DOT Date Code Mount Refusal Acknowledgment Form

Use it when a technician or service advisor declines to mount a customer-supplied tire because the DOT date code is too old, unreadable, or otherwise outside the store’s policy. It is also useful when the tire’s condition raises a safety concern and you need a written record of the refusal. If the tire is accepted, this form is not needed. Keep the form tied to the specific service date and vehicle so the decision is easy to trace later.

A service advisor or manager should complete the refusal details, and the customer should sign the acknowledgment after the reason and policy basis are explained. If the store requires escalation, the manager should be notified and named in the form. The person completing it should record only the facts needed to support the refusal. That keeps the record clear and aligned with data minimization.

No. This form is a focused acknowledgment for a specific refusal decision, not a general vehicle inspection record. It should point to the tire, the visible DOT date code, and the store policy that triggered the refusal. If your process includes a broader inspection, use this form as a companion record rather than a substitute.

Record that the date code was not visible or could not be verified, and note any condition that prevented inspection, such as sidewall wear, dirt, or mounting position. If your policy treats unreadable date codes the same as out-of-policy tires, state that clearly in the refusal reason. Avoid guessing the date code or leaving the field blank without explanation. A precise note is better than an incomplete one.

The form should capture any practical next step, such as offering a compliant replacement tire, referring the customer to a different supplier, or explaining that the tire can be returned once it meets policy. If the store can inspect a different tire or order an approved option, note that in the alternative offered field. This helps show the customer was given a path forward, not just a denial. Keep the language factual and non-argumentative.

It creates a repeatable record for the same kind of decision across different advisors, bays, and locations. By capturing the policy reference, manager notification, and customer acknowledgment, it reduces ad hoc handling and makes audits easier. It also helps train staff on when to escalate rather than improvise. Consistent documentation is especially useful when customers return with questions later.

Yes. You can adjust the policy reference field to match your internal age threshold, inspection rules, or manufacturer guidance. You can also add conditional logic for different tire positions, vehicle types, or escalation paths if your process varies by location. Keep the core fields intact so the refusal record still shows what was checked, why the tire was declined, and what the customer acknowledged.

Start with a single approved version that defines the refusal threshold, who can override it, and what alternatives may be offered. Train service advisors to complete the form at the point of refusal, not after the customer leaves. Then review completed forms for missing fields, unclear policy references, or inconsistent manager escalation. A short rollout guide usually prevents most adoption problems.