AMBULANCE 1832 DAILY

• Conducted on

  Date

• Personal Checking Vehicle

  Select 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

  • 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

• Miles:

• Hours:

FIRST IN BAG

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

  YES

  NO

• Comments:

• Trauma dressing all accounted for

  YES

  NO

• Comments:

• 2 hot packs & 2 Cold packs

  YES

  NO

• Comments:

• All ALS drugs accounted for

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

• Tag #:

OXYGEN

• Onboard O2

  YES

  NO

• Level:

• Comments:

• Stretcher O2 ( In bag: NRB )

  YES

  NO

• Level:

• Comments:

• CPAP O2 ( mask & tubing )

  YES

  NO

• Level:

• Comments:

ZOLL MONITOR

• Batteries Changed

  YES

  NO

• Comments:

• Monitor Tested

  YES

  NO

• Comments:

• Extra Monitor Paper

  YES

  NO

• Comments:

• Electrodes

  YES

  NO

• Comments:

• Defibrillation Pads ( Adult & PEDS )

  YES

  NO

• Comments:

SUCTION

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

• Onboard Suction

  YES

  NO

• Comments:

• Portable Suction

  YES

  NO

• Comments:

INTERIOR CABINETS

• Cabinet 1 fully stocked

  YES

  NO

• Comments:

• Cabinet 2 fully stocked

  YES

  NO

• Comments:

• Cabinet 3 fully stocked

  YES

  NO

• Comments:

• Cabinet 4 fully stocked

  YES

  NO

• Comments:

• Cabinet 5 fully stocked

  YES

  NO

• Comments:

• Cabinet 6 fully stocked

  YES

  NO

• Comments:

• Cabinet 7 fully stocked

  YES

  NO

• Comments:

• Cabinet 8 fully stocked

  YES

  NO

• Comments:

• Cabinet 9 fully stocked

  YES

  NO

• Comments:

• Cabinet 10 fully stocked

  YES

  NO

• Comments:

• Cabinet 11 fully stocked

  YES

  NO

• Comments:

• Cabinet 12 fully stocked

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

CAB

• 2 Passport Tags and 3 Helmet Shields

  YES

  NO

• Comments:

• Knox Box Key

  YES

  NO

• Comments:

• Map Books

  YES

  NO

• Comments:

• Portable Radios (2)

  YES

  NO

• 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 )

  YES

  NO

• Comments:

• iPad Battery Level ( > 75% )

  YES

  NO

• Comments:

• Safety Vest (3)

  YES

  NO

• Comments:

OUTSIDE COMPARTMENTS

• SCBA (2)

  YES

  NO

• SCBA ( A ) PSI:

• SCBA ( B ) PSI:

• Bottles Filled:

  YES

  NO

• Comments :

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

• Pressurized Water Can ( Full )

  YES

  NO

• Comments:

• Water rescue equipment

  YES

  NO

• Comments:

LIGHTING

• Emergency Lights

  YES

  NO

• Comments:

• Reverse Lights

  YES

  NO

• Comments:

• Brake Lights

  YES

  NO

• Comments:

• Head Lights ( Low & High beams )

  YES

  NO

• Comments:

• Turn Signals

  YES

  NO

• Comments:

• Scene Lights

  YES

  NO

• Comments:

• Running Lights

  YES

  NO

• Comments:

FLUIDS

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

• Fuel ( > 3/4 )

  YES

  NO

• Comments:

• Oil

  YES

  NO

• Comments:

• Coolant ( Careful when vehicle is hot )

  YES

  NO

• Comments:

• Transmission ( Check when running )

  YES

  NO

• Comments:

• Power Steering

  YES

  NO

• Comments:

MISC.

• All garbage emptied

  YES

  NO

• Comments:

• Stretcher Clean & Made

  YES

  NO

• Comments:

• Patient Area Clean & Sanitized

  YES

  NO

• Comments:

• CAB Clean & Sanitized

  YES

  NO

• Comments:

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

  YES

  NO

• Comments:

• Outside Washed

  YES

  NO

• Comments:

• Officers Signature:

  Sign