2023 Unannounced Brake Safety Day Data Form Country(Required) Canada Mexico United States of America Province or Territory(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonState or Territory(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasU.S. Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWhat level of CVSA inspection was conducted?(Required) Level I Level II Level IV Level V What type of vehicle (power unit) was inspected?(Required) Truck Tractor/Truck-Trailer Combination Bus/Motorcoach Other What type of braking system is this power unit equipped with?(Required) Air - Disc Air - S-Cam Hydraulic What type of brakes are on the towed units?(Required) Air - Disc Air - S-Cam Hydraulic Electric Which vehicles had dust shields on the brakes? Power Unit Towed Unit(s) N/A Did the power unit have any pad/lining violations? Yes No What were the power unit lining/pad violations? Choose any that apply. Cracks/Voids (as per the regulations) Loose/Missing Worn (as per the regulations) Contaminated Did the towed unit(s) have any pad/lining violations? Yes No What were the tow unit(s) lining/pad violations? Choose any that apply. Cracks/Voids (as per the regulations) Loose/Missing Worn (as per the regulations) Contaminated Was the vehicle or combination declared out of service for defective brakes?(Required) Yes No Why was the vehicle or combination out of service?(Required) 20% Service Brake Violations Defective Linings/Pads on the Steering Axle Other Steering Axle Brake Violations Other Brake Violations (such as brake hoses, drums/rotors, leaks) Found an interesting violation you'd like to share with us? Upload the pic.Max. file size: 256 MB.
