Ambulance Daily Inspection Form Digitalize this paper form now
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Cut inspection time by 50% Uncover more issues and solve them 4x faster Select from over 4000 expert-proofed templates Ambulance Daily Inspection Form Ambulance Physical Condition General Vehicle Condition Is the exterior of the vehicle clean and free of damage? Yes No N/A If damage is noted please take a photo of the damaged area? Add Photo Is the interior cab of the truck clean and free off damage? Yes No N/A If there is damage noted in the cab of the truck please take a picture. Add Photo Is the patient compartment clean and free of damage? Yes No N/A If damage is noted in the patient compartment please take a picture. Add Photo Protocol book on unit? Yes No N/A Fuel and general engine fluids check Fuel level at checkout? (Indicate the closest amount) 1/8 1/4 1/2 3/4 Full Emergency Alert Systems and General Lights Headlights functional? Yes No N/A Clearance lights functional? Yes No N/A Emergency lights functional? Yes No N/A Scene lights functional? Yes No N/A Sirens functional? Yes No N/A Backup alarm functional Yes No N/A Brake lights functional Yes No N/A Tail lights functional? Yes No N/A Turn lights functional? Yes No N/A General Vehicle Section Narrative Patient care equipment Stretcher/Response bags/Monitor Stretcher is present, functioning normally. Batteries are charged? Yes No N/A Stretcher patient restraints including shoulder straps present? Yes No N/A Airway bag is present, stocked correctly with a charged oxygen cylinder? Yes No N/A (check name not set) Yes No N/A Heart Monitor is present, clean, fully charged, with spare batteries on the charger? Yes No N/A Monitor passed user test? Add Photo Response bag present, clean and fully stocked with no expired items? Yes No N/A Patient Compartment Linens stored and clean? Yes No N/A Regular Trash Can Present? Yes No N/A Bio Hazard Trash Can Present? Yes No N/A Portable Suction present and functional? Yes No N/A On Board Suction present and functional? Yes No N/A Transport Ventilator present, clean and functional? Yes No N/A CPAP present, clean and functional? Yes No N/A Safety Equipmeent Safety Equipment 2 Hard hats with goggles? Yes No N/A 2 Pair gauntlet gloves? Yes No N/A 2 Safety Vests Yes No N/A 2 Flashlights? Yes No N/A Sharps Container Yes No N/A 3 Road Reflectors Yes No N/A Hand Sanitizer Yes No N/A 1 Fire Extinguisher Cab, 1 Fire Extinguisher Outside compartment, 1 Fire Extinguisher patient compartment? Yes No N/A Basic Life Support Supplies Oropharyngeal Airway, 1 each size Yes No N/A
Please note that this checklist template is a hypothetical example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.