NEMT vehicle inspection checklist: a free daily pre-trip form

How to use this template

The driver completes this checklist at the start of every shift, before the first pickup, for each vehicle they drive that day. A driver who switches vans mid-shift fills out a second one. The walk-around takes a few minutes once it becomes routine.

• Accessible vehicles also complete the lift, ramp, and securement sections. Sedans and ambulatory vans skip them.
• A failed safety item keeps the vehicle out of service until it is repaired and someone signs off. Do not run trips on a “fail” and fix it later.
• Who keeps it. The office files the signed checklist by vehicle and date. For vehicles covered by FMCSA rules, keep driver inspection reports for three months. Keep maintenance records for one year, and for six months after the vehicle leaves your control. Your broker contract can require longer.

Check your broker’s own vehicle list before you use this form, and add any item it names that is not here. Our guide to NEMT vehicle requirements covers the state rules behind the list.

The template

Vehicle and driver

Outside the vehicle

• Tires: tread depth, inflation, no cuts or bulges
• Wheels and rims: no cracks, lug nuts in place
• Every light works: headlights, turn signals, brake lights, reverse lights, and hazard flashers
• Windshield and windows: no cracks that block the driver’s view
• Wipers and washer fluid work
• Both exterior mirrors in place, clean, and adjusted
• No fluid leaks under the vehicle
• Body: no broken glass, sharp edges, or damaged bumpers
• Company name and phone number visible on both sides (if your state or broker requires it)
• All doors open, close, and latch, including side and rear doors

Driver’s seat and controls

• Service brakes feel firm, and the parking brake holds
• Steering has no excess play
• Horn works
• No warning lights on the dashboard after start-up
• Speedometer and odometer work
• Interior mirror shows the passenger area
• Heat and air conditioning reach the rear of the vehicle
• GPS or current map on board, phone charged and mounted

Passenger area

• Seat belts at every seat latch and release, and are stored off the floor
• Seat belt extensions on board
• Seats secure, with no tears or sharp edges
• Floor clean and dry, with no loose items
• Grab handles and steps secure
• “No smoking” and “All passengers will use seat belts” signs posted (if required)
• Complaint procedure and broker phone number posted (if required)

Safety equipment

• Fire extinguisher charged, mounted, and within the driver’s reach
• First aid kit complete, with nothing expired
• Spill kit: absorbent, gloves, waste bags, scrub brush, disinfectant, deodorizer
• Seat belt cutter within the driver’s reach
• Reflective triangles or other roadside warning devices
• Flashlight works
• Disposable non-latex gloves
• Spare tire or tire repair kit, and a jack
• Seasonal gear when needed, such as traction devices
• Vehicle packet: registration, insurance card, and accident and incident forms

Wheelchair lift or ramp

• Lift or ramp runs through one full cycle: deploy, lower, raise, stow
• Vehicle cannot be moved while the lift is deployed (interlock works)
• Platform edge barriers and the outer roll-off barrier raise and hold
• Platform surface is slip resistant and undamaged
• Handrails are tight
• Manual backup works, and the backup handle or tool is on board
• Ramp side barriers intact, and the ramp attaches firmly to the vehicle
• No hydraulic fluid leaks

Wheelchair and stretcher securement

• Four working tiedowns at each wheelchair station, with no frayed webbing
• Retractors lock and hooks close
• A lap and shoulder belt at each wheelchair station
• Floor tracks and anchors clean and free of debris
• Stretcher vans: stretcher fastener latches, plus chest, hip, knee, and shoulder straps

Result and sign-off

Circle one: Pass / Fail, vehicle out of service

What brokers and auditors look for

Brokers check two things: that the vehicle met the equipment list on the day of the audit, and that your drivers actually inspect it every day. The equipment lists come from a few places.

FMCSA defines a commercial motor vehicle as one used in interstate commerce that is rated at or weighs 10,001 pounds or more, or is designed or used to carry more than 8 passengers including the driver for compensation. Many NEMT minivans fall outside that definition. The federal pre-trip list is still a good starting point, and brokers inspect many of the same parts.

State Medicaid programs add NEMT-specific items. Virginia’s list is one of the most detailed:

• Two exterior mirrors and an interior mirror for watching the passenger area
• Heating that reaches 74 degrees and air conditioning that reaches 68 degrees, measured at the rear of the vehicle
• At least one seat belt extension (two in older vehicles with shorter belts) and a seat belt cutter within the driver’s reach
• A Class A, B, C fire extinguisher within the driver’s reach
• A spill kit and a first aid kit with specific unexpired items
• A vehicle packet with the registration, insurance card, and the broker’s accident and incident forms
• Four working securements and a vehicle-mounted lap and shoulder belt at every wheelchair station

CareOregon adds a flashlight, roadside warning devices, a jack, a spare tire or repair kit, and a bloodborne pathogens spill kit. It also recommends checking fire extinguishers visually every month. After an accident that damages the vehicle, an ASE-certified mechanic has to assess it before it returns to service.

Common mistakes

• Checking every box without looking. A checklist signed at the same minute every morning, with no defects ever found, suggests nobody looked.
• Running on a known defect. Writing “brake noise” in the notes and then driving four trips puts a known safety problem on paper with your name on it.
• Skipping the lift cycle. Lifts fail at the curb with a rider waiting. Cycle it in the lot, before the first pickup.
• Expired first aid supplies and uncharged extinguishers. Both are easy audit findings. Check dates once a month.
• One checklist for two vehicles. Every vehicle a driver operates that day gets its own form.
• Missing paperwork in the glove box. Virginia requires a vehicle packet with the registration, insurance card, and the broker’s incident forms. An expired card or missing forms can fail a broker inspection even when the vehicle is perfect.

For the securement steps drivers follow on every wheelchair ride, use the wheelchair securement checklist. For the ADA rules behind the lift items, see ADA requirements for NEMT vehicles.

Doing the check on the phone

In HealthRide, drivers check out a vehicle at the start of each shift, complete an inspection checklist in the driver app, and record the odometer. Dispatch sees the results right away, including failed inspections, and the checklists are stored with the shift for audits. Vehicle registrations and insurance get expiration reminders on the fleet page.