Daily Vehicle Maintenance Checklist (Pre check)

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Fatigue Score - USE FATIGUE SAFE APP OR PHONE SUPERVISOR for assistance

  Green

  Amber

  Red

• Inspection Date/Time

  Date

• Driver

• Vehicle Registration

  820ZWZ

  777BX8

  768IB4

  791EE2

  Other

• Odometer

physical

• Service interval within label specification

  Yes

  No

  N/A

• Water Level OK

  Yes

  No

  N/A

• Oil Level OK

  Yes

  No

  N/A

• No Apparent Leaks

  Yes

  No

  N/A

• Fuel >1/2 full

  Yes

  No

  N/A

• Turn signals operational

  Yes

  No

  N/A

• Brake lights operational

  Yes

  No

  N/A

• Head Lights

  Yes

  No

  N/A

• Driving Lights

  Yes

  No

  N/A

• Tail Lights

  Yes

  No

  N/A

• Load and side Lights

  Yes

  No

  N/A

• Reverse Quacker

  Yes

  No

  N/A

• Flashing Lights

  Yes

  No

  N/A

• Interior Lights

  Yes

  No

  N/A

• Wheelchair lift and step operates

  Yes

  No

  N/A

• Reversing Cameras

  Yes

  No

  N/A

• Vehicle body in good condition

  Yes

  No

  N/A

• Tyres in good condition

  Yes

  No

  N/A

• Vehicle clean and beds made

  Yes

  No

  N/A

Administration items

• Tablet charged and working

  Yes

  No

  N/A

• Mobile Phone charged and working

  Yes

  No

  N/A

• Patient Care Record Folder stocked per list

  Yes

  No

  N/A

• Authorised Driver credentials present

  Yes

  No

  N/A

• Forms Folder on board

  Yes

  No

  N/A

• Fuel Card

  Yes

  No

  N/A

Other Safety Items

• Fire extinguisher charged and inspected

  Yes

  No

  N/A

• Safety vests

  Yes

  No

  N/A

• Torch

  Yes

  No

  N/A

• Umbrella present and secure

  Yes

  No

  N/A

• Cleaning items adequate

  Yes

  No

  N/A

Medical Equipment

• Stretchers Servicable

  Yes

  No

  N/A

• Linen Pack

  Yes

  No

  N/A

• Wheelchair functional and secure

  Yes

  No

  N/A

• Oxygen Cylinders >25%

  Yes

  No

  N/A

• Defibrilator checked

  Yes

  No

  N/A

• Primary response Kit

  Yes

  No

  N/A

• Airway Kit

  Yes

  No

  N/A

• Inverter Operational

  Yes

  No

  N/A

• PPE adequate

  Yes

  No

  N/A

List any other action items that need to be corrected

• Enter/list issues here.

Signatures

• Driver

  Sign

• Crew

  Sign