Driver Roadside Inspection Response Form

Captures roadside inspection details, CVSA outcomes, DVIR clearance status, violation closure actions, and out-of-service condition (OOSC) resolution.

Inspection Overview

• Inspection Date
  Date the roadside inspection occurred.
• Inspection Time
  Approximate time of the inspection, if known.
• Inspection Location
  General location of the inspection. Do not include unnecessary personal data.
• Driver Name
  Name of the driver involved in the inspection.
• Vehicle Unit Number
  Fleet unit or tractor number associated with the inspection.
• Trailer Number
  Trailer number, if applicable.
• Inspecting Agency
  Agency or authority that conducted the inspection.

CVSA Inspection Outcome

• CVSA Inspection Result
  Select the overall outcome of the CVSA roadside inspection.
• CVSA Level
  Inspection level, if known.
• Number of Violations
  Total number of violations identified during the inspection.
• Inspection Report Number
  Reference number from the inspection report or citation record.
• Inspection Summary
  Brief summary of the inspection findings and any immediate operational impact.

Violation and OOSC Details

• Violation Categories
  Select all categories that apply.
• Violation Details
  Describe each violation and the cited condition(s).
• Was an Out-of-Service Condition Issued?
  Indicate whether the vehicle, driver, or both were placed out of service.
• OOSC Type
  Select the type of out-of-service condition, if applicable.
• OOSC Resolution Notes
  Describe the corrective actions taken to resolve the out-of-service condition.

DVIR Clearance and Corrective Actions

• Was a DVIR Required?
  Indicate whether a Driver Vehicle Inspection Report was required for this event.
• DVIR Clearance Status
  Current DVIR clearance status.
• Defect Correction Date
  Date the defect or issue was corrected, if applicable.
• Corrective Actions Taken
  Describe the repairs, inspections, or administrative actions completed to close the issue.
• Supporting Documents
  Upload repair orders, inspection reports, or other supporting evidence.

Review and Submission

• Submitted By
  Name of the person submitting this form.
• Submission Role
  Role of the person submitting the form.
• I confirm this information is accurate to the best of my knowledge.
  Required acknowledgement before submission.
• Additional Notes
  Optional notes for compliance review or follow-up.