Ambulance | Ambulance Inspection

                                     AMBULANCE INSPECTION CHECKLIST

Ambulance 

Daily Ambulance Inspection Report

Document #

Issue No. 01

Rev. No. 00

Issue Date:

EQUIPMENT DESCRIPTION

Vehicle no

OPERATOR / DRIVER' S NAME

AMBULANCE

LEGEND :

( P ) = SATISFACTORY  ( X ) = REPAIR  ( O ) = REPLACE )

DATE:

SR #

DESCRIPTION

MON

TUES

WED

THUR

FRI

SAT

SUN

REMARKS

1

Oxygen Cylender with pressure & accessries

2

Ignition, Lights & Indicators

3

Engine oil & Fuel level

4

Seat belt intact

5

Steering free / abnormal

6

Radiator coolant & Fan belt

7

Stretcher condition

8

Tyres & spare tyre inflated

9

Control /guages functional

10

wipers & horn working

11

Wheels & brakes

12

Rotary light & hooter

13

Doors locking & view mirror

14

Cleanliness Inside/Outside

15

Fire Extinguisher full

16

First Aid kit

17

Doc: Registration - Route Permit-Insurance, Fitness

18

Personal Valid License

19

Emergency Contacts Available

20

Essential tools & jack

21

A.C in working condition

22

Signature DRIVER

23

Signature DOCTOR / MEDIC

REF

MAJOR REPAIRS NECESSRY (BRIEF DETAIL OF DEFECT)

QTY

MAJOR SPARE PARTS REQUIRED (PART NAME & DESCRIPTION)

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