Ambulance 3 Daily Check

• Conducted on

  Date

• Prepared by

• In Service

  Yes

  No

  N/A

• General Condition

  Good

  Fair

  Poor

  N/A

• Fuel

• Gloves/masks in cab stocked

  Yes

  No

  N/A

• Stretcher Battery Swapped

  Yes

  No

  N/A

Lucas Device

• Clean

  Yes

  No

  N/A

• Suction cup installed

  Yes

  No

  N/A

• Patient arm straps working

  Yes

  No

  N/A

• Head straps and clips present

  Yes

  No

  N/A

• Pull release rings and make sure clasps open

  Yes

  No

  N/A

• Back plate is clean and not cracked

  Yes

  No

  N/A

• Base plate pins secured

  Yes

  No

  N/A

• Swap batteries

  Yes

  No

  N/A

• Turn Lucas on and let it do self test

  Yes

  No

  N/A

• Second battery plugged in and charging

  Yes

  No

  N/A

First In Bag

• Intubation Kit present/stocked

  Yes

  No

  N/A

• IV kit with IO present/stocked

  Yes

  No

  N/A

• CBG kit present/stocked

  Yes

  No

  N/A

• Code Epi 1 & 2

  Yes

  No

  N/A

• Narcan 1 & 2

  Yes

  No

  N/A

• Adult Epi 1 & 2

  Yes

  No

  N/A

• Junior Epi 1 & 2

  Yes

  No

  N/A

• Oral Glucose

  Yes

  No

  N/A

• Aspirin

  Yes

  No

  N/A

• Video Laryngoscope present/charged

  Yes

  No

  N/A

• Portable O2 level normal

  Yes

  No

  N/A

• Trauma Bags

  Yes

  No

  N/A

• Collar Bags

  Yes

  No

  N/A

• Longboards/Scoop Stretcher

  Yes

  No

  N/A

• Speedy Dry

  Yes

  No

  N/A

• Pedi Bag

  Yes

  No

  N/A

• KED/Traction Splint

  Yes

  No

  N/A

• Stair chair

  Yes

  No

  N/A

• Main O2 level normal

  Yes

  No

  N/A

Life Pack

• Free of debris and intact

  Yes

  No

  N/A

• Defib cable

  Yes

  No

  N/A

• Limb lead cable

  Yes

  No

  N/A

• 12 lead cable

  Yes

  No

  N/A

• Pulse Ox

  Yes

  No

  N/A

• BP cuffs (adult, bari, pedi)

  Yes

  No

  N/A

• ETCO2 ETT/NC

  Yes

  No

  N/A

• Spare paper/battery

  Yes

  No

  N/A

• Pedi pulse ox

  Yes

  No

  N/A

• Electrodes in container

  Yes

  No

  N/A

• Spare electrodes in truck

  Yes

  No

  N/A

• Exchanged batteries as needed

  Yes

  No

  N/A

• Perform user test and transmit test

  Yes

  No

  N/A

• IV drawer stocked

  Yes

  No

  N/A

• Fracture-Pak

  Yes

  No

  N/A

• Air splints

  Yes

  No

  N/A

• Pedi-mate

  Yes

  No

  N/A

• Cabinets Stocked/Neat

  Yes

  No

  N/A