Ambulance Licensing Inspection Checklist
Use this form to document an ambulance licensing inspection, record compliance checks, note deficiencies, and capture the final inspection outcome.
Inspection Identification
Inspection Date
*
-
Month
-
Day
Year
Date
Inspection Location / Facility
*
Ambulance Unit / Vehicle Identifier
*
Inspector Name
*
Vehicle and Equipment Compliance
Exterior condition
*
Compliant
Non-compliant
Lights and sirens
*
Compliant
Non-compliant
Tire condition
*
Compliant
Non-compliant
Braking and steering
*
Compliant
Non-compliant
Oxygen supply and equipment
*
Compliant
Non-compliant
Stretcher and restraints
*
Compliant
Non-compliant
First-aid and safety supplies
*
Compliant
Non-compliant
Communication and radio system
*
Compliant
Non-compliant
Inspection Outcome and Follow-up
Overall inspection result
*
Pass
Pass with Corrections
Fail
Deficiency notes
Corrective action deadline
-
Month
-
Day
Year
Date
Inspector name confirmation
First Name
Last Name
Submit Inspection
Should be Empty: