ALSFR Daily Check

• Document No.

• Date/ Time

  Date

• Vehicle Being Checked

  1811

  1815

  1881

  1871

• Prepared by (optional: scan bar Code)

• Officer In Charge

  Select DC Engle DC McCullough DC McManus DC Norfleet Capt. Chase Capt. Stupp

  • DC Engle
  • DC McCullough
  • DC McManus
  • DC Norfleet
  • Capt. Chase
  • Capt. Stupp

• Group Working

  A Group

  B Group

  C Group

  D Group

Cab and Loose Equipment. If equipment is missing or not functional, replace or repair it and indicate complete. if unable to do so make a note, indicate incomplete and advise your duty officer.

• Flares (6)

• Blankets (2)

• SMART Triage Kit

• Flashlight (Charged)

• Portable Radio (Charged)

• Cell Phone (Charged)

• ABC Fire Extinguisher (Pressurized, Annual Inspection done)

• KED

• Narcotic Box Present

  Yes

  No

• Seal Color

  Yellow

  Green

• Seal Number

• Notify Duty Officer

  Yes

  No

Portable Equipment

Airway Bag

• Portable Oxygen Pressure: Airway Bag

• Airway bag center section equipment present and operational.

  Yes

  No

• All missing equipment replaced.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Airway Bag Section 2 sealed

  Yes

  No

• All equipment present per master equipment list and zipper re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Airway Bag Section 3 sealed

  Yes

  No

• All equipment present per master equipment list and zipper re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Airway Bag Section 4 sealed

  Yes

  No

• All equipment present per master equipment list and zipper re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

Med Bag

• Med bag center section sealed.

  Yes

  No

• All missing equipment replaced and section re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Med bag section 1 sealed.

  Yes

  No

• All missing equipment replaced and section re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Med bag section 2 sealed.

  Yes

  No

• All missing equipment replaced and section re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Med bag section 3 sealed.

  Yes

  No

• All missing equipment replaced and section re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Med bag section 4 sealed.

  Yes

  No

• All missing equipment replaced and section re-sealed.

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Monitor ID/ SN (scan QR code)

• All monitor equipment present per master list, batteries charged and spare battery present?

  Yes

  No

• All missing equipment replaced?

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Attach image of user test strip.

  Media

• Trauma bag sealed.

  Yes

  No

• All missing equipment replaced and bag resealed?

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Suction unit charged and user test complete.

• Suction unit kit bag sealed.

  Yes

  No

• All missing equipment replaced and bag resealed?

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

• Spare/ Extra equipment kit bag sealed.

  Yes

  No

• All missing equipment replaced and bag resealed?

  Yes

  No

• Make a note of the problem and advise your duty officer of the deficiency.

Signatures

• Person completing check

  Sign

• Officer in Charge

  Sign