Transcription of COMMERCIAL VEHICLE RECORD OF INSPECTION TRAILER ... …
1 P=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 1 of 4 The original RECORD of INSPECTION must be given to the customer regardless of whether the VEHICLE passes or VEHICLE RECORD OF INSPECTION TRAILER , SEMI- TRAILER , C-DOLLY, CONVERTER DOLLYUnit NumberAddressPostal CodePhone NumberMakeModelYearOdometer VEHICLE InformationpsiDrums/RotorsLinings/PadsPu sh Rod TravelmmLEFTFRONTRIGHTD rums/RotorsLinings/PadsPush Rod TravelDrums/RotorsLinings/PadsPush Rod TravelDrums/RotorsLinings/PadsPush Rod TravelDrums/RotorsLinings/PadsPush Rod Travelpsimmpsipsimmpsipsimmpsimmmmmmpsim mpsimmpsimmpsipsimmpsipsipsimmmmmmpsimmP ark Brake LiningWheel Torque CheckedLeftmmRightmmTransmmInnerft lbsOuterft lbs Type of VEHICLE Gross VEHICLE Weight
2 Registered psimmpsimmmm mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmmmmmmmmmmmmmmmmmmpsimmpsimmRegistered Owner's Name Plate NumbermmDrums/RotorsmmmmLinings/Padsmmmm Push Rod TravelmmpsipsimmmmpsipsimmmmDrum Brakes:Disc Brakes:P=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 2 of 4 COMMERCIAL VEHICLE RECORD OF INSPECTION TRAILER , SEMI- TRAILER , C-DOLLY, CONVERTER DOLLYNOTES:NOTES:NOTES:NOTES:NOTES: Exhaust Liquefied Petroleum Gas (LPG or Propane) Fuel Compressed Natural Gas (CNG) Fuel Suspension & Frame Axle Attaching & Tracking Axle & Axle Spring & Spring Hydraulic System Air-Over-Hydraulic Brake Surge Brake Vacuum Air-Boosted TRAILER Brake Air System Air Brake Valves & Parking Brake & Emergency Air System Brake Drum Brake System Steering Control & Gasoline or Diesel Fuel System (LPG, CNG, & LNG) * SEEAPPENDIX A* Liquefied Natural Gas (LNG)
3 Fuel Air Self-Steer & Controlled-Steer Shock Absorber/Strut Electric Brake Drum Brake System Disc Brake System Brake S-Cam Drum Brake Brake Shoe Travel (Wedge Brakes) Disc Brake System Anti-Lock Brake System (ABS) Stability Control System (ESC) or (RSS) Brake Self Steer & Controlled-Steer AxleSection 1 - Power TrainAPPENDIX "A"Section 2 - SuspensionSection 3H - Hydraulic BrakesSection 3A - Air BrakesSection 4 - SteeringComponentComponentComponentCompo nentComponentComponentComponentComponent ComponentComponentComponentComponentPPPP PPFFFFFFNANANANANANAPPPPPPFFFFFFNANANANA NANAP=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 3 of 4 COMMERCIAL VEHICLE RECORD OF INSPECTION TRAILER , SEMI- TRAILER , C-DOLLY, CONVERTER DOLLYNOTES:NOTES:NOTES:NOTES.
4 Fire Required Reflex Cargo Frame Rails & Unitized Body Cab or Cargo Cargo Tank or Body, Device or Equipment Attached or Mounted to the Tire Tread Tire Tread Tire Sidewall & Manufacturer Tire Inflation Wheel Wheel Hitch Assembly, Structure & Attaching Secondary Attachment (Safety Chain or Cable) Pintle Hook, Pin Hitch, or Coupler Ball Type Roll-Coupling Retro-Reflective TRAILER Cord (output to towed VEHICLE ) Refrigeration/Heater Unit Fuel Fender/Mud Landing Gear on Sliding Axle Assembly (Sliding Bogie) Aerodynamic Device & Rear Impact Guard (RIG) Multi-Piece Spoke Wheel/Demountable Rim Disc Wheel Wheel Fasteners (Nuts, Bolts,& Studs)
5 Automated Coupling Fifth Wheel Oscillating Fifth Wheel Ball-Bearing Type Turntable on TrailerSection 5 - Instruments and Auxiliary EquipmentSection 6 - LampsSection 7 - Electrical SystemSection 8 - BodySection 9 - Tires and WheelsSection 10 - Couplers and HitchesComponentComponentComponentCompon entComponentComponentComponentComponentC omponentComponentComponentComponentPPPPP PFFFFFFNANANANANANAPPPPPPFFFFFFNANANANAN ANAP=PASS F=FAIL NA=Not ApplicableVSSROI2018 Page 4 of 4 COMMERCIAL VEHICLE RECORD OF INSPECTION TRAILER , SEMI- TRAILER , C-DOLLY, CONVERTER DOLLY Certification Customer AcknowledgmentDate of InspectionTechnician Number Facility Number Signature NOTES.
6 The VEHICLE for which this RECORD of INSPECTION is issued has _____ the INSPECTION and I certify it has been inspected in accordance with the VEHICLE INSPECTION Regulation, Alberta Regulation 211/2006 and the applicable INSPECTION (Year/Month/Day)Customer SignatureI understand if a VEHICLE INSPECTION identifies defects and repairs are required, once repaired, the vehicleand this RECORD of INSPECTION (ROI) may be presented to any VEHICLE INSPECTION Facility within 10 days ofthe initial INSPECTION and only the failed items noted on this ROI are required to be re-inspected. If the VEHICLE is not returned for re- INSPECTION within 10 days of the initial date of INSPECTION , a new INSPECTION must be conducted.
