AMBULANCE CHECKLIST

AMBULANCE CHECKLIST
Date of Inspection Contractor
Make of Ambulance Mode
Designated Male Nurse Ambulance Driver
Inspected
By    
S.No. Item To Check  On Site Ambulance Safety Remarks
    General Vehicle Component  
    Good Fair For Repair N/A  
1 Engine Condition          
2 Inside Cab          
3 Wind Shield          
4 Wind Shield Wipers          
5 Steering          
6 Safety Belts          
7 PEDALS: Break          
8 Accelerator          
9 Clutch          
10 Shift Stick          
11 Horns          
12 Door & Latches          
13 Mirrors          
14 Body Condition          
15 Tyre Front          
16 Tyre Rear          
17 Muds Flaps          
18 License Plate & Empty Weight          
19 Reflector          
20 LIGHTS:Head          
21 Tall & Brake          
22 Turn Signals          
 23 Emergency Siren          
24 Emergency Flashing Light          
25 Back Up Alarm          
ENGINE COMPARTMENT & UNDERSIDE
26 Hoses & Lines          
27 Belts          
28 Battery          
29 Fluid Level          
30 Radiator & Cap          
31 Coolant & Protection          
32 Wiring          
33 Filter & Breathers          
34 Fan & Shround          
35 Air Intake System          
36 Exhaust System          
  ASSESSORIES
37 Fire Extinguisher          
38 Emergency Kit          
39 Medical Oxygen          
40 Spine Board          
41 Stretcher          
42 Road Test          
43 Other Please Specify          
44 Operator Manual          
45 inspection Tag          
46 Warranty Card          

Signature

Inspected By Inspected By
Ambulance Driver Male Nurse

Signatur
Date Signature Date e

Acknowledge By
Safety Manager/LSO
Date Signature