AMBULANCE PRE-INSPECTION CHECKLIST

Name of the contractor:

Date of inspection:
Vehicle no:
Valid of insurence:

SL NO Criteria YES/NO/NA REMARKS

1 Ambulance should be physically in good condition.
Tires should be free from damage (Air pressure, cuts,
2
cracks, etc.)
3 Side mirror should in good and in correct position.
4 Windscreen and wipers should be in good condition.
Emergency lights and Audible siren should be in working
5
condition
Emergency contact number should be displayed properly
6
and at visible place.
7 Vehicle should be wothout oil leake, diesel leak
8 Is availsble sufficient level of diesel & oil
Front, Reverse horn, Indicator lights should be in working
9
condition.
10 Seat belt should be in working condition.
Fire Extinguisher available (in good condition, pressure
11
within range)

First Aid Kit should be available in operator cabin (with

valid date) Poisoning—Syrup of Ipecac, activated charcoal
prepacketed dose, snake bit kit, drinking water, Dressing-
12 Gauze pads—100 m x 100 mm universal dressing 250 x
1000 mm, roll of aluminium foils—soft roller bandages 150
mm x 5 mm yards adhesive tape in 75 mm roll safety pins,
bandage sheets, burn sheets

Medical oxygen cylinder with pressure gauge and

13 availability of key to open the cylinder should be available
with canister mask.
14 Stretcher should be available and in good condition.
Fan for ventilation should be available and in good
15 condition.
Driver should have valid and suitable license as per legal
16
requirement.
Normal and Emergency break (Hand Break) should be in
17
working condition.
18 Stepneys or spare wheel should be available.
19 Availability of GPRS tracker In working condition.
20 availability of ambulance vehicle log book.
Availability of all legal documents should be available
21
without expiry (RC&FC, insurance, emission test, etc)
Approved color bed sheet and blanket is available with neet
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and clean
23
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Inspected by name/signature Verified by name/signature