AMBULANCE CHECK SHEET

MODEL NAME AMBULANCE NO MONTH

Date
Guideline
Sl.No Parameters Frequency What to Check How to check Remarks
Photo
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Driver having Valid License Availability of License

1 Daily Visually
with Badge with Badge and validity

Pressure level should be

2 Oxygen Cylinder Daily in- between 60-130 Visually
Kg/cm²/ Refilling details
Container water level
should be in-between the
3 Oxygen Cylinder Water Level Daily Visually
min and max mark of
container
Free from dust & damage
4 Oxygen Cylinder Mask Daily in Mask, covered with Visually
polythene pack

First aid medicines

5 First aid medicines Daily available as per master Visually
list

Siren sound and light

6 Siren and Siren Light Daily Visually
working condition

7 Head Light Daily Light working condition Visually

Self Motor, Brake, Speedo

Working condition and
8 meter, steering condition, Fuel Daily Visually
fuel level indicator
Level

9 Tool Kit and Jockey Daily free from damage Visually

Seat condition (Driver seat,

10 Daily free from damage / loose Visually
attendant seat)

Rear view mirror and Outside Free from dust, dirt and
11 Daily Visually
rear view Mirror damaged condition

Immediate startup of
12 Battery Condition Daily Visually
vehicle

Free from
13 Wind shield Daily Visually
dust/dirt/Damage

14 Wiper condition Daily Working condition Visually

Free from dust, dirt and

15 Floor Mat Daily Visually
damaged condition

16 Horn Daily Working condition Visually

Free from dust, dirt and

17 Stretcher Seat, Seat Lock Daily Visually
damaged condition

Window, Window Glass, Free from dust, dirt and

18 Daily Visually
Handle, Door and Door Lock damaged condition

Pressure level should be

19 Fire Extinguisher Daily in-between 11-18.5 bar/ Visually
free from damage

20 Fire-extinguisher validation Monthly Validation date in label Visually

Vehicle documents (Pollution

Control Board certificate, Availability of Valid
21 Daily Visual
Emission certificate,RC, FC, certificate
road tax and insurance)

Tire condition / Pressure

22 Tyre Pressure Daily Visually
level

Tyre condition / Pressure

23 Stepney tyre condition Daily Visually
level

Vehicle Free from dust,

24 Water cleaning Daily dirt and damaged Visually
condition

25 Seat safety belt Daily Seat belt condition Visually

Availability and Free

26 Petrol tank cap condition Daily Visually
from damage/dust

Engine Oil level should

be in-between the min
27 Engine oil level Weekly and max mark or hole of Visually
checking rod or engine oil
tank

Break Oil level should be

in- between the min and
28 Break oil level Weekly Visually
max mark of break oil
tank
Water/Coolant oil level
Water/Coolant oil level in should be in-between the
29 Weekly Visually
radiator tank min and max mark of
coolant oil tank

Free from dust, dirt and

30 Wheel chair condition Weekly Visually
damaged condition

AMBULANCE DRIVER

OHC STAFF

HSE

IF OK PUT (√ )
IF NOT OK PUT ( X ) Then inform to HR to take necessary action