AMBULANCE CHECKLIST

DATE: __________________________________________________

DRIVER: __________________________________________________
VEHICLE: __________________________________________________

CHECK TIME: ODOMETER

IN

FUEL FULL
3/4TH REFILL LITERS
1/2ND DATE:
1/4TH
EMPTY

VEHICLE GOOD BAD REMARKS

ENGINE
ENGINE OIL
COOLANT
STEERING
BRAKE
SUSPENSION
TIRE PRESSURE

YES NO REMARKS
SPARE TIRE
HEADLIGHT
STOPLIGHT
JACK/TOOLS

WARNING DEVICE
AIRCON
SIREN
OR/CR
EQUIPMENT YES NO REMARKS
STRETCHER
SPINE BOARD
MEDICAL SUPPLIES
OXYGEN TANK
OXYGEN GAUGE
REFILL LITERS
DATE:

TIME TRIP/ DESTINATION PASSENGER

CHECK TIME: ODOMETER

OUT
SIGNATURE: