# Compartments:
Total Capacity:
Cap/Comp:
#1
#2
#3
#4
#5
#6
Lined:
Insulated:
Vpr Rec:
Corrosive Service:
Dedicated Service:
Vac/Full
Opening RH:
Material:
Year:
1. BRAKE SYSTEM
a. SERVICE BRAKES:
Linings move/contact surface when applied
Pads, shoes, sprs, pins, spdrs, rollers, rods
Air chambers, spiders,camshafts/brkts
Air chamber diaphragm, clamps, etc
Measure w/80psi in reservoir. Re-adjust type 30 at 2", long stroke at 2.5"
d. BRAKE HOSE:
c. BRAKE DRUMS OR ROTORS:
e. BRAKE TUBING:
glandhands/gskts/connections
P
Air drum linings at minimum 1/4" T
F
N/A
Rep
P
F
N/A
Rep
P
F
N/A
Rep
P
F
N/A
Rep
1.a.1) Brake Action:
1.a.2) Missing/broken mech comps
1.a.3) Loose brake components
1.a.4) Audible air leaks
1.a.5) Check adjustment
1.a.6) Oil or grease on linings/pads, or not
1.a.7) Air drum linings
1.a.8) Air disc linings
1.c.1) Open flexural cracks/ applied
1.c.2) Portion of drum/rotor falling away
1.d.1) Outer ply damage/impregnation
1.d.2) Bulges/swelling/distortion
1.d.3) Audible air leaks:
1.d.4) Improper/spliced connections
1.d.5) Broken/cracked/crimped hoses
1.e.1) Audible leaks: Tubing/connections
1.e.2) Heat damage, broken, crimped lines
firmly attached
FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION PERIODIC (ANNUAL) INSPECTION
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Comments
Serial#:
Air disc linings at minimum 1/8" T
Copyright 2012-2024 by Allegiance Technology Partners, Inc.
Cnty:
US DOT Number:
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Polar Tank Pros
Facility Registration #
WO #
National Board #
CHECK THE FOLLOWING INSPECTION ITEMS:
CVSA OOS CRITERIA FOR TRAILERS
1. BRAKE SYSTEM (cont.)
l. ANTILOCK BRAKE SYSTEM:
P
F
N/A
Rep
N/A
N/A - Manufactured prior to mandate
1.l.1) No missing ABS malfunction indicator components
1.l.2) ABS malfunction indicator illuminates when power
1.l.3) ABS malfunction indicator lamp does not stay
1.l.4) ABS malfunction indicator lamp cycles when power
1.l.6) No other missing or inoperative ABS components
1.m.1) Brakes are within the brake stroke limit specified
1.m.2) No automatic adjusters replaced by manual
1.m.3) No damaged, loose, or missing components
(i.e., bulb, wiring, etc.)
is first applied to ABS controller (ECU) during initial
power up.
illuminated while power is continuously applied to
the ABS controller (ECU)
is applied (a) Only to the vehicles constant ABS
power circuit, or (b) only to the vehicle's stop
P
F
N/A
Rep
m. AUTOMATIC BRAKE ADJUSTERS
by the vehicle manufacturer
lamp circuit.
NOTE: The National Highway Traffic Safety Administration (NHTSA) mandated that
Anti-lock Brake Systems (ABS) are required on air-brake equipped semi-trailers
equipped with air brakes and manufactured on or after March 1,1998.
NOTE: The National Highway Traffic Safety Administration (NHTSA) mandated that each
commercial motor vehicle manufactured on or after October 20,1994 and equipped with an
air brake system must meet the automatic brake adjustment system and indicator require-
ments of Federal Motor Carrier Safety Administration (FMCSA) Standard 121 applicable to
the motor vehicle at the time it was manufactured.
N/A - Equipped with disc brakes
Manufactured prior to mandate (N/A allowed).
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This unit is equipped with
electric brakes.
NOTE: Any brake found to be out of adjustment on initial inspection must be evaluated
to determine why the automatic brake adjuster is not functioning properly and the problem
must be corrected in order for the vehicle to pass inspection.
It is not acceptable to manually adjust automatic brake adjusters without first correcting
the underlying problem.
Copyright 2012-2024 by Allegiance Technology Partners, Inc.
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Polar Tank Pros
Facility Registration #
WO #
National Board #
CHECK THE FOLLOWING INSPECTION ITEMS:
CVSA OOS CRITERIA FOR TRAILERS
2. COUPLING DEVICES (cont)
f. SAFETY DEVICES
Missing/damaged fasteners. 1/8" to 7/16" = 2 per side min 1/2" to 5/8" = 3 per side min
Weld repairs, small bolts, wire rope, tape, replace
h. FULL TRL DBL RING
Tolerance = 1/8" gap (mfg sug)
P
F
N/A
Rep
P
F
N/A
Rep
e. DRAWBAR/TONGUE:
d. DRAWBAR EYE:
P
F
N/A
Rep
P
F
N/A
Rep
BALL-BRG TURNTABLES
N/A
N/A
N/A
N/A
2.d.1) Cracks on assy = Replace
2.d.2) Crack in attachment welds = replace
2.e.1) Slider has working latch & stop
2.e.2) slider to hsg movement = 1/4" max
2.e.3) Assy/frame attach mvmt = 1/4" max
2.e.4) Cracks on assy = replace
2.f.1) Cable assy:
2.f.2) Improper repairs:
2.h.1) Top flange has 7 fasteners min
2.h.2) Bottom flange has 7 fasteners min
2.h.3) Cracks on mounting = Repair
2.h.4) Cracks on flanges = Replace
2.h.5) Top/bottom flanges touch = Replace
2.h.6) Pry top flange from bottom
2.d.3) Any part of eye reduced by more than
20% = replace
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2.e.5) Leaking air/hyd cylinders, hoses/chambers
2.f.3) Kinked or broken strands
6. Safe Loading
6.a) No part(s) of vehicle or condition of
6.b) Protection of shifting cargo-vehicle has
6.c) No cracks,broken,loose or missing devices
loading /spare tire/load/dunnage can fall onto roadway.
has front-end structure or equivilent device.
including rails, support frames, tiedown bolsters, locking pins, clevises, clamps and hooks.
Copyright 2012-2024 by Allegiance Technology Partners, Inc.
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Polar Tank Pros
Facility Registration #
WO #
National Board #
9. FRAME
a. FRAME MEMBERS:
Cracks, sagging, broken members
5. LIGHTING
a. LAMPS:
Tail/Stop lamps, turn signals, flashers
b. REFLECTORS:
2 amber at front, side, & mid
2 red at rear side & rear
Conspicuity tape, front, sides, rear
8. SUSPENSION
a. AXLE PARTS/MEMBERS:
Spr hgrs tight, cracks, broke/missing pieces. Proper positioning
b. SPRING ASSEMBLY:
Leafs missing, separated, broken parts = Replace
Torsion bars cracks, missing/broken parts/bushings
Air bags condition, air leaks, frame mounts, broken/missing parts
d. TORQUE RADIUS/TRACKING COMPONENTS:
Parts attached to frame cracked loose, broken, missing, worn
10. TIRES
b. TRAILER TIRES:
Flat, leaks, exposed body ply/belt
Tread depth not less than 2/32"
11. WHEELS/RIMS
Bent, broken, sprung, mismatched
Cracks, elongated holes, weld cracks = Replace
U-bolts tight, broken/missing pieces
CHECK THE FOLLOWING INSPECTION ITEMS:
CVSA OOS CRITERIA FOR TRAILERS
P
F
N/A
Rep
P
F
N/A
Rep
P
F
N/A
Rep
P
F
N/A
Rep
P
F
N/A
Rep
9.a.1) Frame Members:
5.a.1) Lamps:
5.b.1) Reflectors Front:
5.b.2) Reflectors Side & Rear:
5.b.3) Reflectors:
8.a.1) Axle - U-bolts:
8.a.2) Axle - Spring Hangers:
8.b.1) Spring Assembly - Leafs:
8.b.2) Spring Assembly - Torsion bars:
8.b.3) Spring Assembly - Air bags:
8.d.1) Torque Radius - Parts attached:
10.b.1) Tires:
10.b.2) Tire Tread:
11.a) LOCK OR SIDE RINGS:
11.b) WHEELS:
10.b.3) Proper inflation
10.b.4) No items lodged between dual tires or
contacting side walls, excluding mud and snow
marker/clearance lights
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11.c) FASTENERS:
Loose, missing, broken, cracked, stripped or ineffective
Loose/missing attaching functioning component
9.1.2) Frame Fasteners:
NOTE: One or more leafs displaced in a manner that could result in contact with a tire, rim or
frame must be repaired back to original configuration.
Copyright 2012-2024 by Allegiance Technology Partners, Inc.
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Polar Tank Pros
Facility Registration #
WO #
National Board #
This vehicle has passed an inspection in accordance with 49CFR Part 396.17
This vehicle has failed an inspection and is not in accordance with 49CFR Part 396.17
QUALIFIED INSPECTOR SIGNATURE
DATE
15. REAR IMPACT GUARD (RIG)
15.a) Full Trailers and Semi trailers with GVWR of 10,001 lbs. or more manufactured on or after 1/26/1998 must be
rearward (not interfering with retroreflective tape)
15.b) Commercial Motor Vehicles manufactured after 12/31/1952 and before 1/26/1998 whereby vertical distance
other comparable means.
CHECK THE FOLLOWING INSPECTION ITEMS:
CVSA OOS CRITERIA FOR TRAILERS
P
F
N/A
Rep
P
F
N/A
Rep
15.a.1) Guard is installed.
15.a.2) Guard is securely attached. No broken/missing
15.a.3) Guard horizontal member extends to within 4" of
15.a.4) Guard horizontal member not more than 22" above
15.a.5) Guard horizontal member does not exceed 12"
15.a.6) Guard horizontal member has cross sectional
15.a.7) Guard certification label is located on forward or
15.b.1) Guard is installed.
15.b.2) Guard is securely attached by bolts, welding or
15.b.3) Guard horizontal member does not exceed 30"
15.b.4) Guard horizontal member extends to within 18" of
15.b.5) Guard horizontal member does not exceed 24"
forward of the rear extremity of the vehicle.
fasteners, weld/parent metal cracks, other damage.
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and not beyond side extremities of vehicle.
ground at any point across full width.
from rear extremity of vehicle.
vertical height of at least 4" across its entire width.
of right end and displays manufacturer's name and address, the statement:
"Manufactured In ______ (insert mo & yr), the letters DOT as certification to FMVSS No. 223".
equipped with a Rear Impact Guard (RIG) unless excepted, see NOTE.
NOTE: Trailers and Semi-trailers with wheels back design (rearmost axle permanently fixed and rearmost tire surface
does not exceed 12" forward of rear bumper outer surface), Pole Trailers, Pulpwood Trailers, Low Chassis (extends
behind rearmost point of rearmost tires and has lower surface that meets RIG specifications in effect/later editions
when mfg'd) and Special Purpose (has work performing equipment that while in transit, resides/moves through area
that could be occupied by the horizontal member of RIG as defined by RIG specifications in effect/later editions
when mfg'd) vehicles are excepted from RIG requirements. Mark item 15.a, 15.b, or N/A box as appropriate.
above ground.
each side extremity of the vehicle.
between rearmost bottom edge of body/chassis and ground is greater than 30" when empty must be equipped
with a Rear Impact Guard (RIG) unless excepted, see NOTE.
facing surface of horizontal member 12" inboard
SPECIFY TRAILER RIG CATEGORY:
15.a REQUIRED
15.b REQUIRED
RIG NOT APPLICABLE
Copyright 2012-2024 by Allegiance Technology Partners, Inc.