HUNTLEY FIRE PROTECTION DISTRICT

VEHICLE MAINTENANCE

07/26/04

DAILY CHECK FORM: AMBULANCE Month/Year______

“X” = Checked and ok.

“O” = If repair is needed. VEH. LIC. # ______

THIS FORM TO BE USED AS A GUIDELINE FOR CHECKING THE VEHICLE

1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13 / 14 / 15 / 16 / 17 / 18 / 19 / 20 / 21 / 22 / 23 / 24 / 25 / 26 / 27 / 28 / 29 / 30 / 31
Record Fuel Level
Check all dash gauges and switches for proper operation and readings.
Check all lights, siren, air horns, and wipers, heaters and A/C controls.
Check cab interior for all Map, Pre-Plan, and ERG books, keys, binoculars, radios, fuel key, spot lights, and cell phone.
Check operation and capacity of all SCBA’s and pass devices.
Visually check all equipment in the compartments.
Check all medical equipment and supplies in cabinets.
Check oxygen pressure in cylinders
Visually check tires and undercarriage.
Inspect condition of Body, Paint, Glass and Cleanliness.
REPAIRS NEEDED OR SAFETY STICKER EXPIRES THIS MONTH. WRITE UP Y or N.
FF INITIALS
LT INITIALS

MILEAGE / ENGINE HOURS

1. / / 9. / / 17. / / 25. /
2. / / 10. / / 18. / / 26. /
3. / / 11. / / 19. / / 27. /
4. / / 12. / / 20. / / 28. /
5. / / 13. / / 21. / / 29. /
6. / / 14. / / 22. / / 30. /
7. / / 15. / / 23. / / 31. /
8. / / 16. / / 24. /

Mileage / Engine hours

Next service @ ______/______. Notify maintenance div when within 500 miles or 10 hrs of next service.

Return completed form to Vehicle Maintenance Division. Use back for comments

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