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Opr-non-transport-inspection-form-provider-050516.pdf 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your Provider Number, Address, City/State/Zip, Phone Number, and Contact E-mail in the designated fields at the top of the form.
- Specify the Location/Address and Vehicle Type or Stationary Unit. Indicate the Level of Care by selecting from ALS, ILS, BLS, or FR options.
- Fill in the V.I.N. if applicable and select whether this is an Initial inspection or Annual review. Check any relevant boxes for Issue License or Self Inspection.
- Review the Equipment section carefully. Ensure all items listed are checked off as compliant and provide comments if necessary.
- Sign and date where indicated for Pre-Hospital Care Provider/Owner or Representative, Illinois Department of Public Health Representative, and EMS System Coordinator.
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