Information

  • Conducted on

  • Personal Checking Vehicle

  • Miles:

  • Hours:

Daily Check

FIRST IN BAG

  • Oxygen equipment ( NEB kit, NRB, Nasal, adult BVM w/ CO2 monitor, pocket mask )

  • Comments:

  • Trauma dressing all accounted for

  • Comments:

  • 2 hot packs & 2 Cold packs

  • Comments:

  • All ALS drugs accounted for

  • Comments:

  • Cric kit ( 12g IV, 14g IV, alcohol preps, scalpel, 3.0 ET Un-cuffed tube, IV pressure infusion bag )

  • Comments:

  • IV Supplies ( IV start kits, IV tubing, NS IV bags, & all IV's )

  • Comments:

  • EZ IO Supplies ( adult needle, PEDS needle, and drill works )

  • Comments:

  • Intubation Kit ( Tube holder, naso & oral airways, light works )

  • Comments:

  • Vital Sign Equipment ( BP cuff, stethoscope, CO monitor, glucometer w/ 5 band-aids/5 lancets/5 alcohol wipes )

  • Comments:

  • Narcotic Box ( Etomidate, Fentanyl, Versed, drug sheet signed )

  • Comments:

  • Tag #:

OXYGEN

  • Onboard O2

  • Level:

  • Comments:

  • Stretcher O2 ( In bag: NRB )

  • Level:

  • Comments:

  • CPAP O2 ( mask & tubing )

  • Level:

  • Comments:

ZOLL MONITOR

  • Batteries Changed

  • Comments:

  • Monitor Tested

  • Comments:

  • Extra Monitor Paper

  • Comments:

  • Electrodes

  • Comments:

  • Defibrillation Pads ( Adult & PEDS )

  • Comments:

SUCTION

  • MAKE SURE ALL EQUIPMENT IS ACCOUNTED FOR AND TESTED TO 300mmHg

  • Onboard Suction

  • Comments:

  • Portable Suction

  • Comments:

INTERIOR CABINETS

  • Cabinet 1 fully stocked

  • Comments:

  • Cabinet 2 fully stocked

  • Comments:

  • Cabinet 3 fully stocked

  • Comments:

  • Cabinet 4 fully stocked

  • Comments:

  • Cabinet 5 fully stocked

  • Comments:

  • Cabinet 6 fully stocked

  • Comments:

  • Cabinet 7 fully stocked

  • Comments:

  • Cabinet 8 fully stocked

  • Comments:

  • Cabinet 9 fully stocked

  • Comments:

  • Cabinet 10 fully stocked

  • Comments:

  • Cabinet 11 fully stocked

  • Comments:

  • Cabinet 12 fully stocked

  • Comments:

  • ALS Cabinet fully stocked ( Check Drugs to Make Sure Not Exp. )

  • Comments:

  • Bench Seat fully stocked ( wool blanket, mustang suit, burn sheet )

  • Comments:

  • Top Cabinet fully stocked ( Towels, blankets, sheets, emesis basin )

  • Comments:

CAB

  • 2 Passport Tags and 3 Helmet Shields

  • Comments:

  • Knox Box Key

  • Comments:

  • Map Books

  • Comments:

  • Portable Radios (2)

  • Comments:

  • 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 )

  • Comments:

  • iPad Battery Level ( > 75% )

  • Comments:

  • Safety Vest (3)

  • Comments:

OUTSIDE COMPARTMENTS

  • SCBA (2)

  • SCBA ( A ) PSI:

  • SCBA ( B ) PSI:

  • Bottles Filled:

  • Comments :

  • Backboards ( 1 w/ spider straps, 1 w/ seat belts, 1 blank ) all clean

  • Comments:

  • C-Collar Bag ( 3 adult & 3 PEDS/infant collars/1 adult, 1 child, & 1 infant head immobilizers )

  • Comments:

  • Splinting Equipment ( 1 XL, 1L, 1M, & Pump w/ hose )

  • Comments:

  • Pressurized Water Can ( Full )

  • Comments:

  • Water rescue equipment

  • Comments:

LIGHTING

  • Emergency Lights

  • Comments:

  • Reverse Lights

  • Comments:

  • Brake Lights

  • Comments:

  • Head Lights ( Low & High beams )

  • Comments:

  • Turn Signals

  • Comments:

  • Scene Lights

  • Comments:

  • Running Lights

  • Comments:

FLUIDS

  • IF FLUIDS ( EXCEPT FUEL ) ARE LOW PLEASE WRITE UP IN EMERGENCY REPORTING

  • Fuel ( > 3/4 )

  • Comments:

  • Oil

  • Comments:

  • Coolant ( Careful when vehicle is hot )

  • Comments:

  • Transmission ( Check when running )

  • Comments:

  • Power Steering

  • Comments:

MISC.

  • All garbage emptied

  • Comments:

  • Stretcher Clean & Made

  • Comments:

  • Patient Area Clean & Sanitized

  • Comments:

  • CAB Clean & Sanitized

  • Comments:

  • Check body for damage ( write any major damage up )

  • Comments:

  • Outside Washed

  • Comments:

  • Officers Signature:

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