DVIR (TM) DVIR (TR) HiddenWho is this from? Total Safety Systems HiddenFull Company Information, with address Total Safety Systems, 225 S Tower Ave, Centralia, WA 98531 HiddenShop Notification Email This form recycles. If you have just made a submission and are seeing this, you are successful. Please drive safely and have a great day!Base or Start City Location* What would you like to do?* Driver Name* First Last Do you have any ELD malfunctions to report?* Please identify the ELD issue.* Unit does not power on. User input cannot be made. Unit does not provide required information. Other Please describe ELD other:* Is this inspection for today’s date?* Please enter date of inspection*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Equipment Info - TractorEquipment Number* 005 008 012 023 024 027 028 031 037 039 040 047 048 052 057 Does the Tractor have defects to report?* Tractor Defects* Air Compressor Air Lines Battery Belts and Hoses Body Brake Accessories Brakes, Parking Brakes, Service Clutch Coupling Devices Defroster/Heater Drive Line Engine Exhaust Fifth Wheel Fluid Levels Frame and Assembly Front Axle Fuel Tanks Lights Mirrors Muffler Oil Pressure Radiator Rear End Reflectors Safety Equipment Starter Steering Suspension System Tire Chains Transmission Trip Recorder Wheels and Rims Windows Windshield Wipers Other Lights-Detailed* Head/Stop Tail/Dash Turn Indicators Clearance/Marker Safety Equipment-Detailed* Fire Extinguisher Flags/Flares/Fusees Reflective Triangles Spare Bulbs and Fuses Spare Seal Beam Please only mark the items that are relevant. Tractor Remarks*Tractor Issue Image Drop files here or Select files Max. file size: 20 MB. MileageBeginning Mileage*Actual Mileage only, please do not include decimals.Ending Mileage*Actual Mileage only, please do not include decimals.HiddenTotal MileageEquipment Info - TrailerAre you Inspecting more than one trailer?* Trailer Number* 1A 2A 6A 9A 11 18D 19A 19B 19D 22A 22B 27A 28A 29A 31A 44A SECOND Trailer Number* 1A 2A 6A 9A 11 18D 19A 19B 19D 22A 22B 27A 28A 29A 31A 44A Does the Trailer have defects to report?* Trailer Defects* Brake Connections Brakes Coupling Devices Coupling (King) Pin Hitch Landing Gear Lights-All Reflectors/Reflective Tape Roof Suspension System Tarpaulin/Winches/Hooks/Securement Devices Tires Wheels and Rims Other Please only mark the items that are relevant. Trailer Remarks*Trailer Issue Image Drop files here or Select files Max. file size: 20 MB. Pre-Trip DVIR InspectionsBefore driving off, a driver must verify that the vehicle is roadworthy and in safe operating condition (Part 396.13 Driver Inspection). He or she must review the last Driver Vehicle Inspection Report (DVIR) to ensure that any repairs to correct the defects noted on the report have been performed. By scrolling to the bottom of this page and selecting your equipment number, you may review previous information and complete repair confirmations as needed. Federal law requires that each driver review the previous daily vehicle inspection report (DVIR) and document that it has been reviewed and whether defects were found. Did you review the previous report?* Is vehicle safe and or legal to operate?* It should be noted that the driver of a commercial motor vehicle subject to this regulation must prepare and submit a report even if no defect or deficiency is discovered by or reported to the driver.Provide your Email* Enter Email Confirm Email If you are calling this vehicle Out Of Service (OOS) you will be required to re-inspect the equipment and sign off on the repairs to ensure a compliant repair process is met. By calling this vehicle OOS, you agree to complete the review process, a notification and request will be sent to you for review upon completion of the repair. I have checked the following DOT required items prior to operating the equipment noted. I will identify the items needing attention by selecting the appropriate check box(s).* Service Brake Parking Brake Steering Mechanism Lighting Devices and Reflectors Tires Horn Windshield Wipers Rear Vision Mirrors Wheels and Rims Emergency Equipment §396.11 Driver vehicle inspection report(s). (a) Equipment provided by motor carrier. (1) Report required. Every motor carrier shall require its drivers to report, and every driver shall prepare a report in writing at the completion of each day's work on each vehicle operated, except for intermodal equipment tendered by an intermodal equipment provider. The report shall cover at least the following parts and accessories:Define Service Brake Issue* Define Parking Brake Issue* Define Steering Issue* Define Lights and Reflectors Issue* Define Tires Issue* Define Horn Issue* Define Windshield Wipers Issue* Define Mirrors Issue* Define Wheels and Rims Issue* Define Emergency Equipment Issue* Driver Signature* Reset signature Signature locked. Reset to sign again Is there any new equipment damage that you need to report?* Did you have any customer or equipment issues to report today?New DamageWhich area of the vehicle is exhibiting new damage?* Front Left Side Right Side Rear What type of front damage are you reporting?* Paint, scratches, dents or other finish surface damage Body damage, scrapes, gouges, rips or tears in body materials Broken glass, chipped glass or fogged windows Lighting, reflectors or other illumination devices Tires, wheels, lugs or other wheel related items Other items not described above Please take front image and upload now* Drop files here or Select files Max. file size: 20 MB. Please provide front note here What type of left side damage are you reporting?* Paint, scratches, dents or other finish surface damage Body damage, scrapes, gouges, rips or tears in body materials Broken glass, chipped glass or fogged windows Lighting, reflectors or other illumination devices Tires, wheels, lugs or other wheel related items Other items not described above Please take left side image and upload now* Drop files here or Select files Max. file size: 20 MB. Please provide left side note here What type of right side damage are you reporting?* Paint, scratches, dents or other finish surface damage Body damage, scrapes, gouges, rips or tears in body materials Broken glass, chipped glass or fogged windows Lighting, reflectors or other illumination devices Tires, wheels, lugs or other wheel related items Other items not described above Please take right side image and upload now* Drop files here or Select files Max. file size: 20 MB. Please provide right side note here What type of rear damage are you reporting?* Paint, scratches, dents or other finish surface damage Body damage, scrapes, gouges, rips or tears in body materials Broken glass, chipped glass or fogged windows Lighting, reflectors or other illumination devices Tires, wheels, lugs or other wheel related items Other items not described above Please take rear image and upload now* Drop files here or Select files Max. file size: 20 MB. Please provide rear note here Please provide additional comments hereWork OrderMake*KenworthPeterbiltFreightlinerFordIf you get this wrong on a consistent basis, you will be required to take remedial training to help you identify what equipment type you are driving. What is wrong with vehicle?* Engine, Check engine light on dash Engine Transmission Tires and wheels Heating and Air Conditioning Body and Glass Audio Visual Entertainment Bathroom Seats and Interior Fifth wheel or trailer mechanical Other Describe Engine Check Light* Describe Engine issue* Describe Transmission issue* Describe tires and wheels issue* Describe heating and air conditioning issue* Describe body and glass issue* Describe audio and visual issue* Describe bathroom issue* Describe seats and interior issue* Describe Other*Please upload an image of your defect if applicableMax. file size: 20 MB.HiddenDriver Reviewing Repairs SignatureHiddenHave the repairs noted been corrected at this time? HiddenDate MM slash DD slash YYYY HiddenFinal Review Signature Reset signature Signature locked. Reset to sign again
