Ambulance inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

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

  Yes

  No

  N/A

• If damage is noted please take picture of damage.

  Media

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

  Yes

  No

  N/A

• If damage is noted please take a picture of damage

  Media

• Is the patient compartment clean and free of damage?

  Yes

  No

  N/A

• If damage is noted please take a picture

  Media

• Add media

  Media

Fuel and general fluid checks

• Current fuel level closest amount

  1/8

  1/4

  1/2

  3/4

  Full

• Are engine levels acceptable?

  Good

  Fair

  Poor

  N/A

• Wiper blades in good condition?

  Good

  Fair

  Poor

  N/A

• Washer fluid levels acceptable?

  Good

  Fair

  Poor

  N/A

• Any indications of leaking fluids?

  Yes

  No

  N/A

Emergency Alert Systems and General Lights

• Headlights functional?

  Yes

  No

  N/A

• Flood lights functional?

  Yes

  No

  N/A

• Emergency lights functional?

  Yes

  No

  N/A

• Sirens functional?

  Yes

  No

  N/A

• Back up alarm functional?

  Yes

  No

  N/A

• Turn signals functional?

  Yes

  No

  N/A

• Back up camera is functional?

  Yes

  No

  N/A

Patient Care Equipment

• Stretcher is functional and batteries are charged?

  Good

  Fair

  Poor

  N/A

• Stretcher locking mechanism is functional ?

  Safe

  At Risk

  N/A