DD 626 Fillable Motor Vehicle Transportation HAZMAT.pdf

MOTOR VEHICLE INSPECTION (TRANSPORTING HAZARDOUS MATERIALS)

(Read Instructions before completing this form.)

This form applies to all vehicles which must be marked or placarded in accordance with Title 49 CFR.

1. BILL OF LADING/TRANSPORTATION CONTROL NUMBER

SECTION 1 - DOCUMENTATION ORIGIN

a.

DESTINATION

b.

2. CARRIER/GOVERNMENT ORGANIZATION

3. DATE/TIME OF INSPECTION

4. LOCATION OF INSPECTION

5. OPERATOR(S) NAME(S)

6. OPERATOR(S) LICENSE NUMBER(S)

7. MEDICAL EXAMINER'S CERTIFICATE*

8. (X if satisfactory at origin)

a. HAZMAT ENDORSEMENT

b. VALID LEASE*

c. ROUTE PLAN

d. ERG OR EQUIVALENT COMMERCIAL:

e. DRIVER'S VEHICLE INSPECTION REPORT*

f. COPY OF 49 CFR PART 397

9. CVSA DECAL DISPLAYED ON

COMMERCIAL

EQUIPMENT*

a. TRUCK/TRACTOR

b. TRAILER

YES NO

SECTION II - MECHANICAL INSPECTION

All items shall be checked on empty equipment prior to loading. Items with an asterisk shall be checked on all incoming loaded equipment.

10. TYPE OF VEHICLE(S) 11. VEHICLE NUMBER(S)

ORIGIN

(1)

DESTINATION

(2)

SAT UNSAT SAT UNSAT

12. PART INSPECTED

(X as applicable)

a. SPARE ELECTRICAL FUSES

b. HORN OPERATIVE

c. STEERING SYSTEM

d. WINDSHIELD/WIPERS

e. MIRRORS

f. WARNING EQUIPMENT

g. FIRE EXTINGUISHER*

h. ELECTRICAL WIRING

i. LIGHTS AND REFLECTORS

j. FUEL SYSTEM*

ORIGIN

(1)

DESTINATION

(2)

SAT UNSAT SAT UNSAT

k. EXHAUST SYSTEM

l. BRAKE SYSTEM*

m. SUSPENSION

n. COUPLING DEVICES

o. CARGO SPACE

p. LANDING GEAR*

q. TIRES, WHEELS, RIMS

r. TAILGATE/DOORS*

s. TARPAULIN*

t. OTHER (Specify)

COMMENTS

(3)

13. INSPECTION RESULTS (X one) ACCEPTED (If rejected give reason under "Remarks". Equipment will be approved if deficiencies are corrected prior to loading.)

REJECTED

15. REMARKS

16. INSPECTOR SIGNATURE (Origin) 17. INSPECTOR SIGNATURE (Destination)

25. INSPECTOR SIGNATURE (Origin) 26. DRIVER(S) SIGNATURE (Origin)

27. INSPECTOR SIGNATURE (Destination) 28. DRIVER(S) SIGNATURE (Destination)

SECTION III - POST LOADING INSPECTION

18. LOADED IAW APPLICABLE SEGREGATION/COMPATIBILITY TABLE OF 49 CFR

19. LOAD PROPERLY SECURED TO PREVENT MOVEMENT

20. SEALS APPLIED TO CLOSED VEHICLE; TARPAULIN APPLIED ON OPEN EQUIPMENT

21. PROPER PLACARDS APPLIED

22. SHIPPING PAPERS/DD FORM 2890 FOR GOVERNMENT VEHICLE SHIPMENTS

23. COPY OF DD FORM 626 FOR DRIVER

24. SHIPPED UNDER DOT SPECIAL PERMIT 868

ORIGIN

(1)

DESTINATION

(2)

SAT UNSAT SAT UNSAT

COMMENTS

(3)

This section applies to Commercial and Government/Military vehicles. All items will be checked prior to release of loaded equipment and shall be checked on all incoming loaded equipment.

DD FORM 626, OCT 2011 PREVIOUS EDITION IS OBSOLETE. Page 1 of 3 Pages

YES NO

14. SATELLITE MOTOR SURVEILLANCE SYSTEM: (X one) ACCEPTED REJECTED

Adobe Professional 8.0

INSTRUCTIONS

SECTION I - DOCUMENTATION

General Instructions.

All items (2 through 9) will be checked at origin prior to loading.

Items with an asterisk (*) apply to commercial operators or equipment only. Only Items 2 through 7 are required to be checked at destination.

Items 1 through 5. Self explanatory.

Item 6. Enter operator's Commercial Driver's License (CDL) number or Military OF-346 License Number. CDL and OF-346 must have the HAZMAT and other appropriate endorsements IAW

49 CFR 383.

Item 7. *Enter the expiration date listed on the Medical Examiner's Certificate.

Item 8.a. Hazardous Materials Certification. In accordance with applicable service regulations, ensure operator has been certified to transport hazardous materials. Check the expiration date on driver's HAZMAT Certification.

b. *Valid Lease. Shipper will ensure a copy of the appropriate contract or lease is carried in all leased vehicles and is available for inspection. (49 CFR 376.12 and 376.11(c)(2)).

c. Route Plan. Prior to loading any Hazard Class/Division 1.1, 1.2, or 1.3 (Explosives) for shipment, ensure that the operator possesses a written route plan in accordance with 49 CFR Part

397. Route Plan requirements for Hazard Class 7 (Radioactive) materials are found in 49 CFR 397.101.

d. Emergency Response Guidebook (ERG) or Equivalent.

Commercial operators must be in possession of an ERG or equivalent document. Shipper will provide applicable ERG page(s) to military operators.

e. *Driver's Vehicle Inspection Report. Review the operator's Vehicle Inspection Report. Ensure that there are no defects listed on the report that would affect the safe operation of the vehicle.

f. Copy of 49 CFR Part 397. Operators are required by regulation to have in their possession a copy of 49 CFR Part 397 (Transportation of Hazardous Materials Driving and Parking Rules). If military operators do not possess this document, shipper will provide a copy to operator.

Item 9. *Commercial Vehicle Safety Alliance (CVSA) Decal.

Check to see if equipment has a current CVSA decal and mark applicable box. Vehicles without CVSA, check documentation of the last vehicle periodic inspection and perform DD Form 626 inspection.

SECTION II - MECHANICAL INSPECTION

General Instructions.

All items (12.a. through 12.t.) will be checked on all incoming empty equipment prior to loading. All UNSATISFACTORY conditions must be corrected prior to loading. Items with an asterisk (*) shall be checked on all incoming loaded equipment.

Unsatisfactory conditions that would affect the safe off-loading of the equipment must be corrected prior to unloading.

SECTION II (Continued)

Item 12.a. Spare Electrical Fuses. Check to ensure that at least one spare fuse for each type of installed fuse is carried on the vehicle as a spare or vehicle is equipped with an overload protection device (circuit breaker). (49 CFR 393.95)

b. Horn Operative. Ensure that horn is securely mounted and of sufficient volume to serve purpose. (49 CFR 393.81)

c. Steering System. The steering wheel shall be secure and must not have any spokes cracked through or missing. The steering column must be securely fastened. Universal joints shall not be worn, faulty or repaired by welding. The steering gear box shall not have loose or missing mounting bolts or cracks in the gear box mounting brackets. The pitman arm on the steering gear output shaft shall not be loose. Steering wheel shall turn freely through the limit of travel in both directions. All components of a power steering system must be in operating condition. No parts shall be loose or broken. Belts shall not be frayed, cracked or slipping. The power steering system shall not be leaking. (49 CFR 396 Appendix G)

d. Windshield/Wipers. Inspect to ensure that windshield is free from breaks, cracks or defects that would make operation of the vehicle unsafe; that the view of the driver is not obscured and that the windshield wipers are operational and wiper blades are in serviceable condition. Defroster must be operative when conditions require. (49 CFR 393.60, 393.78 and 393.79)

e. Mirrors. Every vehicle must be equipped with two rear vision mirrors located so as to reflect to the driver a view of the highway to the rear along both sides of the vehicle. Mirrors shall not be cracked or dirty. (49 CFR 393.80)

f. Warning Equipment. Equipment must include three bidirectional emergency reflective triangles that conform to the requirements of FMVSS No. 125. FLAME PRODUCING DEVICES

ARE PROHIBITED. (49 CFR 393.95)

g. Fire Extinguisher. Military vehicles must be equipped with one serviceable fire extinguisher with an Underwriters Laboratories rating of 10 BC or more. (Commercial motor vehicles must be equipped with one serviceable 10 BC Fire Extinguisher). Fire extinguisher must be located so that it is readily accessible for use and securely mounted on the vehicle. The fire extinguisher must be designed, constructed and maintained to permit visual determination of whether it is fully charged. (49 CFR 393.95)

h. Electrical Wiring: Electrical wiring must be clean and properly secured. Insulation must not be frayed, cracked or otherwise in poor condition. There shall be no uninsulated wires, improper splices or connections. Wires and electrical fixtures inside the cargo area must be protected from the lading. (49 CFR 393.28)

DD FORM 626, OCT 2011 Page 2 of 3 Pages

INSTRUCTIONS

SECTION II (Continued)

i. Lights/Reflectors. (Head, tail, turn signal, brake, clearance, marker and identification lights, Emergency Flashers). Inspect to see that all lighting devices and reflectors required are operable, of proper color and properly mounted. Ensure that lights and reflectors are not obscured by dirt or grease or have broken lenses.

High/Low beam switch must be operative. Emergency Flashers must be operative on both the front and rear of vehicle. (49 CFR 393.24, 25, and 26)

j. Fuel System. Inspect fuel tank and lines to ensure that they are in serviceable condition, free from leaks, or evidence of leakage and securely mounted. Ensure that fuel tank filler cap is not missing. Examine cap for defective gasket or plugged vent.

Inspect filler necks to see that they are in completely serviceable condition and not leaking at joints. (49 CFR 393.83)

k. Exhaust System. Exhaust system shall discharge to the atmosphere at a location to the rear of the cab or if the exhaust projects above the cab, at a location near the rear of the cab.

Exhaust system shall not be leaking at a point forward of or directly below the driver compartment. No part of the exhaust system shall be located where it will burn, char or damage electrical wiring, fuel system or any other part of the vehicle. No part of the exhaust system shall be temporarily repaired with wrap or patches. (49 CFR 393.83)

l. Brake System (to include hand brakes, parking brakes and Low Air Warning devices). Check to ensure that brakes are operational and properly adjusted. Check for audible air leaks around air brake components and air lines. Check for fluid leaks, cracked or damaged lines in hydraulic brake systems. Ensure that parking brake is operational and properly adjusted. Low Air Warning devices must be operative. (49 CFR 393.40, 41, 42, 43, 44, 45, 47, 48, 49, 50, 51, 52, 53, and 55)

m. Suspension. Inspect for indications of misaligned, shifted or cracked springs, loosened shackles, missing bolts, spring hangers unsecured at frame and cracked or loose U-bolts. Inspect for any unsecured axle positioning parts, and sign of axle misalignment, broken torsion bar springs (if so equipped). (49 CFR 393.207)

n. Coupling Devices (Inspect without uncoupling). Fifth Wheels: Inspect for unsecured mounting to frame or any missing or damaged parts. Inspect for any visible space between upper and lower fifth wheel plates. Ensure that the locking jaws are around the shank and not the head of the kingpin. Ensure that the release lever is seated properly and safety latch is engaged. Pintle Hook, Drawbar, Towbar Eye and Tongue and Safety Devices: Inspect for unsecured mounting, cracks, missing or ineffective fasteners (welded repairs to pintle hook is prohibited). Ensure safety devices (chains, hooks, cables) are in serviceable condition and properly attached. (49 CFR 393.70 and 71)

o. Cargo Space. Inspect to ensure that cargo space is clean and free from exposed bolts, nuts, screws, nails or inwardly projecting parts that could damage the lading. Check floor to ensure it is tight and free from holes. Floor shall not be permeated with oil or other substances. (49 CFR 393.84)

p. Landing Gear. Inspect to ensure that landing gear and assembly are in serviceable condition, correctly assembled, adequately lubricated and properly mounted. Item 26. Ensure driver/operator signs DD Form 626 at origin.

DD FORM 626, OCT 2011 Page 3 of 3 Pages

SECTION II (Continued)

q. Tires, Wheels and Rims: Inspect to ensure that tires are properly inflated. Flat or leaking tires are unacceptable. Inspect tires for cuts, bruises, breaks and blisters. Tires with cuts that extend into the cord body are unacceptable. Thread depth shall not be less than: 4/32 inches for tires on a steering axle of a power unit, and 2/32 inches for all other tires.

Mixing bias and radial on the steering axle is prohibited. Inspect wheels and rims for cracks, unseated locking rings, broken, loose, damaged or missing lug nuts or elongated stud holes. (49 CFR 393.75)

r. Tailgate/Doors. Inspect to see that all hinges are tight in body.

Check for broken latches and safety chains. Doors must close securely.

(49 CFR 177.835(h))

s. Tarpaulin. If shipment is made on open equipment, ensure that lading is properly covered with fire and water resistant tarpaulin. (49 CFR 177.835(h))

t. Other Unsatisfactory Condition. Note any other condition which would prohibit the vehicle from being loaded with hazardous materials.

Item 14. For AA&E and other shipments requiring satellite surveillance, ensure that the Satellite Motor Surveillance System is operable. The DTTS Message Display Unit, when operative, will display the signal "DTTS ON". The munitions carrier driver, when practical, will position the DTTS message display unit in a manner that allows the shipping inspector or other designated shipping personnel to observe the "DTTS ON" message without climbing aboard the cab of the motor vehicle.

SECTION III - POST LOADING INSPECTION

General Instructions.

All placarded quantities items will be checked prior to the release of loaded equipment. Shipment will not be released until deficiencies are corrected. All items will be checked on incoming loaded equipment. De-ficiencies will be reported in accordance with applicable service regulations.

Item 18. Check to ensure shipment is loaded in accordance with 49 CFR Part 177.848 and the applicable Segregation or Compatibility Table of 49

CFR 177.848.

Item 19. Check to ensure the load is secured from movement in accordance with applicable service outload drawings.

Item 20. Check to ensure seal(s) have been applied to closed equipment;

fire and water resistant tarpaulin applied on open equipment.

Item 21. Check to ensure each transport vehicle has been properly placarded in accordance with 49 CFR 172.504.

Item 22. Check to ensure operator has been provided shipping papers that comply with 49 CFR 172.201 and 202. For shipments transported by Government vehicle, shipping paper will be DD Form 2890.

Item 23. Ensure operator(s) sign DD Form 626, are given a copy and understand the hazards associated with the shipment.

Item 24. Applies to Commercial Shipments Only. If shipment is made under DOT Special Permit 868, ensure that shipping papers are properly annotated and copy of Special Permit 868 is with shipping papers.