Daily Ambulance Checklist

Ambulance Daily Inspection Form Checklist

S/No.

DESCRIPTION OF CHECKS

=Yes/Good/ =No/Bad

REMARKS

Ambulance Physical Condition General Vehicle Condition Is the exterior of the vehicle clean and free of damage? If damage is noted please take a photo of the damaged area? Upload Media Is the interior cab of the ambulance clean and free off damage? If there is damage noted in the cab of the ambulance please take a picture. Is the patient compartment clean and free of damage? If damage is noted in the patient compartment please take a picture Protocol book on unit? Fuel and general engine fluids check Fuel level at checkout? (Indicate the closest amount)   1/8   1/4   1/2   3/4   Full Are engine oil levels acceptable? Are windshield wiper fluid levels acceptable? Is there any indication of leaking fluids? Emergency Alert Systems and General Lights Headlights functional? Emergency lights functional? Sirens functional? Backup alarm functional • • • • •

1of 2

S/No.

DESCRIPTION OF CHECKS

REMARKS

Brake lights functional Tail lights functional? Turn lights functional? Any additional detail as necessary for any negative findings other than above?

Patient care equipment Stretcher present and in good condition? Stretcher patient restraints including shoulder straps present? Airway bag is present, stocked correctly with a charged oxygen cylinder? Portable oxygen pressure level? (Indicate to the nearest hundred) min: 0 max: 2000 step: 100 • • •

Patient Compartment Linens stored and clean? Regular Trash Can Present?

Safety Equipment 2 Hard hats with goggles? 2 Pair gloves? 2 Safety Vests 1 Flashlight 3 Road Reflectors 1 First Aid kit Hand Sanitizer 1 Fire Extinguisher Cab, 1 Fire Extinguisher patient compartment? Adult Nebulizer Count • •

min: 0 max: 10

2of 2