Maintenance Report

Truck Make (Select One) *

REPORT MONTH (Select One) *

# of tires replaced this month: *

Did you perform any maintenance (this includes preventative) or general repairs on your equipment this month? If so please send copies of all receipts through Drive Axle to: safety@emwayinc.com. *

Yes - maintenance receipts submitted

NO Maintenance to report

Last 8 Digits of Truck Vin # *

Trailer Make (Select One) *

EM Way Inc

EACH MONTH - Please check your safety equipment to make sure it is properly functioning and/or hasn't expired. - Flares – Flags: Fuses; Fire Extinguisher (make sure it is secured in place and not rolling around); Spare Bulbs; Tire Chains (if needed); Straps (for tears); LUBRICATE the 5th Wheel *

By entering your name below you certify that this report is a true and correct statement of work performed. *

Truck #: *

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REPORT YEAR (Select One) *

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Trailer Unit # *

Operator Name: *

MONTHLY MAINTENANCE REPORT

Please send all maintenance and copies of repair receipts, including tire purchases, through the DriveAxle app on your tablet or smart phone. Use the email address: safety@emwayinc.com

NOTE: In order to comply with FMCSA Safety Regulations part 396, it is necessary for every owner/driver of any contracted equipment, to fill out this form and submit to Carrier. EM Way requires all maintenance reports to be completed monthly.

*** Please complete the form below to satisfy FMCSA maintenance reporting requirements.

Preventative maintenance is vital to the safety of the public that we share the roads with. Keeping your equipment in safe operating conditions will also increase your revenue, add life to your equipment and cost less to maintain over time.