NEMT Vehicle Inspection Checklist: A Free Daily Pre-Trip Form

Federal Medicaid law sets a few rules for NEMT drivers but no vehicle standards of its own. CMS says in its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) that vehicle standards generally come from state agencies. States and brokers fill that gap, and several require a written inspection before a van carries riders. This form covers what they check, plus the lift, ramp, and securement parts federal ADA rules require you to keep working.

How to use this template

1. Inspect before the first ride. Do it at the yard, in good light, before the van leaves. As of September 2026, Minnesota requires a daily visual safety inspection from NEMT providers, and Wisconsin requires one at least every 7 days for specialized medical vehicles.
2. Use one form per van, per day. If a driver switches vans mid-shift, the second van gets its own form. Federal rules for commercial vans work the same way: one report for each vehicle driven.
3. Write the date and odometer first. Minnesota’s record must show the date and mileage of each inspection. The same reading can start the day’s trip log.
4. Check every line. Mark each item OK or Fix. Write “N/A” on lines that do not apply, such as the lift section on a sedan. A blank line looks like a skipped check.
5. Run the lift or ramp through a full cycle. Lower it to the ground, raise it to floor height, and stow it. Then do the daily checks in the lift maker’s manual. Minnesota requires lifts to be kept up the way that manual says. For the full lift record, use the wheelchair lift inspection log.
6. Stop on any safety defect. A van with a bad brake, tire, light, lift, or tie-down carries no riders until it is fixed. Minnesota and Wisconsin both require the repair first. Call dispatch right away so the day’s trips can move to another van.
7. Write down the repair. Record what was fixed, who fixed it, and when, on the same form. Then copy it into your vehicle maintenance log.
8. File the forms. Keep them as long as the longest rule that applies to you. The table at the end of this page lists the common ones.

The template

Part 1: Van and inspection details

Field	Write the entry here in pen
Date (mm/dd/yyyy) and time
Driver’s printed name
Vehicle or fleet number
Plate number and state
Vehicle type (sedan, minivan, wheelchair van, stretcher van)
Odometer reading
Fuel level
State or broker inspection sticker current (yes or no, date due)

Part 2: Walk-around and driving safety

Item	What to check	OK	Fix
Service brakes	Pedal firm, no pulling or grinding
Parking brake	Holds the van on a slope
Steering	No looseness, no warning light
Headlights, turn signals, brake lights, flashers	All work, lenses not cracked
Reflectors and clearance lights	In place and clean
Interior and lift door lights	All work
Tires	Pressure on the door label, at least 1/8 inch of tread, no cuts or bulges
Wheels and lug nuts	No loose or missing nuts, no cracked rims
Horn	Works
Wipers and washer fluid	Wipers clear the glass, fluid filled
Windshield and mirrors	No cracks, clean, both outside mirrors and the inside mirror in place
Dash warning lights	None on after start
Leaks	No fresh fluid under the van
Heat and air conditioning	Both work
Doors and windows	Open, close, and latch
Seats and seat belts	Seats bolted down, every belt latches and releases, belts off the floor

Part 3: Wheelchair lift or ramp (N/A if none)

Item	What to check	OK	Fix
Full cycle	Deploys to the ground, rises to the floor, stows, no odd noise or jerking
Interlock	Van cannot move while the lift is out
Controls	Every button works and stops when released
Manual backup	Pump handle or backup device on board and working
Roll-off barriers	Outer barrier rises, side edges in place
Platform	Slip-resistant surface, no bent edges, edge stripe visible
Handrails	Both tight
Hydraulics, cables, bolts	No leaks, frays, or loose bolts
Ramp, if equipped	Surface intact, side edges in place, locks to the van, stows secured

Part 4: Securement stations (N/A if none)

Item	What to check	OK	Fix
Tie-downs	Four at each station, each locks and releases, straps not frayed or cut
Floor track or anchors	Clean, fittings click in and hold
Lap and shoulder belt	One set at each station, latches and releases
Belt extenders	On board
Strap or belt cutter	Within the driver’s reach
Stretcher, if carried	Mount locks, every strap buckles, mattress intact

Part 5: Safety equipment on board

Item	What to check	OK	Fix
Fire extinguisher	Mounted within reach, gauge in the charged zone, tag current
First aid kit	Sealed or restocked
Body fluid or spill kit	Absorbent, gloves, waste bags, disinfectant
Disposable gloves	Non-latex, on board
Flashlight	Works
Warning triangles	Three, clean
Phone or radio	Charged, in a hands-free mount
Hand sanitizer and cleaning supplies	On board
Blanket, ice scraper, traction devices	As the season and your state require
Spare tire or tire repair kit, and a jack	On board
Spare fuses	On board if the fuse box is inside the van

Part 6: Papers, signs, and cleanliness

Item	What to check	OK	Fix
Registration and insurance card	In the van, not expired
Accident and incident forms	In the van
Company name on both sides	Readable, with any number your state requires
No smoking and seat belt signs	Posted inside
Broker phone numbers and complaint steps	Posted where your broker requires
Interior	Clean, dry floor, no tripping hazards, loose items tied down

Part 7: Sign-off

Field	Write the entry here in pen
Defects found (describe each)
Safe to carry riders today (yes or no)
Dispatch told (time and name)
Repair made (what, by whom, date)
Repair checked by (name and signature)
Driver signature

Which rule each item meets

No single rule lists every item on this form. The table shows the rule behind each item that has one, using states and brokers with clear written rules. Compare it with your own state rules and broker manual, and add anything they ask for.

Item	Where it is required
Brakes, parking brake, steering, lights and reflectors, tires, horn, wipers, mirrors, emergency equipment	Minnesota daily inspection list; the federal daily report list for commercial vans, which adds wheels, rims, and coupling devices
Lifts, ramps, and wheelchair or stretcher securement	Minnesota daily inspection list; Wisconsin inspection list; federal ADA rules (keep them working); Arizona (lifts and restraints kept safe)
At least 1/8 inch of tread, no cracked windshield or mirrors	Wisconsin
Seats bolted down, a belt for every seat, belts off the floor	Minnesota; MTM Health in Virginia; CareOregon
Doors and windows open and close as designed	Minnesota; Wisconsin
Heat and air conditioning	Minnesota (must work); Wisconsin; MTM Health in Virginia (about 68 degrees cooling and 74 degrees heating, measured from the rear)
Four tie-downs, a working interlock, and a lap and shoulder belt at each wheelchair station	MTM Health in Virginia; the lap and shoulder belt also in federal ADA design rules
Lift interlock, manual backup, barriers, and a contrasting platform edge	Federal ADA design rules
Lights at the lift door, inside and out	Federal ADA design rules
Fire extinguisher	Minnesota (dry chemical, at least 5B:C, with a gauge, mounted in a bracket in vans); MTM Health in Virginia (Class A, B, C, within reach); CareOregon; Wisconsin
First aid kit	Minnesota (dust-proof, labeled “FIRST AID,” with gauze pads, roll bandages, tape, and scissors); MTM Health in Virginia; CareOregon; Wisconsin
Body fluid or spill kit	Minnesota; MTM Health in Virginia (absorbent, gloves, waste bags, brush, disinfectant, deodorizer); CareOregon
Flashlight	Minnesota; CareOregon; Wisconsin
Warning triangles	Minnesota (three); CareOregon (roadside reflective or warning devices)
Strap or belt cutter	Minnesota (no exposed sharp edge); MTM Health in Virginia; CareOregon
Seat belt extenders	Minnesota (when needed); MTM Health in Virginia (at least two); MTM Health’s standard agreement; CareOregon
Disposable gloves	CareOregon (non-latex)
Hand sanitizer and cleaning supplies	MTM Health in Virginia
Two-way communication	Minnesota (hands-free if a phone); MTM Health’s standard agreement
Blanket, ice scraper, traction devices	Minnesota (blanket always, ice scraper October 1 to April 30); CareOregon (traction devices when needed, seasonal equipment)
Spare fuses	Minnesota (vehicles with a fuse box inside)
Spare tire or tire repair kit, and a jack	CareOregon
Company name on both sides	Minnesota (with the USDOT number, readable from 50 feet); MTM Health in Virginia (name and phone, letters at least 3 inches high); Arizona (company sign or logo)
No smoking sign	Minnesota; MTM Health in Virginia; MTM Health’s standard agreement
Registration, insurance card, accident and incident forms or steps	MTM Health in Virginia; CareOregon
Clean interior, no tripping hazards	Minnesota; CareOregon

For the full rules on each vehicle type, see NEMT vehicle requirements. For the kit itself, use the first aid kit checklist.

State and broker rules that set the schedule

Minnesota. Minnesota Statutes 256B.0625 requires every NEMT provider to follow the state’s special transportation service rules, except public transit, volunteers, and not-for-hire vehicles. Those rules (Minnesota Rules chapter 8840, as of September 2026) require a daily visual safety inspection of 11 items. The record must show the date, the mileage, and the repairs needed, on the state’s form or one with the same information. Any defect that might affect safe operation must be fixed before the vehicle goes into service. MnDOT inspects each vehicle at least once a year and can inspect without notice.

Wisconsin. A specialized medical vehicle must be inspected, and the inspection written down, at least every 7 days by an assigned driver or mechanic (DHS 105.39, as of September 2026). The list covers every light, the brakes, steering and suspension, heater and defroster, air conditioning, doors, lifts and ramps, wheelchair locks, and restraints. Deficiencies must be fixed before any rider is carried, and the driver documents the fix.

MTM Health in Virginia. Its handbook (May 2026, approved August 10, 2026) requires every vehicle to be inspected before it carries members and again twice a year. Each inspected van gets a sticker on the outside of the rear passenger side window that shows pass, in process, or fail. Vehicles out of compliance can be removed from service until they are fixed. Wheelchair vans that take hospital discharges must also carry a wheelchair with a seat at least 20 inches wide.

CareOregon. Its manual (version 1.3, February 2024) requires a safety inspection by an ASE-certified mechanic within the last year and a yearly ADA compliance certification for wheelchair vans. It recommends checking each fire extinguisher by eye every month, and at least once a year, to confirm it is charged and works. After an accident or other incident that damages the vehicle, an ASE-certified mechanic must check it before it returns to service.

Arizona. The AHCCCS fee-for-service manual (revised July 31, 2026) requires wheelchair vans to have lifts that safely load and unload riders, restraints that hold the wheelchair in transit, and safety features kept up as needed.

What federal ADA rules require for lifts, ramps, and securement

Federal ADA rules apply to public and private transportation companies alike. Under 49 CFR 37.161, you must keep lifts, securement devices, and other access features working, and repair them promptly. While a feature is out of order, you must take reasonable steps to serve the riders who need it.

The stricter lift rule in 49 CFR 37.163 applies to public entities. They must run regular and frequent lift checks, have drivers report a lift failure by the fastest means available, and take the van out of service before its next service day. A private company that runs demand response rides under contract with a public entity is held to the same rules (49 CFR 37.23).

The design rules in 49 CFR 38.23 tell you what a working lift and station look like:

• Lift strength. The lift is built for at least 600 pounds.
• Interlock. The van cannot move while the lift is not stowed.
• Backup. An emergency method must lower an occupied lift to the ground and stow the empty lift if power fails.
• Barriers. Side barriers are at least 1 1/2 inches high, and the outer barrier stays raised whenever an occupied platform is more than 3 inches off the ground.
• Ramps. Side barriers are at least 2 inches high, and the ramp attaches firmly to the van while in use.
• Securement. A secured wheelchair moves no more than 2 inches in any direction, and each station has its own lap belt and shoulder harness.

Under 49 CFR 37.165, your driver must help riders with lifts, ramps, and securement when needed or asked. You must carry a rider in a wheelchair when the lift and van can hold the chair and rider together, and you may not refuse a ride because the chair cannot be secured to your satisfaction. Drivers must be trained to use the equipment safely (49 CFR 37.173). See wheelchair securement for the steps at each station.

If federal commercial vehicle rules cover your vans

Federal motor carrier rules cover a van used in interstate commerce that is rated at 10,001 pounds or more, or is designed or used to carry more than 8 people, driver included, for pay (49 CFR 390.5T). The same rules list exceptions, including “the transportation of human corpses or sick and injured persons” (49 CFR 390.3T). Ask FMCSA whether that exception covers your trips before you count on it. For the full test, see FMCSA vehicle inspection rules and rural NEMT.

When they apply, as of September 2026:

• Before driving, the driver must be satisfied the van is in safe operating condition (49 CFR 396.13).
• At the end of each day’s work, the driver writes a report on each van driven if a defect was found or reported. It covers brakes, parking brake, steering, lights and reflectors, tires, horn, wipers, mirrors, wheels and rims, emergency equipment, and coupling devices (49 CFR 396.11). A company that runs only one commercial van is exempt.
• Before the van runs again, the company repairs any safety defect and certifies the repair on the report.
• Once a year, each van passes a periodic inspection, with proof carried on the van (49 CFR 396.17).

How long to keep inspection records

Rule	How long
Minnesota Rules 8840.6100 (daily safety inspection records)	3 months
Minnesota Rules 8840.6100 (maintenance and other records under chapter 8840)	At least 3 years
Wisconsin DHS 105.39 (inspection and repair records)	At least 12 months
49 CFR 396.11 (driver vehicle inspection reports, commercial vans)	3 months
49 CFR 396.3 (inspection, repair, and maintenance records, commercial vans)	1 year, and 6 months after the van leaves your fleet

The longest rule that applies to you wins. Broker contracts can add their own. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, asks providers to keep full records of their operations for 10 years and allows unannounced inspections. For routine service schedules, see NEMT vehicle maintenance.