Information
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Conducted on
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Personal Checking Vehicle
- Allen Badger
- Ben Rittenhouse
- Matt Cappelen
- Mike Baumgart
- Scott Lyng
- Kevin Shrader
- Andrew Shultz
- Paul Ursini
- Andrew Shiner
- John Loesch
- Jeff Sherwood
- Pat Watson
- Scott Sulak
- Scott Miller
- Scott Birchall
- Steven Tarczynski
- Jon Gray
- Joe Long
- Cody Conway
- Neil Werner
- Matt Bracken
- Tony Marcuccelli
- Jim Logan
- Dan Bartelt
- Chris Wampnar
- Robert Putman
- John Yanni
- Dave VanDusen
- Bryan Phelps
- John Mahoney
- Chris Durkop
- Derick Kameyer
- Greg Olsen
- Johnny Sengmany
- Adam Mackey
- Dan Moreno
- Michael Pagliara
- Jimmy Clarke
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Miles:
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Hours:
Daily Check
FIRST IN BAG
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Oxygen equipment & Airway Equipment Tagged?
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Comments:
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Tag #:
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IV Supplies, Center Pocket, & Top Pocket Tagged?
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Comments:
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Tag#:
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Vital Sign Equipment Tagged?
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Comments:
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Tag#:
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Narcotic Box ( Etomidate, Fentanyl, Versed, drug sheet signed )
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Comments:
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Tag #:
PEDIATRIC BAG
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Front Pocket Tagged?
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Tag#:
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Comments:
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Top Pocket Tagged?
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Tag#:
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Comments:
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Center Pocket Tagged?
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Tag#:
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Comments:
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Left Pocket Tagged?
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Tag#:
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Comments:
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Right Pocket Tagged?
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Tag#:
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Comments:
OXYGEN
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Onboard O2
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Level:
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Comments:
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Stretcher O2 ( In bag: NRB )
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Level:
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Comments:
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CPAP Bag Tagged?
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Tag#:
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Comments:
ZOLL MONITOR
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Batteries Changed
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Comments:
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Monitor Tested
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Comments:
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Extra Monitor Paper
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Comments:
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Electrodes
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Comments:
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Defibrillation Pads ( Adult & PEDS )
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Comments:
SUCTION
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MAKE SURE ALL EQUIPMENT IS ACCOUNTED FOR AND TESTED TO 300mmHg
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Onboard Suction
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Comments:
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Portable Suction
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Comments:
INTERIOR CABINETS
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Cabinet 1 Tagged?
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Comments:
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Tag#:
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Cabinet 2 Tagged?
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Comments:
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Tag#:
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Cabinet 6 Tagged?
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Comments:
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Tag#:
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Cabinet 7 Tagged?
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Comments:
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Tag#:
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Cabinet 8 Tagged?
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Comments:
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Tag#:
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Cabinet 9 Tagged?
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Comments:
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Tag#:
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Cabinet 10 Tagged?
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Comments:
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Tag#:
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Cabinet 11 Tagged?
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Comments:
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Tag#:
CAB
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2 Passport Tags and 3 Helmet Shields
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Comments:
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Knox Box Key
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Comments:
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Map Books
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Comments:
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Clipboard Ready ( 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 )
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Comments:
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iPad Battery Level ( > 75% )
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Comments:
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Safety Vest (3)
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Comments:
OUTSIDE COMPARTMENTS
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SCBA (2)
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SCBA ( A ) PSI:
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SCBA ( B ) PSI:
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Bottles Filled:
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Comments :
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Backboards ( 1 w/ spider straps, 1 w/ seat belts, 1 blank ) all clean
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Comments:
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C-Collar Bag ( 3 adult & 3 PEDS/infant collars/1 adult, 1 child, & 1 infant head immobilizers )
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Comments:
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Splinting Equipment ( 1 XL, 1L, 1M, & Pump w/ hose )
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Comments:
LIGHTING
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Emergency Lights
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Comments:
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Reverse Lights
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Comments:
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Brake Lights
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Comments:
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Head Lights ( Low & High beams )
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Comments:
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Turn Signals
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Comments:
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Scene Lights
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Comments:
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Running Lights
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Comments:
FLUIDS
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IF FLUIDS ( EXCEPT FUEL ) ARE LOW PLEASE WRITE UP IN EMERGENCY REPORTING
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Fuel ( > 3/4 )
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Comments:
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Oil
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Comments:
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Coolant ( Careful when vehicle is hot )
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Comments:
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Transmission ( Check when running )
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Comments:
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Power Steering
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Comments:
MISC.
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All garbage emptied
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Comments:
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Stretcher Clean & Made
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Comments:
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Patient Area Clean & Sanitized
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Comments:
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CAB Clean & Sanitized
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Comments:
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Check body for damage ( write any major damage up )
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Comments:
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Outside Washed
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Comments:
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Officers Signature:
