NORFOLK SOUTHERN RAILWAY POLICE CREW HAULER SAFETY INSPECTION
Inspection Results—OK_________Exception___________Out of Servcie________Report #____________
Date___________Location_________________________________Time________Milepost____________
Driver___________________OLN#___________________State___________Exp. Date:______________
DOB_________________M/F___________DriversLog-Y/N____________Current-Y/N_______________
Address_______________________________________________________________________________
VEH Vin #___________________________________Mileage___________________________________
Tag #_______________Exp Date_____________State_____________Veh #________________________
Make_____________________Model____________________Color__________________Year_________
Company Name_________________________________________________________________________
Inspection:
1. Valid State Inspection – Y/N__________Exp Date_____________State_____________________
2. Brakes – Check Pedal Travel & Firmness – OK_____________Defect______________________
3. Park Brake-OK____________Defect_________________________________________________
4. Steering (Excessive Play)-OK_____________Defect
5. Horn-OK________Defect__________________________________________________________
6. Lights: Headlights-OK________ Taillights-OK_______ Brakelights-OK__________
7. Turn Signals-OK_______ Backup Lights-OK______ Tag Light-OK___________
8. Defect(s)_______________________________________________________________________
9. Backup Alarm-OK__________Defect________________________________________________
10. Mirrors-OK_____________Defect___________________________________________________
11. Glass-OK______________Defect___________________________________________________
12. Windshield (Incls. Wipers & Defroster)-OK__________Defect____________________________
13. Exhaust system-OK_____________Defect____________________________________________
14. License Tags-OK___________Defect________________________________________________
15. Driver’s Seat-OK____________Defect_______________________________________________
16. Seat Belts-OK___________Defect___________________________________________________
17. Doors-OK__________Defect_______________________________________________________
18. Tires-OK___________Defect_______________________________________________________
19. Spare Tire-OK_______Defect______________________________________________________
20. Luggage Area-OK________Defect__________________________________________________
21. Cargo Net-OK_________Defect____________________________________________________
22. Fire Extinguisher Y/N___________Mounted______________Charged______________________
23. First Aid Kit-Y/N___________Defect________________________________________________
24. Vehicle Cleanliness-Interior________________________Exterior__________________________
25. Insurance Card-Y/N________Reg. Card-Y/N________DDC 4 Card-Y/N________Date________
26. Crew Comment Cards-Y/N________Displayed-Y/N____________________________________
Remarks:
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Inspecting Officer_______________________________________________________________________