Information

  • 1831 Weekly Check

  • Conducted on

  • Personal checking vehicle

  • Vehicle Miles:

  • Vehicle Hours:

ZOLL MONITOR

ZOLL Monitor

  • Tested Monitor

  • Comments:

  • Adult Defib Pads ( 1 )

  • Expiration Date:

  • Comments:

  • Peds Defib Pads ( 1 )

  • Expiration Date:

  • Comments:

  • Defib Test Cord ( 1 )

  • Comments:

  • Adult Electrodes ( 1 pk )

  • Comments:

  • Peds Electrodes ( 1 pk )

  • Comments:

  • Spare Battery ( 1 ): Rotate battery

  • Comments:

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

  • Comments:

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

  • Comments:

  • Razor ( 1 )

  • Comments:

  • CO2 ET Tube Connecter ( 2 )

  • Comments:

  • CO2 Nasal Monitor ( 2 )

  • Comments:

  • SPO2 Sensor ( 1 )

  • Comments:

  • Peds SPO2 Sensor ( 1 )

  • Comments:

JUMP BAG

Airway Pocket

  • Adult BVM w/ CO2 Monitor ( 1 )

  • Comments:

  • Pocket Mask ( 1 )

  • Comments:

  • Tube Holders ( 2 )

  • Comments:

  • King Tubes

  • Size 3 ( 1 )

  • Comments:

  • Size 4 ( 1 )

  • Comments:

  • Size 5 ( 1 )

  • Comments:

  • Intubation Kit

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

  • Comments:

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

  • Comments:

  • Lubricant Packets ( 2 )

  • Comments:

  • ET Tubes

  • 5.5 ( 1 )

  • Comments:

  • 6.0 ( 1 )

  • Comments:

  • 6.5 ( 1 )

  • Comments:

  • 7.0 ( 1 )

  • Comments:

  • 7.5 ( 2 )

  • Comments:

  • 8.0 ( 2 )

  • Comments:

  • 8.5 ( 1 )

  • Comments:

  • 9.0 ( 1 )

  • Comments:

  • 10ml Syringe ( 1 )

  • Comments:

  • Benzocaine ( 1 )

  • Exp. Dates:

  • Comments:

  • Forceps ( 1 )

  • Comments:

  • Stylets ( 2 )

  • Comments:

  • Nasopharyngeal ( )

  • Comments:

  • Oropharyngeal ( )

  • Comments:

  • Tape ( 1 )

  • Comments:

  • Surgical Masks ( 2 )

  • Comments:

  • Spare Batteries ( 2 )

  • Comments:

Side Pocket

  • NRB Mask ( 1 )

  • Comments:

  • Nasal Cannula ( 1 )

  • Comments:

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

  • Albuterol Exp. Date:

  • Atrovent Exp. Date:

  • Comments:

Vitals Side Pocket

  • Blood Pressure Cuff ( 1 adult )

  • Comments:

  • SPO2 Monitor

  • Comments:

  • Stethoscope ( 1 )

  • Comments:

  • Pen light ( 1 )

  • Comments:

  • Glucometer Case

  • Glucometer ( Make sure it is working )

  • Comments:

  • Test Strips ( 5 )

  • Comments:

  • Lancets ( 5 )

  • Comments:

  • Alcohol Preps ( 5 )

  • Comments:

  • Bandaids ( 5 )

  • Comments:

IV Pocket

  • Tape

  • Comments:

  • Thermometer ( w/ covers )

  • Comments:

  • Carpoject

  • Comments:

  • Oral Glucose

  • Comments:

  • Exp. Date:

  • Large Gloves

  • Comments:

  • XL Gloves

  • Comments:

  • IV Start Kit

  • Comments:

  • IV Tubing

  • Comments:

  • NS IV Bags

  • Comments:

  • Ring Cutter

  • Comments:

  • Syringe/Needle Kit

  • 3mL syringe ( 1 )

  • Comments:

  • 3mL w/ Monoject SmarTip ( 3 )

  • Comments:

  • 3mL w/ 22g 1 1/2 Needle ( 2 )

  • Comments:

  • 5mL Syringe ( 2 )

  • Comments:

  • 10mL Syringe ( 3 )

  • Comments:

  • 21g x 1" Safety Needle ( 1 )

  • Comments:

  • 22g x 1 1/2" Safety Needle ( 1 )

  • Comments:

  • 22g x 1 1/2" Hypodermic Needle ( 1 )

  • Comments:

  • Filter Straw ( 2 )

  • Comments:

  • MAD Nasal ( 1 )

  • Comments:

  • 1mL 29g x 1/2" Insulin Syringe ( 1 )

  • Comments:

  • Filter Needle

  • Comments:

  • IV Catheters

  • 14g IV

  • Comments:

  • 16g IV

  • Comments:

  • 16g Delnor IV

  • Comments:

  • 18g IV

  • Comments:

  • 18g Delnor IV

  • Comments:

  • 20g IV

  • Comments:

  • 20g Delnor IV

  • Comments:

  • 22g IV

  • Comments:

  • 22g Delnor IV

  • Comments:

  • 24g IV

  • Comments:

  • 60mL Syringe

  • Comments:

  • 20mL Syringe

  • Comments:

  • 10mL NS Syringe

  • Comments:

  • Sharps Container ( 1 )

  • Comments:

CENTER OF JUMP BAG

  • MAD ( 1 )

  • Comments:

  • Nail Polish Remover

  • Comments:

  • Alcohol Preps ( 5 )

  • Comments:

  • 3mL Syringe

  • Comments:

  • SmarTip Needle ( 1 )

  • Comments:

  • 500mL Sterile Water ( 1 )

  • Comments:

  • Tape ( 1 )

  • Comments:

  • Filter Strew ( 1 )

  • Comments:

  • 4 x 4 Gauze ( 2 )

  • Comments:

  • ACE Roll ( 1 )

  • Comments:

  • Trauma Shears ( 1 )

  • Comments:

  • 4" Cling ( 1 )

  • Comments:

  • SAM Splint ( 1 )

  • Comments:

  • Cold Pack ( 2 )

  • Comments:

  • Hot Pack ( 2 )

  • Comments:

  • ALS Drugs

  • Aspirin

  • Exp. Dates:

  • Comments:

  • Atropine ( 2 )

  • Exp. Dates:

  • Comments:

  • Amiodarone ( 1 )

  • Exp. Dates:

  • Comments:

  • Adenosine ( 3 )

  • Exp. Dates:

  • Comments:

  • Benadryl ( 1 )

  • Exp. Dates:

  • Comments:

  • Dextrose 50% ( 1 )

  • Exp. Dates:

  • Comments:

  • Epi 1:1000 ( 3 )

  • Exp. Dates:

  • Comments:

  • Epi 1:10,000 ( 4 )

  • Exp. Dates:

  • Comments:

  • Glucagon ( 1 )

  • Exp. Dates:

  • Comments:

  • Lidocaine ( 1 )

  • Exp. Dates:

  • Comments:

  • Magnesium Sulfate ( 2 )

  • Exp. Dates:

  • Comments:

  • Nitroglycerin

  • Exp. Dates:

  • Comments:

  • Narcan

  • Exp. Dates:

  • Comments:

  • Sodium Bicarbonate ( 1 )

  • Exp. Dates:

  • Comments:

  • Vasopressin ( 2 )

  • Exp. Dates:

  • Comments:

  • Verapamil ( 2 )

  • Exp. Dates:

  • Comments:

  • Zofran Tablet ( 2 )

  • Exp. Dates:

  • Comments:

  • Zofran Vial ( 1 )

  • Exp. Dates:

  • Comments:

  • Narcotic Box

  • Old Drug Tag #:

  • New Drug Tag #:

  • Etomidate

  • Exp. Dates:

  • Comments:

  • Fentanyl

  • Exp. Dates:

  • Comments:

  • Versed 5mg/5mL

  • Exp. Dates:

  • Comments:

  • Versed 5mg/1mL

  • Exp. Dates:

  • Comments:

TOP POCKET

  • EZ IO Needle ( 2 Adult )

  • Comments:

  • Exp. Dates:

  • EZ IO Needle ( 1 PEDS )

  • Comments:

  • Exp. Dates:

  • EZ IO Gun ( Make sure it's working )

  • Comments:

  • 10mL NS Flush

  • Comments:

  • 14g IV

  • Comments:

  • 12g IV

  • Comments:

  • 10g IV

  • Comments:

  • Alcohol Preps

  • Comments:

  • Scalpel

  • Comments:

  • 3.0 ET Un-cuffed Tube

  • Comments:

  • IV Pressure Infusion Bag

  • Comments:

  • Additional Comments:

PEDS BAG

TOP POCKET PEDS BAG

  • Pediatric NRB Mask ( 1 )

  • Comments:

  • Pediatric Nasal Cannula

  • Comments:

  • Infant Nasal Cannula

  • Comments:

  • Pediatric Simple Mask

  • Comments:

LEFT SIDE POCKET PEDS BAG

  • Bone Marrow Needle

  • Comments:

  • 1000ml NS IV Bag

  • Comments:

  • IV 10 Drip Tubing

  • Comments:

  • IV Start Kit

  • Comments:

FRONT SIDE POCKET PEDS BAG

  • BP Cuff and Stethoscope

  • Comments:

  • Pen Light

  • Comments:

  • SPO2 Monitor

  • Comments:

  • EKG Electrodes

  • Comments:

RIGHT SIDE POCKET PEDS BAG

  • CO2 Monitor

  • Comments:

  • 10ml Syringe

  • Comments:

  • Trauma Shears

  • Comments:

  • Thermometer

  • Comments:

  • Lubricant ( 2 )

  • Comments:

  • Forceps

  • Comments:

  • Laryngoscope Handle

  • Comments:

  • SAM Splint

  • Comments:

  • Stylet

  • Comments:

CENTER PEDS BAG

  • Pediatric BVM

  • Comments

  • Infant BVM

  • Comments:

  • Broselow Tape

  • Comments:

  • 4X4 Gauze ( 2 )

  • Comments:

  • Cling Wrap

  • Comments:

  • Gauze Rolls ( 4 )

  • Comments:

  • Tape

  • Comments

  • Meconium Aspirator

  • Comments:

  • Alcohol Preps

  • Comments

  • Bandaids

  • Comments:

  • Misc. OPA & NPA

  • Comments:

  • ET Tube Holder

  • Comments:

  • Emisis Bag

  • Comments:

  • RED

  • 22-24g IV

  • Comments:

  • 3.5 UC Tube

  • Comments:

  • 14 French NPA

  • Comments:

  • 0-1 Straight Blade

  • Comments:

  • 40-50mm OPA

  • Comments:

  • PURPLE

  • 20-24g IV

  • Comments:

  • 4 UC Tube

  • Comments:

  • 18 French NPA

  • Comments:

  • 1 Straight Blade

  • Comments:

  • 50-60mm OPA

  • Comments:

  • YELLOW

  • 18-22g IV

  • Comments:

  • 4.5 UC Tube

  • Comments:

  • 20 French NPA

  • Comments:

  • 1-2 Straight Blade

  • Comments:

  • 50-60mm OPA

  • Comments:

  • WHITE

  • 18-22g IV

  • Comments:

  • 5 UC Tube

  • Comments:

  • 22 French NPA

  • Comments:

  • 1-2 Straight Blade

  • Comments:

  • 50-60mm OPA

  • Comments:

  • BLUE

  • 18-20g IV

  • Comments:

  • 5.5 UC Tube

  • Comments:

  • 24 French NPA

  • Comments:

  • 2 Curved or Straight Blade

  • Comments:

  • 60-70mm OPA

  • Comments:

  • ORANGE

  • 18-20g IV

  • Comments:

  • 6 C Tube

  • Comments:

  • 26 French NPA

  • Comments:

  • 2 Curved or Straight Blade

  • Comments:

  • 70-80mm OPA

  • Comments:

  • GREEN

  • 16-20g IV

  • Comments:

  • 6.5 C Tube

  • Comments:

  • 30 French NPA

  • Comments:

  • 3 Curved or Straight Blade

  • Comments:

  • 80mm OPA

  • Comments:

  • Additional Comments:

IV CABINET

IV Drug Cabinet

  • Bandaids ( 1 )

  • Comments:

  • IV Start Kit ( 4 )

  • Comments:

  • 10ml NS Flushes ( 2 )

  • Comments:

  • 18g x 1 1/2" Needle ( 2 )

  • Comments:

  • 21g x 1" Needle ( 2 )

  • Comments:

  • 22g x 1 1/2" Needle ( 2 )

  • Comments:

  • 23g x 1" Needle ( 2 )

  • Comments:

  • 25g x 1 1/2" Needle ( 2 )

  • Comments:

  • Filter Straws ( 2 )

  • Comments:

  • Filter Needle ( 5 )

  • Comments:

  • 1ml Syringe ( 1 )

  • Comments:

  • 2ml Syringe ( 1 )

  • Comments:

  • 3ml Syringe ( 1 )

  • Comments:

  • 3ml Syringe with Smartip ( 1 )

  • Comments:

  • 12ml Syringe ( 1 )

  • Comments:

  • Butterfly Needles ( 21g & 23g ): Total of 2

  • Comments:

  • Lancets ( 5 )

  • Comments:

  • MAD Device ( 2 )

  • Comments:

  • Alcohol Preps ( 5 )

  • Comments:

  • Tape ( 2 )

  • Comments:

  • IV Catheters

  • 14g IV ( 2 )

  • Comments:

  • 16g IV ( 2 )

  • Comments:

  • 18g IV ( 2 )

  • Comments:

  • Delnor Type 18g IV ( 1 )

  • Comments:

  • 20g IV ( 2 )

  • Comments:

  • Delnor Type 20g IV ( 1 )

  • Comments:

  • 22g IV ( 2 )

  • Comments:

  • Delnor Type 22g IV ( 1 )

  • Comments:

  • 24g IV ( 2 )

  • Comments:

  • Additional Comments:

ALS DRUG EQUIPMENT

ALS Drug Equipment

  • Alcohol Preps ( 1 box )

  • Comments:

  • 0.9% NaCL Solution 10ml Flush

  • Comments:

  • 0.9% NaCL Solution 3ml ( 5 )

  • Comments:

  • Exp. Dates:

  • MAD Device ( 1 )

  • Comments:

  • 3ml Syringe w/ Needle ( 1 )

  • Comments:

  • 1ml Syringe w/ Needle ( 1 )

  • Comments:

  • Spare Test Strips ( 1 box )

  • Comments:

  • Spare Lancets ( 5 )

  • Comments:

  • Filter Straws ( 2 )

  • Comments:

  • Filter Needle ( 2 )

  • Comments:

  • 1ml Syringe ( 1 )

  • Comments:

  • 3ml Syringe ( 4 )

  • Comments:

  • 5mL Syringe ( 4 )

  • Comments:

  • 10mL Syringe ( 2 )

  • Comments:

  • 20mL Syringe

  • Comments:

  • 60mL Syringe

  • Comments:

  • Carpoject ( 1 )

  • Comments:

  • Needles

  • 18g x 1 1/2"

  • Comments:

  • 20g x 1"

  • Comments:

  • 21g x 1"

  • Comments:

  • 22g x 1 1/2"

  • Comments:

  • 23g x 1"

  • Comments:

  • 25g x 1 1/2"

  • Comments:

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

  • Amiodarone ( 2 )

  • Expiration Dates:

  • Comments:

  • Aspirin

  • Expiration Dates:

  • Comments:

  • Albuterol ( 2 )

  • Expiration Dates:

  • Comments:

  • Atrovent ( 3 )

  • Expiration Dates:

  • Comments:

  • Atropine ( 5 )

  • Expiration Dates:

  • Comments:

  • Adenosine ( 1 )

  • Expiration Dates:

  • Comments:

  • Benadryl ( 1 )

  • Expiration Dates:

  • Comments:

  • Dopamine ( 1 ) with 60 Drip Tubing

  • Expiration Dates:

  • Comments:

  • Dextrose 50% ( 1 )

  • Expiration Dates:

  • Comments:

  • Epi 1:1000 ( 3 )

  • Expiration Dates:

  • Comments:

  • Epi 1:10,000 ( 7 )

  • Expiration Dates:

  • Comments:

  • Glucagon ( 2 )

  • Expiration Dates:

  • Comments:

  • Lidocaine ( 4 )

  • Expiration Dates:

  • Comments:

  • Magnesium Sulfate ( 2 )

  • Expiration Dates:

  • Comments:

  • Narcan 2ml ( 2 )

  • Expiration Dates:

  • Comments:

  • Narcan 1ml ( 3 )

  • Expiration Dates:

  • Comments:

  • Nitroglycerine ( 1 )

  • Expiration Dates:

  • Comments:

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

  • Expiration Dates:

  • Comments:

  • Tetracaine ( 1 )

  • Expiration Dates:

  • Comments:

  • Vasopressin ( 1 )

  • Expiration Dates:

  • Comments:

  • Zofran ( 1 Vial )

  • Expiration Dates:

  • Comments:

  • Zofran ( 1 Tablet )

  • Expiration Dates:

  • Comments:

  • Additional Comments:

CPAP

CPAP

  • Mask

  • Comments:

  • O2 Bottle

  • PSI:

PORTABLE SUCTION

  • Tubing

  • Comments:

  • Additional Comments:

INTERIOR CABINETS

Interior Cabinet #1

  • BVM

  • Adult ( 1 )

  • Comments:

  • Adult CO2 Detector ( 1 )

  • Comments:

  • Exp. Date:

  • Child ( 1 )

  • Comments:

  • PEDS CO2 Detector ( 1 )

  • Comments:

  • Exp. Date:

  • Infant ( 1 )

  • Comments:

  • Infant CO2 Detector ( 1 )

  • Comments:

  • Exp. Date:

  • 500ml Sterile Water ( 2 )

  • Comments:

  • Exp. Dates:

  • 1000ml Sodium Chloride ( 3 )

  • Comments:

  • Exp. Dates:

  • 500ml Sodium Chloride ( 2 )

  • Comments:

  • Exp. Dates:

Interior Cabinet #2

  • 1 Nebulizer tx w/ 1 Albuterol & 1 Atrovent

  • Albuterol Dates:

  • Atrovent Dates:

  • Comments:

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

  • Albuterol Dates:

  • Atrovent Dates:

  • Comments:

  • Adult Nasal Cannula ( 5 )

  • Comments:

  • Adult NRB ( 3 )

  • Comments:

  • 0.9% NaCl Solution 3ml

  • Comments:

  • Exp. Dates:

  • Peds NRB ( 3 )

  • Comments:

  • Peds Nasal Cannula ( 3 )

  • Comments:

  • Infant NRB ( 3 )

  • Comments:

  • Infant Nasal Cannula ( 3 )

  • Comments:

Interior Cabinet #3

  • Triage Tags ( 1 set )

  • Comments:

  • Drug Tags ( 1 bag )

  • Comments:

  • Rubberbands ( 1 bag )

  • Comments:

  • Safety Vest ( 1 )

  • Comments:

Interior Cabinet #4

  • Stethoscope w/ Accessories ( 1 )

  • Comments:

  • Multi Cuff BP Bag

  • 1 Adult

  • Comments:

  • 1 Large Adult

  • Comments:

  • 1 Child

  • Comments:

  • 1 Infant

  • Comments:

  • 1 Thigh

  • Comments:

  • Gauge ( 1 )

  • Comments:

  • Spare Child BP Cuffs ( 2 )

  • Amount:

  • 1 Stethoscope

  • Amount:

  • 1 Bag of Extra Pieces For Stethoscope

  • Amount:

Interior Cabinet #5

  • Cavi Wipes ( 1 )

  • Comments:

  • Garbage Bags & Soil Linen Bags

  • Comments:

Interior Cabinet #6

  • N95 Masks ( 5 )

  • Comments:

  • Safety Glasses ( 3 )

  • Comments:

Interior Cabinet #7

  • Adult EtCO2 Cannulas ( 2 )

  • Comments:

  • Adult EtCO2 Tube Connectors ( 2 )

  • Comments:

  • Peds Electrodes 1pk.

  • Comments:

  • Adult Electrodes 1pk.

  • Comments:

  • EKG Paper ( 2 )

  • Comments:

  • Adult Defib Pads ( 1 )

  • Expiration Date:

  • Comments:

Interior Cabinet #8

  • Baby Bottle ( 1 )

  • Comments:

  • OB Kit ( 1 )

  • Comments:

  • Baby Bunting Foil ( 2 )

  • Comments:

Interior Cabinet #9

  • IV Pressure Infusion Bag ( 1 )

  • Comments:

  • 10 or 15 Drip IV Tubing ( 5 )

  • Comments:

  • 1000ml Sodium Chloride IV Bags ( 3 )

  • Expiration Dates:

  • Comments:

  • 60 Drip IV tubing ( 2 )

  • Comments:

  • Blood Tubing ( 2 sets )

  • Comments:

Interior Cabinet #10

  • Survival Warp ( 2 )

  • Comments:

  • Soft Restraints ( 2 sets )

  • Comments:

  • Towels ( 3 )

  • Comments:

  • Hand Sanitizer

  • Comments:

  • Red Biohazard Bag ( 5 )

  • Comments:

  • Pocket Mask ( 1 )

  • Comments:

Interior Cabinet #11

  • Adult Arm Slings

  • 1 Large

  • Comments:

  • 1 Medium

  • Comments:

  • 1 Small

  • Comments:

  • Peds Slings ( 2 )

  • Comments:

  • SAM Splints ( 3 )

  • Comments:

  • Face Shields ( 5 )

  • Comments:

  • ACE Wraps ( 4 )

  • Comments:

  • 4" Cling ( 2 )

  • Comments:

  • 4 1/2" Kerlix ( 1 )

  • Comments:

  • Eye Pads ( 4 )

  • Comments:

  • Tape ( 4 )

  • Comments:

  • Petrolatum/Vaseline

  • ( 2 ) 3x9

  • Comments:

  • ( 2 ) 3x18

  • Comments:

  • Arm Board ( 1 )

  • Comments:

  • Trauma Shears ( 1 )

  • Comments:

  • Triangle Bandages ( 3 )

  • Comments:

  • ACS Chest Seal Pads ( 1 )

  • Comments:

  • 4x4 Gauze ( 15 )

  • Comments:

Interior Cabinet #12

  • Trauma Dressing ( 4 )

  • Comments:

  • Burn Sheet ( 2 )

  • Comments:

  • Aluminum Foil ( 1 )

  • Comments:

  • Isolation Kits ( 3 )

  • Comments:

  • Cold Packs ( 5 )

  • Comments:

  • Hot Packs ( 5 )

  • Comments:

Suction ( All equipment is accounted for, clean, and working )

  • Onboard Suction ( test unit )

  • Comments:

  • Portable Suction ( test unit )

  • Comments:

Bench

  • Mustang Suit w/ Ice Boots

  • Comments:

  • 50' Throw Bag ( 1 )

  • Comments:

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

  • Comments:

  • Emergency Blanket

  • Comments:

  • Wool Blanket ( 4 )

  • Comments:

  • Burn Sheet ( 1 )

  • Comments:

  • Pillows ( 2 )

  • Comments:

  • Umbrella ( 1 )

  • Comments:

Spare Items

  • Oxygen Bottle ( 2 )

  • Comments:

  • Emesis Basin ( 2 )

  • Comments:

  • Sheets ( 3 )

  • Comments:

  • Blankets ( 3 )

  • Comments:

MISC.

  • Drug Sheet Signed

  • Comments:

  • Stretcher Clean & Made

  • Comments:

  • Patient Area Clean And Sanitized

  • Comments:

  • Additional Comments:

EXTERIOR CABINETS

Exterior Cabinet #1

  • Pressurized Water Can

  • Comments:

  • 6' Pike Pole

  • Comments:

  • O2 Bottle

  • Comments:

  • Peds Hare Traction

  • Comments:

  • Adult Hare Traction

  • Comments:

  • Air splints ( 1L, 1M, 1S, & Pump )

  • Comments:

  • KED

  • Comments:

  • Broom ( 1 )

  • Comments:

  • Hydrant Bag

Exterior Cabinet #2

  • Body Bag

  • Comments:

  • Wool Blankets

  • Comments:

  • ABC Extinguisher

  • Comments:

  • Transfer Tarp

  • Comments:

  • Safety Blanket

  • Comments:

  • Throw Bag

  • Comments:

  • Noodle

  • Comments:

  • Life Vest

  • Comments:

  • Bolt Cutters

  • Comments:

  • Spare Cot Straps

  • Comments:

Exterior Cabinet #3

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

  • SCBA ( A ) P.S.I. :

  • SCBA ( B ) P.S.I. :

  • Comments:

  • Flashlights ( 2 ):<br>Both work

  • Comments:

  • Irons ( 1 halligan & 1 flat head axe )

  • Comments:

Exterior Cabinet #4

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

  • Comments:

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

  • Comments:

  • Child Car Seat

  • Comments:

  • C-Collar Bag

  • Adult Collars ( 2 )

  • PEDS/Infant Collars ( 3 )

  • Baby No Neck Collar

  • Adult Head Immobilizers ( 2 )

  • PEDS/Infant Head Immobilizer ( 1 )

  • Adult Head Immobilizers ( 2 )

  • Comments:

  • Child Head Immobilizers ( 2 )

  • Comments:

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

  • Comments:

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

  • Comments:

  • Extra Spider Straps

  • Comments:

  • Additional Comments:

CAB

CAB

  • Portable Radios ( 2 )

  • Comments:

  • Flashlight ( 1 )

  • Comments:

  • iPad Charged ( >75% )

  • Comments:

  • Gloves ( 1XL, 1L, 1M )

  • Comments:

  • Knox Box Key

  • Comments:

  • Passport Tags ( White & Red )

  • Comments:

  • Helmet Shields ( 2 )

  • Comments:

  • Safety Vests ( 2 )

  • Comments:

  • Road Triangles

  • Comments:

  • ERG Book

  • Comments:

  • Maps ( FRC, County, South Elgin )

  • Comments:

  • Garage Openers ( Station 1, Delnor, & St. Joes )

  • Comments:

CLIPBOARD

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

  • 10 Run Sheets

  • 10 Hippa Forms

  • 10 AMA/Refusal Forms

  • 10 Multiple Release Forms

  • 5 EMS Rehab Forms

  • 1 School Bus Form

  • 1 Involuntary Form

MISC.

  • Cab Vacuumed & Cleaned Out

  • Comments:

  • Additional Comments:

MAINTENANCE

LIGHTS

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

  • Emergency Lights

  • Comments:

  • Headlights ( High & Low Beam )

  • Comments:

  • Turn signals

  • Comments:

  • Brake Lights

  • Comments:

  • Scene Lights

  • Comments:

  • Running Lights

  • Comments:

  • Reverse Lights

  • Comments:

FLUID LEVEL

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

  • Fuel ( > 3/4 )

  • Comments:

  • Oil

  • Comments:

  • Coolant

  • Comments:

  • Transmission

  • Comments:

  • Power steering

  • Comments:

  • Washer Fluid

  • Comments:

TIRE PRESSURE

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

  • Front Tires

  • Front Left PSI:

  • Front Right PSI:

  • Comments:

  • Rear Tires

  • Left Inner PSI:

  • Left Outer PSI:

  • Right Inner PSI:

  • Right Outer PSI:

  • Comments:

  • Additional Comments:

  • Officers Signature:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.