Medical Stretcher Maintenance Checklist Form
Complete this checklist to log the inspection, condition, and maintenance actions for a medical stretcher.
Stretcher Identification Number
*
Location or Department
*
Date and Time of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector's Full Name
*
First Name
Last Name
General Condition of Stretcher Frame
*
Excellent
Good
Fair
Poor
Wheels and Casters Condition
*
All functional and undamaged
Minor wear, functional
Major wear or damage
Replacement needed
Brakes Functionality
*
Fully functional
Partially functional
Non-functional
Mattress or Padding Condition
*
Clean and undamaged
Minor wear or stains
Torn or heavily soiled
Replacement required
Maintenance Actions Performed
Is Follow-up Maintenance Required?
*
No
Yes
Additional Notes or Follow-up Details
Submit Checklist
Should be Empty: