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Patient transportation business

Update date: April 1, 2021

PDF format

It is in PDF file format, so please print it out and use it.
Note : We recommend using plain paper for printing and A4 or B5 print size.
Thermal paper for thermal printers will not be accepted.

File Download Opens in a new window.Separate Form No. 3 Disinfection Implementation Record Sheet (PDF: 30KB)

File Download Opens in a new window.Separate Form No. 4 Unique Incident Report (PDF: 49KB)

File Download Opens in a new window.Attached Form No. 5 Patient Transport Crew Training Application Form (PDF: 65KB)

File Download Opens in a new window.Appended Form No. 6 Specially Qualified Person Application Form (PDF: 56KB)

File Download Opens in a new window.Attached Form No. 7 Patient Transport Business Certification (Renewal) Application Form (PDF: 53KB)

File Download Opens in a new window.Attached Form No. 9 Notification of vehicle for transporting patients, etc. (PDF: 50KB)

File Download Opens in a new window.Attached Form No. 9-2 Notification of vehicle for transporting patients, etc. (vehicle photo) (PDF: 48KB)

File Download Opens in a new window.Separate Form No. 10 Application for reissuance of certificate of eligibility (PDF: 62KB)

File Download Opens in a new window.Attached Form No. 11 Application for reissuance of patient transport operator/vehicle certification mark (PDF: 46KB)

File Download Opens in a new window.Attached Form No. 12 Notification of Change in Business Content (PDF: 42KB)

File Download Opens in a new window.Attached Form No. 19 Certification Mark Receipt (PDF: 54KB)

Word/Excel format

It is in Word and Excel file format, so please print it out and use it.
Note : We recommend plain paper and print sizes of A4 and B5.
Thermal paper for thermal printers cannot be accepted.

File Download Opens in a new window.Separate Form No. 3 Disinfection Implementation Record Sheet (Excel: 11KB)

File Download Opens in a new window.Separate Form No. 4 Unique Incident Report (Excel: 15KB)

File Download Opens in a new window.Separate Form No. 5 Patient Transport Crew Attendance Application Form (Excel: 15KB)

File Download Opens in a new window.Appended Form No. 6 Specially Qualified Person Application Form (Excel: 14KB)

File Download Opens in a new window.Separate Form No. 7 Patient Transport Business Certification (Renewal) Application Form (Excel: 19KB)

File Download Opens in a new window.Attached Form No. 9 Notification of vehicle for transporting patients, etc. (Excel: 12KB)

File Download Opens in a new window.Attached Form No. 9-2 Notification of vehicle for transporting patients, etc. (vehicle photo) (Excel: 10KB)

File Download Opens in a new window.Separate Form No. 10 Application for reissuance of certificate of eligibility (Excel: 15KB)

File Download Opens in a new window.Attached Form No. 11 Application for reissuance of patient transport operator/vehicle certification mark (Excel: 18KB)

File Download Opens in a new window.Attached Form No. 12 Notification of Change in Business Content (Excel: 18KB)

File Download Opens in a new window.Separate Form No. 19 Certification Mark Receipt (Excel: 20KB)

To open PDF files, you need Adobe Acrobat Reader DC (formerly Adobe Reader).
If you don't have it, you can download it for free from Adobe.
Get Adobe Acrobat Reader DCDownload Adobe Acrobat Reader DC

Inquiries about this page

Inagi City Fire Department Headquarters Police Department
2111 Higashinagumanuma, Inagi City, Tokyo (Inagi Fire Station)
Phone: 042-377-7119 Fax: 042-377-0119

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Inagi City Hall

2111 Higashinagumanuma, Inagi City, Tokyo 206-8601
Office hours: 8:30 a.m. to 5:00 p.m. Main phone: 042-378-2111 Fax: 042-377-4781
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