Title Page

  • Conducted on

  • Prepared by

  • Location

Vehicle condition

  • Is the exterior of the vehicle clean and free of damage?

  • If damage is noted please take picture of damage.

  • Is the interior of the cab clean and free of damage?

  • If damage is noted please take a picture of damage

  • Is the patient compartment clean and free of damage?

  • If damage is noted please take a picture

  • Add media

Fuel and general fluid checks

  • Current fuel level closest amount

  • Are engine levels acceptable?

  • Wiper blades in good condition?

  • Washer fluid levels acceptable?

  • Any indications of leaking fluids?

Emergency Alert Systems and General Lights

  • Headlights functional?

  • Flood lights functional?

  • Emergency lights functional?

  • Sirens functional?

  • Back up alarm functional?

  • Turn signals functional?

  • Back up camera is functional?

Patient Care Equipment

  • Stretcher is functional and batteries are charged?

  • Stretcher locking mechanism is functional ?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.