COMPLIANCE STATEMENT Monthly or Quarterly (please circle the frequency of compliance checks, must be done at least quarterly) Year covered: ________________ From: ________________ To: ________________ Number of drivers medical Number of Number of Number of Number Number of AMMS Permit: Load assessments conducted vehicles in the daily recorded of faults Dimension & verification records during compliance period fleet prestart repaired services loading checks Period checks Trucks Trailers Dollies Actual No. of Completed Missed No. of No. of No. Missed Restrictions No. of No. No. of No. of No. of No. No. of trips Level of mass prime number checks on time or faults faults attended or applied by failed of cautions / vehicles of where excess for missed repaired not o/due Doctor medicals loads infringements in MMS trips each movers completed o/due closed loads / court taken occurred trip out matters Reviewed By Date of review Reviewed By Date of review Reviewed By Date of review Reviewed By Date of review Comments Signed & Dated: ________________________________________
COMPLIANCE STATEMENT Monthly or Quarterly (please circle the frequency of compliance checks, must be done at least quarterly) Year covered: ________________ From: ________________ To: ________________ Period Number of vehicles in the fleet Number of daily prestart checks Number of recorded services Number of faults repaired Number of drivers medical assessments conducted during compliance period Number of Dimension & loading checks AMMS Permit: Load verification records Trucks prime movers Trailers Dollies Actual number completed No. of checks missed Completed on time Missed or o/due No. of faults repaired No. of faults not closed out No. attended Missed or o/due Restrictions applied by Doctor No. of failed medicals No. of loads No. of loads No. of cautions / infringements / court matters No. of vehicles in MMS No. of trips taken No. of trips where occurred Level of mass excess for each trip Reviewed By Date of review Reviewed By Date of review Reviewed By Date of review Reviewed By Date of review Comments Signed & Dated: ________________________________________
Compliance-Statement.docx