Vehicle Inspection Form
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1VEHICLE INSPECTION FORM
Please call 983 2232 for inspection appointment for each vehicle. Please complete shaded area prior to
inspection appointment for vehicle(s)
Appointment date_______________ Time _________
Complete This Top Portion Before Inspection
Please Don’t Be Late
Firm Name _______________________________ Vehicle License No_________________________
Physical Address __________________________ Vin Number_______________________________
Mailing Address ___________________________ Make________________Year_________________
City _____________________________________ AKS/USDOT/ICCMC# (if applicable)__________
State _________________ Zip________________ __________________________________________
Telephone # ______________________________
_________________________________________
Fax #____________________________________
Current Registration Yes _______ No _______
Commercial__________ Courtesy_____________ Registration Expiration:___________________
Vehicle Color(s) ___________________________ Insurance Expiry Date: ___________________
Number of Passengers including driver__________
Headlights
Right_______
Left______
High beams
Right ______Left _______
Turn Signals
Front
Right______
Left_______
Rear
Right______
Left _______
Tail Lights
Right____
Left____
Emergency Flashers
Front______ Rear_______
Emergency Brake ________
Brakes _____________ (checked from slow roll)
Horn ___________
Tires
RF____ LF____ RR______
LR_______ Comments ________________________
Exhaust System______________ Wipers________________
Defrosters ____________
Windshield___________________ Mirrors________________
Window Glass_________
Signage in compliance ______________ Description of Logo ____________________________
Date of Inspection_____________ By: _____________________________________________
Pass_____ Fail_____ Reason for Failure________________________________________________
________________________________________________________________________________
This inspection is checking for basic compliance with state vehicle equipment regulations as outlined in Alaska
Administrative Code 13.04. This examination does not purport to be an official commercial motor vehicle
inspection as outlined in Alaska Administrative Code 13.05. The owner/operator of this vehicle understands
that he is responsible for full compliance with AAC 13.04, and that this vehicle must be maintained in a safe,
sound condition at all times when the vehicle is used as for-hire transportation.
___________________________________________________
______________________________
Owner/Operator signature
Date
Inspection Date__________________ Pass _______ Fail ________
___________________________________________________
______________________________
Inspector
Date
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