Department of Safety
AMBULANCE VECHILE CHECKLIST
Month Year :-
Vehicle No :-
Insurance Valid
Pollution Valid
WEEKS
SATISFACTION
SATISFACTION
SATISFACTION
SATISFACTION
(YES/NO)
(YES/NO)
(YES/NO)
(YES/NO)
SR. NO CHECKLIST POINTS REMARKS
2ND
3RD
4TH
1ST
Check the driving license is available with
01
driver and Name ?
Check the Driver fitness certificate is
02 available? Timely check reports are
available?
Ambulance clutch & breaks is properly
03
works?
Check is there head lights is properly
04
works?
Check ambulance headlight and tail light is
05
properly working?
06 All horns are properly sound?
Is there fire extinguisher is available with
07 ambulance? Fire extinguisher is refilled?
Green colors indicate on it?
Ambulance having a first aid box? And all
08 required medicines are available? Stricture
is available?
09 Check the tire air is proper pressurized?
Check on the vehicle on Rear side
“AMBULANCE” & Front side is
10 clearly readable (front side check with
mirror) – Word’s dull color, any word is
scratched not acceptable.
11 Oxygen cylinder is available and Working ?
12 Fuel Tank Full
13 Oil Level OK
14 Cabinet Compartment Lights (back)
15 Reading Light (back)
16
Siren Light Working?
17 Siren OK (all modes)
18 Reverse Alarm is working?
19 Wiper Blades is Good Condition?
20 Rear View Mirrors OK (interior/exterior)
21 All Windows Clean?
22 Dashboard Dusted
23 Floors Clean (inside front/back)
24 Bumpers/Running Boards Clean
25 Wheels Clean
26 All Doors (inside) are Cleaned/Disinfected
27 Stretcher is good working condition?
28 Billow Neat & Clean?
29 Back Compartment Seats Clean
30 Back Compartment Cabinets and Shelves
Clean
31 All Doors open/close Good and Weather
Stripping OK
32 Insurance valid date
33 FC/RC Valid date
34 Smoke Test Certificate
35 Emergency Light / Goggle & Rain coat
36 Tools kit available
37 Spare Wheel is good working condition
Inspected By:
Driver Sign
Vehicle In charge
Safety Officer Sign
Safety HOD Sign
Remarks
