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DAILY AMBULANCE CHECKLIST FORM
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Ambulance No:____________________ Date:_____________
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SN Areas/Items/Equipments Checked12345678910111213141516171819202122232425262728293031
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ACleanliness
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1Internal
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2External
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BEngine
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1Battery Water
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2Engine Oil
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3Radiator Fluid
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4Washer Fluid
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5Break Fluid
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6Fuel Level
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7Spare Tyre, Tyre Range, and Hydraulic Jack
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8Tyre Pressure
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9Fire Extinguisher with date of last inspection
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10Start & keep the engine running for 20 minutes (listen/observe for any untoward sounds/vibration)
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11Wipers
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12Washers
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13Horn
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14Communication
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15Sirens
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16Air Conditioner
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17Heater
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Lights (Dash, Dome, Spotlight, Turn Signal Indicator, etc)
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CLighting (Turn on and visible check the following)
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1Emergency and warning lights
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2Headlights (low & high)
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3Running / box lights
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4Turn signals / 4 ways
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5Break lights
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6Back-up lights
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7Emergency flashers
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DEmergency Equipments / Supplies
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1Emergency ambulance bag
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2Portable cardiac monitor
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3Portable AED with padsThis we can add in old ambulance checklist checked by staff nurse remove from here
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4Portable ventilator
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5Portable & fixed oxygen cylinder
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6Portable suction apparatus
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7BP apparatus & stethoscope
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8Extrication device
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9Stretcher
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EInitialThis check list checked by driver
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