EMS Inspection Checklist Form
Complete this checklist to ensure all EMS operational standards are met before service.
Vehicle Exterior Condition
*
Excellent
Good
Fair
Needs Attention
Emergency Lights and Sirens Functionality
*
Fully Operational
Partially Operational
Not Working
Medical Equipment Inventory
*
Complete
Partial
Missing Items
Oxygen Supply Level
*
Full
Sufficient
Low
Empty
Defibrillator (AED) Status
*
Ready for Use
Battery Low
Pads Missing/Expired
Not Working
Personal Protective Equipment (PPE) Availability
*
All Present
Some Missing
Not Available
Interior Cleanliness and Sanitation
*
Clean and Sanitized
Needs Cleaning
Unsanitary
Radio and Communication Devices
*
All Devices Working
Some Devices Not Working
No Devices Working
Fire Extinguisher Status
*
Present and Charged
Present but Needs Service
Missing
Additional Notes or Issues Identified
Submit Inspection
Should be Empty: