Ambulance Checks

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

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Medical Bag Intubation Equipment

• Heine Laryngoscope

  Yes

  No

  N/A

• Guedel Airways (assorted sizes)

  Yes

  No

  N/A

• ETT Tubes (assorted sizes)

  Yes

  No

  N/A

• ETT Connections

  Yes

  No

  N/A

• Lubricant

  Yes

  No

  N/A

• Tape

  Yes

  No

  N/A

• Resus Shields

  Yes

  No

  N/A

• Pocket Mask

  Yes

  No

  N/A

• Spare Batteries

  Yes

  No

  N/A

• 10 mL Syringe

  Yes

  No

  N/A

• Ambu Bag

  Yes

  No

  N/A

• Tracheostomy Bag

  Yes

  No

  N/A