Reference: F-26/IMS-PR-06

SHIBH AL JAZIRA CONTRACTING COMPANY

QHSE DEPARTMENT Rev. 00
Ambulance Driver Weekly Checklist
Date July 15, 2018

Medical Facility: First Aid Station Vehicle No: _____________ Driver's Name: During the month of :

Day checked and initials

No Items Checked Remarks if deficient
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
General cleaning
1
inside and outside.
2 Air Conditioning
3 Directional lights.
4 Fuel Gauge
5 Horn.
6 Siren
7 Mirrors.
8 Steering Wheel.
9 Seat belts
10 Hand Brake
11 Foot Brake

12 Radio Communication

Engine oil /
13
transmission oil
14 Fan belts
15 Radiotor
Wiper water reservoir
16
level
17 Battery
18 Flashers
Head lights, low and
19
high beam
20 Tail lights
Stop lights and
21
parking lights
22 Muffler
Tire Condition and
23
pressure
Spare tire and tire
24
changing tools
25 Triangle
26 Fire extinguisher

Ambulance Driver Signature

Note: Copy must be submitted to QHSE Department

 Male Nurse Name & Signature

F-26/IMS-PR-06, Rev. 00