Form B

PREVENTIVE MAINTENANCE SERVICE & INSPECTION

B – Service & Inspection PM Service Authorization #: MA

CUSTOMER / FLEET NAME DATE ODOMETER / ENGINE HOURS / FUEL REPAIR ORDER #

ADDRESS UNIT NO. VIN # (LAST 7 DIGITS) VEHICLE MAKE & MODEL

CITY, STATE / PROVINCE, ZIP / POSTAL CODE PHONE DEALER NAME & CODE

COMPLETE ALL OF THE INSPECTION AND SERVICE POINTS ACCORDING TO THE SERVICE WORKED ON AND INDICATE:
√ = OK O = REPAIR REQUIRED X = REPAIR COMPLETED N = NOT APPLICABLE
CIRCLE INSPECTION: B REAR FRAME: B
Physical Damage, Sheet Metal, Frame & X-members, Frame & Xmembers - Cracks / Fasteners - Loose, Broken, Missing
th
Grill & Radiator, Wheels, Bumpers 5 Wheel Mounting & Condition / Check Adjustment / handle locked
Air Leaks Air Lines & Glad-hands
Headlights – High & Low Beams Trailer Light Cord & Connectors
Road Lights Pintle – Hook / Eye Mounting & Condition
Clearance Lights / Reflectors Inner & Outer Hub Seals Leaks
Turn Lights Spring Shackles & Hanger Brackets
Brake Lights Spring Leaves / Bushings / Shocks / Air Bags
Emergency Flasher Radius Rods / Torque Arms
Backup / Load Lights TIRES & WHEELS: B
License Plates, Permits & Mounting Missing Valve Caps / Tighten Stem Locks
Mud Flaps / Serviceable Cracks Or Loose Wheel Lugs
Fuel Tank Mounting / Filler Cap in place Tandem Mating / Tire Clearance
Fuel Crossover Line (Droop, Damage) If equipped Irregular Wear / Air Leaks
Fuel Leaks Tire Pressure (Record Below)
Exhaust System-Condition, Leaks & Mounting Bolts Remaining Tread (Record Below)
CAB – COE: Hold Down Latches
Inspect Clutch Cable ( If Applicable) TIRE INSPECTION
Mounts Enter Air Pressure Before Adjustment
Front Pivot Assembly
Jack Operation & Leaks Front Tandem Rear Tandem
Safety Locks, Tip-Over Stop(Visual Inspection) Front Axle PSI PSI
INITIAL DRIVE IN: B
Clutch Pedal Free Travel 32nd’s 32nd’s
PSI
Parking Brake – Brakes applied upon activation of control
32nd’s
Glass for Cracks or Chips PSI PSI

Steering Wheel Free Play & Column Mounting

32nd’s 32nd’s
Door Window Operation
Interior Lights
Cranking System Operation
Gauges / Warning Lights – Illumination / Operational: PSI PSI
Maintain Low Idle
Oil Pressure PSI 32nd’s 32nd’s

Low Air Pressure Warning Devices

Air Cleaner Restriction Gauge 32nd’s PSI PSI

Electronic Warning Module / A&B Cluster Lights On/Off

32nd’s 32nd’s
Governed Air Pressure: PSI - KpA
Air Pressure Drop-Brakes Not Applied: (PSI-KpA/min.)
Air Pressure Drop-Brakes Applied: (PSI-KpA/min.) Air Pressure Adjusted to: . _____________.
Windshield Wiper / Washer Condition & Operation Front Tires Rear Tires
Horns (Electric & Air) ENGINE OIL CHANGE / CHASSIS LUBE ~ BEGIN: B
Mirrors / Heated / Motorized Operation Engine Oil Analysis –Take Sample (See PM Service Work Authorization)
Service Indicator Reset Remove Engine Oil Pan Drain Plug / Drain Oil
Drain Water from Air Tanks Inspect Engine Oil Drain Plug for Debris
Air Tank Check Valve Verify Replacement Filters Part Numbers
Emergency Operation of Spring Brakes Lubricate Door Hinges & Latches
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Tractor Protection Valve Breakaway Test Chassis Lubrication / 5 Wheel / Drive Line / Fan Hub
Fire Extinguisher Charge UNDER VEHICLE: B
Flare Kit / Reflectors – Readily Accessible Rear Axle Leaks & Lubricant Level
BATTERIES: B Rear Axle Breathers – Clear
Hold-Down & Box-Mounting Bolts Drive Lines – U-Joints & Slip Yokes
Signs of Over-Charging – Visual Inspection Brake Hoses for Cracks, Chafing any damage extending thru Outer Ply
Sealed Type – Condition: Adjust Brakes – Check Auto Slack Adjusters
Brakes: Lining Remaining – Estimate of thickness – NO DISASSEMBLY
Color of Charge Indicator Check 1 Box Front Axle Front Tandem Rear Tandem
for Each Battery per column. Left Right Left Right Left Right
½ “ or more
1 2 3 4 ¼ “ to ½ “
Less than ¼ “

R 08/05 This inspection complies with the DOT Federal Annual and California 90 day inspection requirements. Page 1 of 2
 B LEVEL SERVICE & INSPECTION PAGE - 2

UNDER VEHICLE (continued): B DRIVER’S COMMENTS:

Drum Condition – Visual Inspection: (Good, Fair, Bad) – NO DISASSEMBLY
Check 1 Box Front Axle Front Tandem Rear Tandem
per column. Left Right Left Right Left Right
GOOD
FAIR
BAD

Transmission Leaks & Lubricant Level

Engine & Transmission Mounts
Engine Oil Pan Plug – Reinstall TECHNICIAN’S COMMENTS:
Steering Gear – Cracks & Leaks, Mounting brackets loose fasteners
Steering Shaft Splines & Joint(s)
Pitman Arm
Drag Link
Steering Arms
Tie Rod Arms
Tie Rod Ends
Radius Rods / Torque Arms
Spring Shackles & Hanger Brackets
King Pin Wear
Spring Leaves / Shocks / Air Bags
Front Axle Beam for cracks or obvious welded repairs
Wheel Bearing Play
Front Hub Lubricant Level / Leaks
ENGINE COMPARTMENT B
Oil Filter(s) – Replace
Fuel Filter(s) – Replace
Fuel Water Separator – Replace (See PM Service Work Authorization)
Engine Oil - Replace
Check for Leaks: Engine Oil / Fuel
Engine Oil Level
Cranking System: Visual Inspection Loose Connections
Cab, Chassis Grounds
Steering Gear –Fluid Level
Check Hydraulic Brake Fluid Level ( Medium Duty – If Applicable )
Vibration Damper Condition
Drive Belt(s) Condition
Drive Belt(s) Adjustment
Air Compressor & pulley, mtg brackets; broken, cracked, loose parts
Fan Shroud
Fan Assembly & Idler Pulley
Fan Clutch & Over-Ride Operation
Check Water Pump – Leaks
Engine Block Heater (Continuity Test)
Radiator – Exterior Condition
Radiator Mounting This Inspection has been completed and complies with
Hose Condition & Connections FMCSR49CFR, 396.17-23 appendix G DOT Annual
Air Conditioning Compressor / Condenser Mounts / Leaks Inspection and 34505.5a CVC CHP Inspection.
Cooling: Check Supplemental Coolant Additive / Conditioner to Mfg Spec
SCA’s OK Undercharged Overcharged
Coolant Level New Inspection Sticker Applied to Vehicle
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Coolant Protection (Freeze Point) : _ (degrees Fahrenheit / Celsius)
Replace Coolant Filter (If applicable -See PM Service Work Authorization) VIN # _______________________________________________
Pressure Test / Check Leaks (Last 7 Digits Required for Annual Inspection)
Air Cleaner Mounting / Interference
Contaminant Accumulation INSPECTED BY: _____________________________________
Vacuator Valve – Operation & Condition
APPROVED BY: _____________________________________
DOT INSPECTION EXPIRATION DATE:
/ /
DAY / MONTH / YEAR
I acknowledge that all items noted on this form as requiring repair(s) have been explained to me.
OTHER - INSPECTIONS EXPIRATION DATE: I further accept responsibility for all items indicated on this form requiring repair, that were not
/ / repaired at my direction, and shall indemnify and hold harmless the Dealer, Kenworth Truck Co.
DAY / MONTH / YEAR Company, PCC and PACCAR Inc, their officers, directors, and employees, from and against any
and all claims, suits, damages, costs, losses, and expenses, including attorney’s fees, in any
manner resulting from or arising out of the failure of an unrepaired part, component or system.

APPROVED BY: __________________________________________

CUSTOMER SIGNATURE REQUIRED HERE

R 08/05 This inspection complies with the DOT Federal Annual and California 90 day inspection requirements Page 2 of 2