Information
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1831 Weekly Check
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Conducted on
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Personal checking vehicle
- Allen Badger
- Matt Cappelen
- Ben Rittenhouse
- Mike Baumgart
- Scott Lyng
- Andrew Schultz
- Paul Ursini
- Andy Shiner
- Jeff Sherwood
- John Loesch
- Patrick Watson
- Scott Sulak
- Scott Miller
- John Gray
- Scott Birchall
- Steve Tarczynski
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Vehicle Miles:
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Vehicle Hours:
ZOLL MONITOR
ZOLL Monitor
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Tested Monitor
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Comments:
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Adult Defib Pads ( 1 )
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Expiration Date:
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Comments:
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Peds Defib Pads ( 1 )
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Expiration Date:
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Comments:
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Defib Test Cord ( 1 )
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Comments:
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Adult Electrodes ( 1 pk )
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Comments:
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Peds Electrodes ( 1 pk )
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Comments:
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Spare Battery ( 1 ): Rotate battery
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Comments:
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4 Lead Cables ( 1 ): Cleaned & Wrapped Up
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Comments:
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12 Lead Cables ( 1 ): Cleaned & Wrapped Up
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Comments:
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Razor ( 1 )
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Comments:
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CO2 ET Tube Connecter ( 2 )
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Comments:
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CO2 Nasal Monitor ( 2 )
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Comments:
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SPO2 Sensor ( 1 )
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Comments:
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Peds SPO2 Sensor ( 1 )
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Comments:
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Additional Comments:
JUMP BAG
Jump Bag
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Airway Pocket & O2 Side Pocket 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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Tag#:
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Comments:
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Vitals Pocket Tagged?
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Tag#:
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Comments:
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Additional Comments:
PEDS BAG
PEDIATRIC BAG
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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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Front 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:
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Additional Comments:
CPAP / PORTABLE SUCTION
CPAP
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Tag #:
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Comments:
PORTABLE SUCTION
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Tubing
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Comments:
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Suction Catheters 8, 10, 12, & 16
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Comments:
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Additional Comments:
INTERIOR CABINETS
Interior Cabinet #1
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Tag #:
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Comments:
Interior Cabinet #2
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Tag #:
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Comments:
ALS DRUG EQUIPMENT
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Tag #:
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Comments:
PMIC Desk
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SOP's
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Comments:
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Cell Phone with charger
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Comments:
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Calculator
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Comments:
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Safety Vest
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Comments:
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Portable Suction Gun
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Comments:
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Suction Tubing
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Comments:
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Suction Catheters
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Comments:
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Suction Canister
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Comments:
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Test Suction Unit to 300 mmhg
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Comments:
Interior Cabinet #3
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Triage Tags
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Comments:
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Drug Tags
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Comments:
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Rubberbands
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Comments:
Interior Cabinet #4
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Cavi Wipes
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Comments:
Interior Cabinet #5
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N95 Masks
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Comments:
Interior Cabinet #6
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Tag #:
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Comments:
Interior IV Cabinet #7
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Tag #:
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Comments:
Interior Cabinet #8
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Tag #:
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Comments:
Interior Cabinet #9
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Tag #:
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Comments:
Interior Cabinet #10
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Tag #:
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Comments:
Interior Cabinet #11
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Tag #:
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Comments:
Bench
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Wool Blanket ( 1 )
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Comments:
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Burn Sheet ( 1 )
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Comments:
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Pillows ( 2 )
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Comments:
Spare Items
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Oxygen Bottle ( 2 )
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Comments:
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Emesis Basin ( 2 )
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Comments:
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Sheets ( 3 )
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Comments:
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Blankets ( 3 )
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Comments:
MISC.
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Stretcher Clean & Made
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Comments:
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Patient Area Clean And Sanitized
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Comments:
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Additional Comments:
EXTERIOR CABINETS
Exterior Cabinet #1
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Pressurized Water Can
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Comments:
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6' Pike Pole
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Comments:
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O2 Bottle
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Comments:
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Peds Hare Traction
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Comments:
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Adult Hare Traction
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Comments:
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Air splints ( 1L, 1M, 1S, & Pump )
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Comments:
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KED
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Comments:
Exterior Cabinet #2
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Body Bag
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Comments:
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Wool Blankets
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Comments:
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ABC Extinguisher
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Comments:
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Transfer Tarp
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Comments:
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Safety Blanket
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Comments:
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Stair Chair: in working order & clean
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Comments:
Exterior Cabinet #3
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SCBA ( 2 ) :<br>Everything in working order. Bottle full w/ no leaks
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SCBA ( A ) P.S.I. :
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SCBA ( B ) P.S.I. :
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Comments:
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Flashlights ( 2 ):<br>Both work
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Comments:
Exterior Cabinet #4
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Scoop Stretcher:<br>Clean and in working order
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Comments:
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Backboards w/ Straps:<br>1 w/ spider straps, 1 w/ seat-belts, 1 blank. All clean
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Comments:
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Child Car Seat
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Comments:
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C-Collar Bag ( 2 Adult, 3 Peds/Infant )
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Comments:
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Adult Head Immobilizers ( 2 )
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Comments:
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Child Head Immobilizers ( 2 )
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Comments:
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Peds Backboard:<br>Clean w/ all straps
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Comments:
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Extra Spider Straps
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Comments:
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Additional Comments:
CAB
CAB
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Portable Radios ( 2 )
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Comments:
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Flashlight ( 1 )
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Comments:
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iPad Charged ( >75% )
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Comments:
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Gloves ( 1XL, 1L, 1M )
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Comments:
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Knox Box Key
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Comments:
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Passport Tags ( White & Red )
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Comments:
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Helmet Shields ( 2 )
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Comments:
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Safety Vests ( 2 )
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Comments:
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Maps ( FRC, County, Bartlett )
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Comments:
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Garage Openers ( Station 1, Delnor, & St. Joes )
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Comments:
CLIPBOARD
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IF SHEETS ARE LOW PLEASE PRINT THEM OUT AND REPLACE THEM
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10 Run Sheets
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10 Hippa Forms
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10 AMA/Refusal Forms
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10 Multiple Release Forms
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5 EMS Rehab Forms
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1 School Bus Form
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1 Involuntary Form
MISC.
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Cab Vacuumed & Cleaned Out
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Comments:
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Additional Comments:
MAINTENANCE
LIGHTS
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IF ANYTHING IS NOT WORKING PLEASE WRITE IT UP IN EMERGENCY REPORTING
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Emergency Lights
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Comments:
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Headlights ( High & Low Beam )
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Comments:
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Turn signals
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Comments:
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Brake Lights
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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:
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Reverse Lights
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Comments:
FLUID LEVEL
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IF FLUIDS ARE LOW PLEASE ADD, IF WE HAVE HERE, THEN PUT IT 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
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Comments:
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Transmission
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Comments:
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Power steering
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Comments:
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Washer Fluid
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Comments:
TIRE PRESSURE
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IF TIRES ARE LOW PLEASE ADD AIR AND THEN PUT IT IN EMERGENCY REPORTING
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Front Tires
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Front Left PSI:
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Front Right PSI:
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Comments:
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Rear Tires
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Left Inner PSI:
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Left Outer PSI:
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Right Inner PSI:
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Right Outer PSI:
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Comments:
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Additional Comments:
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Officers Signature:
