Inspection Checklist
| Does the vehicle comply with the following requirements? | Yes | No |
|---|---|---|
| Clean interior and exterior | ||
| Properly functioning speedometer and odometer | ||
| Properly functioning air conditioning, heater and defroster | ||
| Smoking prohibition use notice posted in vehicle interior, easily visible to the passenger(s) | ||
| Vehicle inspection up to date | ||
| Ability to properly secure child safety seats, when provided by an enrollee or caregiver | ||
| Sufficiently stocked with personal protective equipment in accordance with OSHA Standards |
I attest that this vehicle meets all the policies for transporting Medicaid enrollees. Furthermore, all items above are a true and accurate summary of the vehicle's condition.