Emergency Medical Services (Ems) Systems Ambulance Inspection Form Page 3
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3Communication
Safety/General Vehicle
[92] Ambulance emergency run reports with data required by IDPH
[97] Patient area is clean
(Minimum 10)
[98] Equipment in patient area is secured/crash-stable
OR
[99] Flashlight (minimum one)
[93] Electronic documentation with paper backup
[100] Fire extinguishers (5 pound ABC, two with current service tag)
[94] Illinois Poison Center Number
[101] Emergency warning lights operational
[95] IDPH Central Complaint Hotline number (must be posted
where visible to patient)
[102] Siren operational
[96] Ambulance-to-hospital radio tested and working
[103] Flood lights operational
[104] Current Illinois Department of Transportation – issued safety
inspection sticker on windshield
[105] No visually apparent issues which would compromise the
safety of the patient, the ambulance personnel or the public
Inspector’s Comments:
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Revised August 2012
IOCI 14-116
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