Patient transportation business
Last updated: 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.
Separate Form No. 3 Disinfection Implementation Record Sheet (PDF: 30KB)
Separate Form No. 4 Unique Incident Report (PDF: 49KB)
Attached Form No. 5 Patient Transport Crew Training Application Form (PDF: 65KB)
Appended Form No. 6 Specially Qualified Person Application Form (PDF: 56KB)
Attached Form No. 7 Patient Transport Business Certification (Renewal) Application Form (PDF: 53KB)
Attached Form No. 9 Notification of vehicle for transporting patients, etc. (PDF: 50KB)
Attached Form No. 9-2 Notification of vehicle for transporting patients, etc. (vehicle photo) (PDF: 48KB)
Separate Form No. 10 Application for reissuance of certificate of eligibility (PDF: 62KB)
Attached Form No. 11 Application for reissuance of patient transport operator/vehicle certification mark (PDF: 46KB)
Attached Form No. 12 Notification of Change in Business Content (PDF: 42KB)
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.
Separate Form No. 3 Disinfection Implementation Record Sheet (Excel: 11KB)
Separate Form No. 4 Unique Incident Report (Excel: 15KB)
Separate Form No. 5 Patient Transport Crew Attendance Application Form (Excel: 15KB)
Appended Form No. 6 Specially Qualified Person Application Form (Excel: 14KB)
Separate Form No. 7 Patient Transport Business Certification (Renewal) Application Form (Excel: 19KB)
Attached Form No. 9 Notification of vehicle for transporting patients, etc. (Excel: 12KB)
Attached Form No. 9-2 Notification of vehicle for transporting patients, etc. (vehicle photo) (Excel: 10KB)
Separate Form No. 10 Application for reissuance of certificate of eligibility (Excel: 15KB)
Attached Form No. 11 Application for reissuance of patient transport operator/vehicle certification mark (Excel: 18KB)
Attached Form No. 12 Notification of Change in Business Content (Excel: 18KB)
Separate Form No. 19 Certification Mark Receipt (Excel: 20KB)
Inquiries regarding this page
Inagi City Fire Department Headquarters Police Department Phone: 042-377-7119