1830 Weekly

• 1830 Weekly Check

• Conducted on

  Date

• Personnel Checking Vehicle

• Vehicle Miles:

• Vehicle Hours:

CAB

• Portable Radios ( 2 )

  YES

  NO

• Comments:

• iPad Charged ( >75% )

  YES

  NO

• Comments:

• Gloves ( 1XL, 1L, 1M )

  YES

  NO

• Comments:

• Knox Box & Mabas Keys

  YES

  NO

• Comments:

• Safety Vests ( 2 )

  YES

  NO

• Comments:

• ERG Book

  YES

  NO

• Comments:

• Maps ( FRC, County, South Elgin )

  YES

  NO

• Comments:

• Garage Openers ( Station 3, Delnor, & St. Joes )

  YES

  NO

• Comments:

CLIPBOARD

• IF SHEETS ARE LOW PLEASE PRINT THEM OUT AND THEN HIT YES!

• 10 Run Sheets

  YES

  NO

• 10 Hippa Forms

  YES

  NO

• 10 AMA/Refusal Forms

  YES

  NO

• 10 Multiple Release Forms

  YES

  NO

• 5 EMS Rehab Forms

  YES

  NO

• 5 School Bus Form

  YES

  NO

• 1 Involuntary Form

  YES

  NO

MISC.

• Cab Vacuumed & Cleaned Out

  YES

  NO

• Comments:

• Additional Comments:

Exterior Cabinet #1

• Pressurized Water Can

  YES

  NO

• Comments:

• 6' Pike Pole

  YES

  NO

• Comments:

• O2 Bottle

  YES

  NO

• Comments:

• Peds Hare Traction

  YES

  NO

• Comments:

• Adult Hare Traction

  YES

  NO

• Comments:

• Air splints ( 1L, 1M, 1S, & Pump )

  YES

  NO

• Comments:

• KED

  YES

  NO

• Comments:

• Broom ( 1 )

  YES

  NO

• Comments:

Exterior Cabinet #2

• Body Bag

  YES

  NO

• Comments:

• Wool Blanket

  YES

  NO

• Comments:

• Transfer Tarp

  YES

  NO

• Comments:

• Safety Blanket

  YES

  NO

• Comments:

• Throw Bag

  YES

  NO

• Comments:

• Noodle

  YES

  NO

• Comments:

• Water Fins

  YES

  NO

• Comments:

• Life Vest

  YES

  NO

• Comments:

• Spare Cot Straps

  YES

  NO

• Comments:

• Water Bottles

  YES

  NO

• Comments:

Exterior Cabinet #3

• SCBA ( 2 ) :<br>Everything in working order. Bottle full w/ no leaks

  YES

  NO

• SCBA ( A ) P.S.I. :

• SCBA ( B ) P.S.I. :

• SCBA A Pressure

• SCBA B Pressure

• Comments:

• Flashlights ( 2 ):<br>Both work

  Working

  Needs Repair

• Comments:

• Irons ( 1 halligan & 1 flat head axe )

  YES

  NO

• Comments:

• Bolt Cutters

  YES

  NO

• Comments:

• Passport Boards (Red & White)

  YES

  NO

• Comments:

• 3-Helmet Shields

  YES

  NO

• Comments:

Exterior Cabinet #4

• Scoop Stretcher:<br>Clean and in working order

  Working

  Needs Repair

• Comments:

• Backboards w/ Straps:<br>1 w/ spider straps, 1 w/ seat-belts, 1 blank. All clean

  YES

  NO

• Comments:

• Child Car Seat

  YES

  NO

• Comments:

• C-Collar Bag

• Adult Collars ( 2 )

  YES

  NO

• PEDS/Infant Collars ( 3 )

  YES

  NO

• Baby No Neck Collar

  YES

  NO

• Adult Head Immobilizers ( 2 )

  YES

  NO

• PEDS/Infant Head Immobilizer ( 1 )

  YES

  NO

• Adult Head Immobilizers ( 2 )

  YES

  NO

• Comments:

• Child Head Immobilizers ( 2 )

  YES

  NO

• Comments:

• Peds Backboard:<br>Clean w/ all straps

  YES

  NO

• Comments:

• Stair Chair:<br>Chair in working order and clean

  Working

  Needs Repair

• Comments:

• Extra Spider Straps

  YES

  NO

• Comments:

• Additional Comments:

Interior Cabinet #1

• BVM

• Adult ( 1 )

  YES

  NO

• Comments:

• Adult CO2 Detector ( 1 )

  YES

  NO

• Comments:

• Exp. Date:

• Exp. Date:

• Child ( 1 )

  YES

  NO

• Comments:

• PEDS CO2 Detector ( 1 )

  YES

  NO

• Comments:

• Exp. Date:

• Exp. Date:

• Infant ( 1 )

  YES

  NO

• Comments:

• Infant CO2 Detector ( 1 )

  YES

  NO

• Comments:

• Exp. Date:

• Exp. Date:

• Pocket Mask

  YES

  NO

• Comments:

• Sterile Water ( 2000mL )

  YES

  NO

• Comments:

• Exp. Dates:

• Sodium Chloride ( 2000mL )

  YES

  NO

• Comments:

• Exp. Dates:

Interior Cabinet #2

• 1 Nebulizer tx w/ 1 Albuterol & 1 Atrovent

  YES

  NO

• Albuterol Dates:

• Atrovent Dates:

• Comments:

• Atrovent Dates:

• Albuterol Dates:

• 1 Inline Nebulizer Kit w/ 1 Albuterol & 1 Atrovent

  YES

  NO

• Albuterol Dates:

• Atrovent Dates:

• Comments:

• Albuterol Dates:

• Atrovent Dates:

• Saline Packets ( 6 )

  YES

  NO

• Exp. Dates:

• Comments:

• Oxygen Tubing ( 1 )

  YES

  NO

• Comments:

• Adult Nasal Cannula ( 3 )

  YES

  NO

• Comments:

• Adult NRB ( 3 )

  YES

  NO

• Comments:

• Peds NRB ( 3 )

  YES

  NO

• Comments:

• Peds Nasal Cannula ( 3 )

  YES

  NO

• Comments:

• Infant NRB ( 3 )

  YES

  NO

• Comments:

• Infant Nasal Cannula ( 3 )

  YES

  NO

• Comments:

Interior Cabinet #3

• Triage Tags ( 1 set )

  YES

  NO

• Comments:

• Drug Tags ( 1 bag )

  YES

  NO

• Comments:

• Rubberbands ( 1 bag )

  YES

  NO

• Comments:

Action Area

• Cell phone with charger

  YES

  NO

• Comments:

• Stethoscope

  YES

  NO

• Comments:

• Calculator

  YES

  NO

• Comments:

• St Joes SMO Protocol book

  YES

  NO

• Comments:

Captains Chair Compartment

• Safety Vest ( 1 )

  YES

  NO

• Comments:

• Portable Radio

  YES

  NO

• Comments:

Suction Drawer 1

• 2- 8fr suction catheters

  YES

  NO

• Comments:

• 2- 10fr suction catheters

  YES

  NO

• Comments:

• 2- 12fr suction catheters

  YES

  NO

• Comments:

• 2- 16fr suction catheters

  YES

  NO

• Comments:

• 2- 18fr suction catheters

  YES

  NO

• Comments:

Suction Drawer 2

• 3- Suction Tubing

  YES

  NO

• Comments:

• 3- Yankauers

  YES

  NO

• Comments:

• 1- Manual Suction with canister and assorted tips

  YES

  NO

• Comments:

Onboard Suction

• 1- Suction Canister

  YES

  NO

• Comments:

• 1- Suction Tubing

  YES

  NO

• Comments:

• 1- Yankauer

  YES

  NO

• Comments:

SUCTION TESTED TO 300 mmhg

Interior Cabinet #4

• Stethoscope w/ Accessories ( 1 )

  YES

  NO

• Comments:

• Multi Cuff BP Bag

• 1 Adult

  YES

  NO

• Comments:

• 1 Large Adult

  YES

  NO

• Comments:

• 1 Child

  YES

  NO

• Comments:

• 1 Infant

  YES

  NO

• Comments:

• 1 Thigh

  YES

  NO

• Comments:

• Gauge ( 1 )

  YES

  NO

• Comments:

• Spare Child BP Cuffs ( 2 )

  YES

  NO

• Amount:

• 1 Stethoscope

  YES

  NO

• Amount:

• 1 Bag of Extra Pieces For Stethoscope

  YES

  NO

• Amount:

Interior Cabinet #5

• Garbage Bags, Soil Linen Bags & Bio Bags

  YES

  NO

• Comments:

Interior Cabinet #6

• N95 Masks ( 5 )

  YES

  NO

• Comments:

• Safety Glasses ( 3 )

  YES

  NO

• Comments:

• Face Shields ( 5 )

  YES

  NO

• Comments:

Interior Cabinet #7

• Adult EtCO2 Cannulas ( 2 )

  YES

  NO

• Comments:

• Adult EtCO2 Tube Connectors ( 2 )

  YES

  NO

• Comments:

• Peds Electrodes minimum of 24

  YES

  NO

• Comments:

• Adult Electrodes minimum of 24

  YES

  NO

• Comments:

• EKG Paper ( 2 )

  YES

  NO

• Comments:

• Adult Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Peds Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

Interior Cabinet #8

• Baby Bottle ( 1 )

  YES

  NO

• Comments:

• OB Kit ( 1 )

  YES

  NO

• Comments:

• Baby Bunting Foil ( 2 )

  YES

  NO

• Comments:

• Survival Wrap

  YES

  NO

• Comments:

Interior Cabinet #9

• Emesis Basin, Wash Basin, Towel & Urinal

  YES

  NO

• Comments:

Interior Cabinet #10

• Soft Restraints ( 2 sets )

  YES

  NO

• Comments:

• Towels ( 3 )

  YES

  NO

• Comments:

• Hand Sanitizer

  YES

  NO

• Comments:

• Cleaning Supplies

  YES

  NO

• Comments:

Interior Cabinet #11

• Non PEDS Arm Slings or Triangle Bandages 5 Total

  YES

  NO

• Comments:

• Peds Slings ( 2 )

  YES

  NO

• Comments:

• SAM Splints ( 3 )

  YES

  NO

• Comments:

• ACE Wraps ( 4 )

  YES

  NO

• Comments:

• Kling Rolls ( 10 )

  YES

  NO

• Comments:

• 4x4 Gauze ( 20 )

  YES

  NO

• Comments:

• Eye Pads ( 2 )

  YES

  NO

• Comments:

• Tape ( 4 )

  YES

  NO

• Comments:

• Vaseline Gauze ( 2 )

  YES

  NO

• Comments:

• Arm Board ( 2 long/2 small )

  YES

  NO

• Comments:

• Trauma Shears ( 1 )

  YES

  NO

• Comments:

• Occlusive Dressing ( 2 )

  YES

  NO

• Comments:

Interior Cabinet #12

• Trauma Dressing ( 5 )

  YES

  NO

• Comments:

• Burn Sheet ( 1 )

  YES

  NO

• Comments:

• Aluminum Foil ( 1 )

  YES

  NO

• Comments:

• Isolation Kits ( 5 )

  YES

  NO

• Comments:

• Cold Packs ( 3 )

  YES

  NO

• Comments:

• Hot Packs ( 5 )

  YES

  NO

• Comments:

Bench

• Mustang Suit w/ Ice Boots

  YES

  NO

• Comments:

• 150' Water Rescue Rope w/ Carabiners ( 1 )

  YES

  NO

• Comments:

• Wool Blanket ( 1 )

  YES

  NO

• Comments:

• Pillows ( 2 )

  YES

  NO

• Comments:

• Umbrella ( 1 )

  YES

  NO

• Comments:

Interior Cabinet 13

• CPAP ( O2 Bottle, Tubing, Mask w/ Filter, and Regulator )

  YES

  NO

• Comments:

• O2 Pressure:

• Portable Suction ( Test Unit To 300)

  YES

  NO

• Comments:

Spare Items

• Oxygen Bottle ( 2 )

  YES

  NO

• Comments:

• Sheets ( 3 )

  YES

  NO

• Comments:

• Blankets ( 3 )

  YES

  NO

• Comments:

• ABC Extinguisher

  YES

  NO

• Comments:

• Box of Gloves - medium (1), Large (2) & X-Large (1)

  YES

  NO

• Comments:

• Additional Comments:

TOP POCKET PEDS BAG

• Pediatric NRB Mask ( 1 )

  YES

  NO

• Comments:

• Pediatric Nasal Cannula

  YES

  NO

• Comments:

• Infant Nasal Cannula

  YES

  NO

• Comments:

• Pediatric Simple Mask

  YES

  NO

• Comments:

LEFT SIDE POCKET PEDS BAG

• Bone Marrow Needle

  YES

  NO

• Comments:

• 1000ml NS IV Bag

  YES

  NO

• Exp. Date:

• Comments:

• IV 10 Drip Tubing

  YES

  NO

• Comments:

• IV Start Kit

  YES

  NO

• Comments:

FRONT SIDE POCKET PEDS BAG

• BP Cuff and Stethoscope

  YES

  NO

• Comments:

• Pen Light

  YES

  NO

• Comments:

• Thermometer

  YES

  NO

• Comments:

RIGHT SIDE POCKET PEDS BAG

• 10ml Syringe

  YES

  NO

• Comments:

• Trauma Shears

  YES

  NO

• Comments:

• Lubricant ( 2 )

  YES

  NO

• Comments:

• Forceps

  YES

  NO

• Comments:

• Laryngoscope Handle with spare batteries

  YES

  NO

• Comments:

• SAM Splint

  YES

  NO

• Comments:

• Saline Flushes ( 2 )

  YES

  NO

• Exp. Dates:

• Comments:

CENTER PEDS BAG

• Pediatric BVM with ETCO2

  YES

  NO

• Exp. Dates:

• Comments

• Infant BVM with ETCO2

  YES

  NO

• Exp. Dates:

• Comments:

• Broselow Tape

  YES

  NO

• Comments:

• 4X4 Gauze ( 2 )

  YES

  NO

• Comments:

• Gauze Rolls and Kling Wrap ( 4 )

  YES

  NO

• Comments:

• Tape

  YES

  NO

• Comments

• Meconium Aspirator

  YES

  NO

• Comments:

• Alcohol Preps ( 5 )

  YES

  NO

• Comments

• Bandaids ( 5 )

  YES

  NO

• Comments:

• ET Tube Holder ( 2 )

  YES

  NO

• Comments:

• Emisis Bag

  YES

  NO

• Comments:

• RED

• 22-24g IV

  YES

  NO

• Comments:

• 3 & 3..5 UC Tube

  YES

  NO

• Comments:

• 14 French NPA

  YES

  NO

• Comments:

• 0-1 Straight Blade

  YES

  NO

• Comments:

• 40-50mm OPA

  YES

  NO

• Comments:

• PURPLE

• 20-24g IV

  YES

  NO

• Comments:

• 4 UC Tube

  YES

  NO

• Comments:

• 18 French NPA

  YES

  NO

• Comments:

• 1 Straight Blade

  YES

  NO

• Comments:

• 50-60mm OPA

  YES

  NO

• Comments:

• YELLOW

• 18-22g IV

  YES

  NO

• Comments:

• 4.5 UC Tube

  YES

  NO

• Comments:

• 20 French NPA

  YES

  NO

• Comments:

• 1-2 Straight Blade

  YES

  NO

• Comments:

• 50-60mm OPA

  YES

  NO

• Comments:

• WHITE

• 18-22g IV

  YES

  NO

• Comments:

• 5 UC Tube

  YES

  NO

• Comments:

• 22 French NPA

  YES

  NO

• Comments:

• 1-2 Straight Blade

  YES

  NO

• Comments:

• 50-60mm OPA

  YES

  NO

• Comments:

• BLUE

• 18-20g IV

  YES

  NO

• Comments:

• 5.5 UC Tube

  YES

  NO

• Comments:

• 24 French NPA

  YES

  NO

• Comments:

• 2 Curved or Straight Blade

  YES

  NO

• Comments:

• 60-70mm OPA

  YES

  NO

• Comments:

• ORANGE

• 18-20g IV

  YES

  NO

• Comments:

• 6 C Tube

  YES

  NO

• Comments:

• 26 French NPA

  YES

  NO

• Comments:

• 2 Curved or Straight Blade

  YES

  NO

• Comments:

• 70-80mm OPA

  YES

  NO

• Comments:

• GREEN

• 16-20g IV

  YES

  NO

• Comments:

• 6.5 C Tube

  YES

  NO

• Comments:

• 30 French NPA

  YES

  NO

• Comments:

• 3 Curved or Straight Blade

  YES

  NO

• Comments:

• 80mm OPA

  YES

  NO

• Comments:

• Additional Comments:

Narcotic Box

• Old Tag Number

• New Tag Number

• 40Mg Etomidate

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• Versed 5MG/5ML Total of 15MG

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• Versed 5MG/1ML Total of 10MG

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• Fentynal 200MCG Total

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

ALS Drug box

• ALS Drugs: PLEASE MAKE SURE TO GET DRUGS EXCHANGED 30 DAYS BEFORE EXPIRATION DATE.

• Aspirin 12-81mg Tablets

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2-Atrovent 0.5mg

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Albuterol 2.5mg

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Amiodarone 150mg Vials

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- 6mg Adenosine Vials

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Benadryl 50 mg

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• 3- Epinephrine 1:1000 1mg/1ml Ampules

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• 2- Glucagon complete dosages

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Magnesium Sulfate 1Gm/2ml Vials

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Nitroglycerine bottle 0.4mg >1/2 full

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Oral Glucose Gel

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Tetracaine bottle

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Vasopressin 20 Unit vial

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Zofran 4mg Vial

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Zofran 4mg Tablet

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• Alcohol Prep Pads

  YES

  NO

• Comments:

• MAD Device ( 2 )

  YES

  NO

• Comments:

ALS drugs box lower

• 1- Dopamine 400mg in 250ml IV bag with ( 3 ) 60 Drip Tubing

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• Filter Straws ( 2 )

  YES

  NO

• Comments:

• Filter Needle ( 2 )

  YES

  NO

• Comments:

• 1ml Syringe ( 2 )

  YES

  NO

• Comments:

• 3 or 6 mL Syringe ( 2 )

  YES

  NO

• Comments:

• 10 or 12 mL Syringe ( 2 )

  YES

  NO

• Comments:

• 20mL Syringe (1)

  YES

  NO

• Comments:

• 60mL Syringe ( 1 )

  YES

  NO

• Comments:

• Carpoject ( 1 )

  YES

  NO

• Comments:

• Needles

• 18g (2)

  YES

  NO

• Comments:

• 21g or 22g (2)

  YES

  NO

• Comments:

• 25g (2)

  YES

  NO

• Comments:

• 0.9% NaCL Solution 10ml Flush ( 4 )

  YES

  NO

• Exp. Date:

• Comments:

• Expiration Dates:

ALS drugs in drawer

• 5-Atropine 1mg Preload

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Dextrose 50% 50ml/25 Gm

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• 6- Epinephrine 1:10,000 1mg Preload

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 4-Lidocaine 100mg/5ml Preload

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2-Narcan 2mg/2ml

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- 50mEq Sodium Bicarbonate w/ 60mL Syringe and Needle ( 1 )

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

ALS Drug Drawer equipment

• Alcohol Preps ( 1 box )

  YES

  NO

• Comments:

• Spare Test Strips ( 1 box )

  YES

  NO

• Comments:

• Spare Lancets

  YES

  NO

• Comments:

• Additional Comments:

IV Cabinet

• IV Tubing ( 2 )

  YES

  NO

• Comments:

• IV Start Kit ( 2 )

  YES

  NO

• Comments:

• Tape ( 2 )

  YES

  NO

• Comments:

• IV Catheters

• 14g IV ( 1 )

  YES

  NO

• Comments:

• 16g IV ( 1 )

  YES

  NO

• Comments:

• 18g IV ( 2 )

  YES

  NO

• Comments:

• 20g IV ( 2 )

  YES

  NO

• Comments:

• 22g IV ( 2 )

  YES

  NO

• Comments:

• 24g IV ( 2 )

  YES

  NO

• Comments:

• IV Bags ( 4 )

  YES

  NO

• Comments:

• Pressure Infuser ( 1 )

  YES

  NO

• Comments:

• Additional Comments:

ZOLL Monitor

• Tested Monitor

  YES

  NO

• Comments:

• Adult Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Peds Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Defib Test Cord ( 1 )

  YES

  NO

• Comments:

• Adult Electrodes minimum of 12

  YES

  NO

• Comments:

• Peds Electrodes minimum of 12

  YES

  NO

• Comments:

• Spare Battery ( 1 ): Rotate battery

  YES

  NO

• Comments:

• 4 Lead Cables ( 1 ): Cleaned & Wrapped Up

  YES

  NO

• Comments:

• 12 Lead Cables ( 1 ): Cleaned & Wrapped Up

  YES

  NO

• Comments:

• Razor ( 1 )

  YES

  NO

• Comments:

• CO2 ET Tube Connecter ( 1 )

  YES

  NO

• Comments:

• CO2 Nasal Monitor ( 2 )

  YES

  NO

• Comments:

• SPO2 Sensor ( 1 )

  YES

  NO

• Comments:

• Infant SPO2 Sensor ( 2 )

  YES

  NO

• Comments:

Top Pocket

• NRB Mask ( 1 )

  YES

  NO

• Comments:

• Nasal Cannula ( 1 )

  YES

  NO

• Comments:

• Neb TX w/ 1 Albuterol & 1 Atrovent ( 1 kit )

  YES

  NO

• Albuterol Exp. Date:

• Atrovent Exp. Date:

• Comments:

• Albuterol Exp. Date:

• Atrovent Exp. Date:

Left Side Pocket

• Adult BVM w/ CO2 Monitor ( 1 )

  YES

  NO

• Exp. Date:

• Comments:

Right Side Pocket

• Blood Pressure Cuff ( 1 adult )

  YES

  NO

• Comments:

• SPO2 Monitor

  YES

  NO

• Comments:

• Stethoscope ( 1 )

  YES

  NO

• Comments:

• Glucometer Case

• Glucometer ( Make sure it is working )

  YES

  NO

• Comments:

• Test Strips ( 5 )

  YES

  NO

• Comments:

• Lancets ( 5 )

  YES

  NO

• Comments:

• Alcohol Preps ( 5 )

  YES

  NO

• Comments:

• Bandaids ( 5 )

  YES

  NO

• Comments:

Front Pocket

• Tape ( 3 total w/ 1 paper )

  YES

  NO

• Comments:

• Thermometer ( w/ covers )

  YES

  NO

• Comments:

• 1- Trauma Dressing

  YES

  NO

• Comments:

• 1- Burn Sheet

  YES

  NO

• Comments:

• 1- SAM Splint

  YES

  NO

• Comments:

• 2-Kling Rolls

  YES

  NO

• Comments:

• 1- 4 X 4 Tray <br>

  YES

  NO

• Comments:

• 1- Ice Pack

  YES

  NO

• Comments:

• 500mL Sterile Water ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Trauma Shears ( 1 )

  YES

  NO

• Comments:

• 1- Pen Light

  YES

  NO

• Comments:

• Ring Cutter

  YES

  NO

• Comments:

Zipper Area in Front Pouch

• Large Gloves

  YES

  NO

• Comments:

• XL Gloves

  YES

  NO

• Comments:

CENTER OF JUMP BAG

Center Compartment Clear Flap

• King Tubes

• Size 3 ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Size 4 ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Size 5 ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• 1- Pressure Infuser

  YES

  NO

• Comments:

• Intubation Kit

• Miller Laryngoscope Blades ( 3 ): Put Blade on handle to make sure light works

  YES

  NO

• Comments:

• Mac Laryngoscope Blades ( 3 ): Put Blades on handle to make sure light works

  YES

  NO

• Comments:

• Lubricant Packets ( 2 )

  YES

  NO

• Comments:

• Tube Holders ( 2 )

  YES

  NO

• Comments:

• 10ml Syringe ( 1 )

  YES

  NO

• Comments:

• Benzocaine ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Forceps ( 2 )

  YES

  NO

• Comments:

• Stylets ( 1s, 1m, 1L )

  YES

  NO

• Comments:

• Nasopharyngeal ( 1 each of sizes 12-34 )

  YES

  NO

• Comments:

• Oropharyngeal ( 5 )

  YES

  NO

• Comments:

• Tape ( 1 )

  YES

  NO

• Comments:

• Surgical Masks ( 2 )

  YES

  NO

• Comments:

• Spare Batteries ( 2 C )

  YES

  NO

• Comments:

Cric & Needle Decompression kit

• 14g IV ( 2 )

  YES

  NO

• Comments:

• Alcohol Preps ( 5 )

  YES

  NO

• Comments:

• Scalpel

  YES

  NO

• Comments:

• 3.0 ET Un-cuffed Tube

  YES

  NO

• Comments:

Check ET Tube expiration dates

• ET Tubes

• 5.0

  YES

  NO

• Comments:

• 5.5 ( 1 )

  YES

  NO

• Comments:

• 6.0 ( 1 )

  YES

  NO

• Comments:

• 6.5 ( 1 )

  YES

  NO

• Comments:

• 7.0 ( 1 )

  YES

  NO

• Comments:

• 7.5 ( 2 )

  YES

  NO

• Comments:

• 8.0 ( 2 )

  YES

  NO

• Comments:

• 8.5 ( 1 )

  YES

  NO

• Comments:

• 9.0 ( 1 )

  YES

  NO

• Comments:

IV Pouch

• IV Catheters

• 14g IV

  YES

  NO

• Comments:

• 16g IV ( 1 )

  YES

  NO

• Comments:

• 18g IV ( 2 )

  YES

  NO

• Comments:

• 20g IV ( 2 )

  YES

  NO

• Comments:

• 22g IV ( 1 )

  YES

  NO

• Comments:

• 24g IV ( 1 )

  YES

  NO

• Comments:

• 1- Saline Bag

  YES

  NO

• Comments:

• 1- 10 Drop Tubing

  YES

  NO

• Comments:

• 2- IV Start Kit

  YES

  NO

• Comments:

• 1-Sharps Shuttle

  YES

  NO

• Comments:

ALS Drug Box

• ALS Drug Box

• Old Drug Tag Number

  Yes

  No

  N/A

• Comments:

• New Drug Tag Number

  Yes

  No

  N/A

• Comments:

Center Zipper Compartment

• 2 Adult EZ-IO Needles

  YES

  NO

• EXP:

• Comments:

• 2 PEDS EZ-IO Needles

  YES

  NO

• EXP:

• Comments:

• EZ-IO Gun

  YES

  NO

• Comments:

• Alcohol Preps ( 3 )

  YES

  NO

• Comments:

• 2- Saline Flushes

  YES

  NO

• EXP:

• Comments:

Medication Pull Out Flaps

• 4- 81mg Aspirin Tablets

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- 150mg Amiodarone Vials

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 3- 6mg Adenosine vials

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Benadryl 50mg Vial

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 3- Epinephrine 1:1000 1mg/1ml Ampules

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Glucagon 1mg powder & 1ml Sterile water

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- Magnesium Sulfate 1Gm/2ml Vial

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Etomidate 40 Mg

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1-Nitroglycerin 0.4mg

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1-Verapamil 10mg/4ml vial

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Zofran 4mg Tablet

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Zofran 4mg Vial

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- Vasopressin 20 Unit Vials

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Fentynal 100 mcg

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Versed 5mg/5ml

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Versed 5mg/1ml Total of 10MG

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

Boxed Medication Area

• 1-1mg Atropine Preloads

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Dextrose 50% 25Gm/50ml Preload

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 4- Epinephrine 1:10,000 1mg Preloads

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- 100mg/5ml Lidocaine Preload

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- Narcan 2mg/2ml

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Sodium Bicarbonate 50 mEq

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- 15Gm Oral Glucose tubes

  YES

  NO

• Comments:

• Exp. Date:

Syringe Area

• 2- 1ML Syringe

  YES

  NO

• Comments:

• 2- 3ML Syringe

  YES

  NO

• Comments:

• 2- 10ML Syringe

  YES

  NO

• Comments:

• 1- 20ML Syringe

  YES

  NO

• Comments:

• 2- Filter Straws

  YES

  NO

• Comments:

• 2- Filter Needles

  YES

  NO

• Comments:

• 2- 21g Needles

  YES

  NO

• Comments:

• 2- 22g Needles

  YES

  NO

• Comments:

• 2- MAD Device

  YES

  NO

• Comments:

• Additional Comments:

LIGHTS

• IF ANYTHING IS NOT WORKING PLEASE WRITE IT UP IN EMERGENCY REPORTING

• Emergency Lights

  Working

  Needs Repair

• Comments:

• Headlights ( High & Low Beam )

  Working

  Needs Repair

• Comments:

• Turn signals

  Working

  Needs Repair

• Comments:

• Brake Lights

  Working

  Needs Repair

• Comments:

• Scene Lights

  Working

  Needs Repair

• Comments:

• Running Lights

  Working

  Needs Repair

• Comments:

• Reverse Lights

  Working

  Needs Repair

• Comments:

• Interior and compartment lighting

  Working

  Needs Repair

• Comments:

FLUID LEVEL

• IF FLUIDS ARE LOW PLEASE ADD, IF WE HAVE HERE, THEN PUT IT IN EMERGENCY REPORTING

• Fuel ( > 3/4 )

  GOOD

  LOW

• Comments:

• Oil

  GOOD

  LOW

• Comments:

• Coolant

  GOOD

  LOW

• Comments:

• Transmission

  GOOD

  LOW

• Comments:

• Power steering

  GOOD

  LOW

• Comments:

• Washer Fluid

  GOOD

  LOW

• Comments:

TIRE PRESSURE

• IF TIRES ARE LOW PLEASE ADD AIR AND THEN PUT IT IN EMERGENCY REPORTING

• Front Tires

  GOOD

  LOW

• Front Left PSI:

• Front Right PSI:

• Comments:

• Rear Tires

  GOOD

  LOW

• Left Inner PSI:

• Left Outer PSI:

• Right Inner PSI:

• Right Outer PSI:

• Comments:

• Additional Comments:

• Officers Signature:

  Sign

AFTER PRESSING FINISH GO TO AUDITS AND SEND AUDIT