Cargo & Security · Free Form
Delivery Change Verification Record
Document an independent callback before acting on a changed destination, consignee, pickup, or freight-release instruction.
Who It’s For
Dispatchers and drivers receiving changed delivery or freight-release instructions.
How to Use It
Use when instructions change unexpectedly. Keep the load in a safe, authorized location while dispatch verifies the request using a trusted contact source. Do not rely on the phone number, link, or email signature supplied in the change request.
What’s Included
- Original and requested instructions
- Independent callback evidence
- Approval or hold decision
Retain the original request, verified written instructions, and supporting records. Do not publish completed forms or load details. If information conflicts, escalate through the company security process before release.
Put It into Practice
Need help applying this to your operation? Run the DOT Compliance Self-Check.
Related Downloads
Official References
Check the applicable requirements alongside your company procedures.
Using This Download
Is this a fillable PDF?
This is a printable 1-page PDF. Complete it by hand after printing, or add text with a PDF editor. It does not contain interactive form fields.
Can MSM customize it for our company?
Yes. MSM clients can ask their MSM team to adapt the resource to company procedures, reporting contacts, equipment, and branding. The standard public download is available to everyone.
Reviewed October 26, 2026. These resources support U.S. trucking safety work. Apply the rules, exceptions, equipment instructions, and state requirements relevant to your operation. A completed form does not by itself establish compliance.