Ambulance Supply and Equipment Inspection

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• What unit is being inspected?

  2151

  2152

  2153

Cab

• Clip Board (inventory in appropriate section)

  Yes

  No

  N/A

• Maps

  Yes

  No

  N/A

• Emergency Response Guidebook (current edition)(Passenger Door)

  Yes

  No

  N/A

• Portable Radio (functional)

  Yes

  No

  N/A

• Hospital Key Cards / Fobs (Warren, Morristown, Pocono, Hunterdon, Hackettstown)

  Yes

  No

  N/A

• Reflective Vests (driver and passenger door pockets)

  Yes

  No

  N/A

• Garage Door Opener

  Yes

  No

  N/A

• Fuel Card (clipped to driver's visor)

  Yes

  No

  N/A

• Binoculars

  Yes

  No

  N/A

Outside of Ambulance

Driver's Side Compartment 1

• Reeves

  Safe

  At Risk

  N/A

• Main Oxygen Cylinder (Note pressure and it leaking when turned on) (minimum 500 psi)

  Safe

  At Risk

  N/A

• Fire Extinguisher (initial tag also)<br>

  Safe

  At Risk

  N/A

Driver's Side Compartment 2

• First Aid / Trauma Bag (Orange) Inventory in appropriate section

  Yes

  No

  N/A

• Oxygen Bag (inventory in appropriate section)

  Yes

  No

  N/A

• Flashlights (2)

  Yes

  No

  N/A

• Burn Kit (Note Seal #)(inventory in appropriate section)

  Yes

  No

  N/A

• MAST Trousers

  Yes

  No

  N/A

• Towel Bag

  Yes

  No

  N/A

• Rehab / MCI Bag

  Yes

  No

  N/A

• Flares (10)

  Yes

  No

  N/A

• Work Gloves (2 Pair)

  Yes

  No

  N/A

• Body Bags (2)

  Yes

  No

  N/A

• Caution Tape (1)

  Yes

  No

  N/A

• Refelctive Vest (2)

  Yes

  No

  N/A

• Halligan Bar (1)

  Yes

  No

  N/A

• Hacksaw (3 spare blades)

  Yes

  No

  N/A

• Contact Paper (1 roll)

  Yes

  No

  N/A

• Lawn Mower Blade (1)

  Yes

  No

  N/A

Driver's Side Compartment 3

• Gatorade (1 case)

  Yes

  No

  N/A

• Water (1 case)

  Yes

  No

  N/A

• Blanket Roll (1)

  Yes

  No

  N/A

• Rescue Helmet (2)

  Yes

  No

  N/A

• Work Gloves (2 pair)

  Yes

  No

  N/A

• Jumper Cables (1)

  Yes

  No

  N/A

• Tool Box

  Yes

  No

  N/A

• Triage Bags (2) (note seal numbers)

  Yes

  No

  N/A

Passenger Side Compartment 1

• Pillow (1)

  Yes

  No

  N/A

• Bed Pan (1)

  Yes

  No

  N/A

• Large Emesis Pan (4)

  Yes

  No

  N/A

• Urinal (1)

  Yes

  No

  N/A

• CPR Board (1)

  Yes

  No

  N/A

• AED (inventory in appropriate section)

  Yes

  No

  N/A

• Portable Suction (test functionality) inventory in appropriate section

  Yes

  No

  N/A

Passenger Side Compartment 2

• Backboard (2)

  Yes

  No

  N/A

• Orthopedic Stretcher

  Yes

  No

  N/A

• Stairchair

  Yes

  No

  N/A

• KED (2)

  Yes

  No

  N/A

Interior Cabinets

Driver's Side 1

• BVM - Adult (1)

  Yes

  No

  N/A

• BVM - Child (1)

  Yes

  No

  N/A

• BVM - Infant (1)

  Yes

  No

  N/A

• Manual Suction Unit (1)

  Yes

  No

  N/A

• Nasal Cannula - Adult (5)

  Yes

  No

  N/A

• Nasal Cannula - Pediatric (5)

  Yes

  No

  N/A

• Non-Rebreather - Adult (5)

  Yes

  No

  N/A

• Non-Rebreather - Pediatric (5)

  Yes

  No

  N/A

• Oxygen Tubing (3)

  Yes

  No

  N/A

• Humidifier Jars (2)

  Yes

  No

  N/A

• Trauma Shears (2)

  Yes

  No

  N/A

• Ammonia Inhalants (10) Note Expiration Date

  Yes

  No

  N/A

• Insect Sting Swabs (10) Note Expiration Date

  Yes

  No

  N/A

• Foil Blanket (1)

  Yes

  No

  N/A

• Pen Lights (2) (Check functionality)

  Yes

  No

  N/A

• Bite Stick (2)

  Yes

  No

  N/A

• Infant Suction Catheters (4)

  Yes

  No

  N/A

• 8 Fr Catheters (4)

  Yes

  No

  N/A

• 10 Fr Catheters (4)

  Yes

  No

  N/A

• 12 Fr Catheters (4)

  Yes

  No

  N/A

• 14 Fr Catheters (4)

  Yes

  No

  N/A

• 16 Fr Catheters (4)

  Yes

  No

  N/A

• 18 Fr Catheters (4)

  Yes

  No

  N/A

• Yankuer (4)

  Yes

  No

  N/A

• Large Bore Yankuer (4)

  Yes

  No

  N/A

• Demand Masks (2)

  Yes

  No

  N/A

• Small Emesis Basin (3)

  Yes

  No

  N/A

• Oral Airways Size 0-5 (2 sets)

  Yes

  No

  N/A

• Nasal Airways 18 fr - 34 fr (1 set)

  Yes

  No

  N/A

• Surilube (10 Packets)

  Yes

  No

  N/A

• Surgical Masks (10)

  Yes

  No

  N/A

• InstaGlocose (2) (note expiration dates)

  Yes

  No

  N/A

• Digital Thermometer and probe covers

  Yes

  No

  N/A

Drivers Side 2

• Suction Canisters with lids (3)

  Yes

  No

  N/A

• Suction Tubing (5)

  Yes

  No

  N/A

• Sterile Water (1) (note expiration date)

  Yes

  No

  N/A

• CPR Pocket Mask (1)

  Yes

  No

  N/A

• Sanitizing Wipes (1 Box)

  Yes

  No

  N/A

• Tissues

  Yes

  No

  N/A

• Convenience Bags (2)

  Yes

  No

  N/A

Drivers Side 3

• CIDs (2)

  Yes

  No

  N/A

• Collar Bag (inventory in appropriate section)(1)

  Yes

  No

  N/A

• 4x4 Gauze Pads (50)

  Yes

  No

  N/A

• 3x3 Gauze Pads (40)

  Yes

  No

  N/A

• 2x2 Gauze Pads (40)

  Yes

  No

  N/A

• 5x9 Gauze Pads (12)

  Yes

  No

  N/A

• Eye Pads (12)

  Yes

  No

  N/A

• Non-Adhesive Gauze (4)

  Yes

  No

  N/A

• Aluminum Foil (1 box)

  Yes

  No

  N/A

• Kerlex (6)

  Yes

  No

  N/A

• Band-aids (1 box) minimum 1/2 full

  Yes

  No

  N/A

• 1" Roller Gauze (12)

  Yes

  No

  N/A

• 2" Roller Gauze (12)

  Yes

  No

  N/A

• 4" Roller Gauze (12)

  Yes

  No

  N/A

• Petroleum Bandage (4)

  Yes

  No

  N/A

• 1/2" Tape (2)

  Yes

  No

  N/A

• 1" Tape (2)

  Yes

  No

  N/A

• 2" Tape (2)

  Yes

  No

  N/A

Driver's Side 4

• Saline (8) Note closest expiration date

  Yes

  No

  N/A

• Sterile Water (8) Note closest expiration date

  Yes

  No

  N/A

• Eye Wash (8) Note closest expiration date

  Yes

  No

  N/A

• Cold Packs (12)

  Yes

  No

  N/A

• Heat Packs (4)

  Yes

  No

  N/A

• Cravats (24)

  Yes

  No

  N/A

• Large Cling Wrap (6)

  Yes

  No

  N/A

• Chuck Pads (5)

  Yes

  No

  N/A

• OB Kits (2) Sealed (inventory on box)

  Yes

  No

  N/A

Passenger Side 1

• Sheets (5)

  Yes

  No

  N/A

• Blankets (6)

  Yes

  No

  N/A

• Towels

  Yes

  No

  N/A

• Disinfecting Wipes (at least 1/4 full)

  Yes

  No

  N/A

• Spray Bottle Envirocide (at least 1/4 full)

  Yes

  No

  N/A

• Patient Privacy Packages (2)

  Yes

  No

  N/A

• Tyvek Suits (2)

  Yes

  No

  N/A

Passenger Side Stairwell

• Spare oxygen cylinders (2)

  Yes

  No

  N/A

Passenger Side 2

• Blood Pressure Cuffs<br>Large Adult, Peds, Infant

  Yes

  No

  N/A

• Spare Batteries for Pulse Oximeters (6)

  Yes

  No

  N/A

• Stethoscope<br>Adult, Infant

  Yes

  No

  N/A

• Spare Gloves Small, Med, Large, X-Large (1 box each unopened)

  Yes

  No

  N/A

• Restraints

  Yes

  No

  N/A

• Toys

  Yes

  No

  N/A

• Bible

  Yes

  No

  N/A

Treatment Shelf

• Pulse Oximeter (check functionality)

  Yes

  No

  N/A

• CO Ox Meter (2153 only) (check functionality)

  Yes

  No

  N/A

• Adult BP Cuff & Stethescope

  Yes

  No

  N/A

• Gloves Small, Med, Large, X-Large (one box each)

  Yes

  No

  N/A

Bench Seat

• Portable Stretcher (behind backrest)

  Yes

  No

  N/A

• Peds Backboard (1)

  Yes

  No

  N/A

• Padded Board Splint Kit (see appropriate section for inventory)

  Yes

  No

  N/A

• Short Board

  Yes

  No

  N/A

• Traction Splint

  Yes

  No

  N/A

• Wool Blanket

  Yes

  No

  N/A

• Child Seat

  Yes

  No

  N/A

• Is the case in good condition?

  Yes

  No

  N/A

Left Outside Compartment

• 10x30 Trauma Dressing

  Yes

  No

  N/A

Right Outside Pocket

• Adult BP Cuff & Stethoscope

  Yes

  No

  N/A

Main Compartment

Lid Pocket

• Instaglucose (note expiration date)

  Yes

  No

  N/A

• Tourniquet

  Yes

  No

  N/A

• Trauma Shears (1)

  Yes

  No

  N/A

• Pen Light (2)

  Yes

  No

  N/A

Top Row

• Sting Swabs (note expiration date)

  Yes

  No

  N/A

• Ammonia Inhalants (note expiration date)

  Yes

  No

  N/A

• Bite Stick (2)

  Yes

  No

  N/A

• Snake Bite Kit (1)

  Yes

  No

  N/A

• Ring Cutter

  Yes

  No

  N/A

• Tweezer

  Yes

  No

  N/A

• Safety Pins

  Yes

  No

  N/A

Middle Row

• Eye Pads (5)

  Yes

  No

  N/A

• Band-Aids (15)

  Yes

  No

  N/A

• 1" Roller Gauze (2)

  Yes

  No

  N/A

• 2" Roller Gauze (2)

  Yes

  No

  N/A

• 3" Roller Gauze (2)

  Yes

  No

  N/A

• 1/2" Tape (1)

  Yes

  No

  N/A

• 1" Tape (1)

  Yes

  No

  N/A

• 2" Tape (1)

  Yes

  No

  N/A

• 3" Tape (1)

  Yes

  No

  N/A

• Cravats (6)

  Yes

  No

  N/A

Bottom Row

• 5x9 Gauze Pads (8)

  Yes

  No

  N/A

• 8x7.5" Gauze Pads (5)

  Yes

  No

  N/A

• 4x4 Gauze Pads (15)

  Yes

  No

  N/A

• 3x3 Gauze Pads (10)

  Yes

  No

  N/A

• 2x2 Gauze Pads (10)

  Yes

  No

  N/A

• Ice Packs

  Yes

  No

  N/A

• Large Kerlix Roll (1)

  Yes

  No

  N/A

• Vaseline Gauze Pad (2)

  Yes

  No

  N/A

• Gloves (4 Pairs)

  Yes

  No

  N/A

• Sterile Water (note expiration date) (1)

  Yes

  No

  N/A

• CPR Mask (1)

  Yes

  No

  N/A

• Emmesis Bags (2)

  Yes

  No

  N/A

• Is the case in good condition?

  Yes

  No

  N/A

Peds Compartment

• Nasal Cannula (3)

  Yes

  No

  N/A

• Non-Rebreather (3)

  Yes

  No

  N/A

Adult Compartment

• Nasal Cannula (3)

  Yes

  No

  N/A

• Non-Rebreather (3)

  Yes

  No

  N/A

End Compartment

• Epi-Pen Adult (1) (note expiration date)

  Yes

  No

  N/A

• Epi-Pen Jr (1) (note expiration date)

  Yes

  No

  N/A

• Instant Glucose (note expiration date)

  Yes

  No

  N/A

• Spare Oxygen Tubing (1)

  Yes

  No

  N/A

Main Compartment

• Oxygen Cylinder (minimum 800 psi)

  Yes

  No

  N/A

• Regulator

  Yes

  No

  N/A

• Oxygen Wrench

  Yes

  No

  N/A

• Adult BP Cuff & Stethoscope

  Yes

  No

  N/A

Lid

• Nasal Airway Kit

  Yes

  No

  N/A

• Oral Airway Kit

  Yes

  No

  N/A

• Adult BVM

  Yes

  No

  N/A

• Is the case in good condition?

  Yes

  No

  N/A

• Is the seal intact. (note the date on the seal)<br>The date on the seal is the closest expiration date. If it is close open and replace expiring items.

  Yes

  No

  N/A

• Sterile Water (8)

  Yes

  No

  N/A

• Trauma Shears

  Yes

  No

  N/A

• 60x96 Burn Dressing

  Yes

  No

  N/A

• 20x30 Burn Dressing (2)

  Yes

  No

  N/A

• 15x20 Burn Dressing (2)

  Yes

  No

  N/A

• 12x12 Burn Dressing (2)

  Yes

  No

  N/A

• Face Masks (2)

  Yes

  No

  N/A

• 3" Roller Gauze (2)

  Yes

  No

  N/A

• 2" Roller Gauze (2)

  Yes

  No

  N/A

• 1" Tape (1)

  Yes

  No

  N/A

• 1/2" Tape (1)

  Yes

  No

  N/A

• Kerlix (1)

  Yes

  No

  N/A

• Is the case in good condition?

  Yes

  No

  N/A

• Towels (8)

  Yes

  No

  N/A

• Blankets (2)

  Yes

  No

  N/A

• Is the case in good condition?

  Yes

  No

  N/A

• Tarp

  Yes

  No

  N/A

• Garbage Bags

  Yes

  No

  N/A

• Large Adult BP Cuffs (4)

  Yes

  No

  N/A

BP Cuff Kits (4) (each should have the following contents)

• Stethoscope

  Yes

  No

  N/A

• Trauma Shears

  Yes

  No

  N/A

• Adult BP Cuff

  Yes

  No

  N/A

Clipboard (4) (these items should be in each clipboard)

• Pens (4)

  Yes

  No

  N/A

• Rehab Sheets (20)

  Yes

  No

  N/A

• PCR Page 1 (20)

  Yes

  No

  N/A

• PCR page 2 (20)

  Yes

  No

  N/A

• RMA (20)

  Yes

  No

  N/A

• Add Kit

Triage Kit

• Is the case in good condition?

  Yes

  No

  N/A

• Is the bag sealed? (note seal number)<br>If the seal is in place mark inventory section N/A

  Yes

  No

  N/A

Inventory

• Triage Tags (25)

  Yes

  No

  N/A

• Grease Pencils (2)

  Yes

  No

  N/A

• Pens (2)

  Yes

  No

  N/A

• Oral Airways (90mm) (5)

  Yes

  No

  N/A

• Oral Airways (100mm) (5)

  Yes

  No

  N/A

• Oral Airways (110mm) (5)

  Yes

  No

  N/A

• In the box in good condition?

  Yes

  No

  N/A

• Assorted Wrenches

  Yes

  No

  N/A

• Assorted Screwdrivers

  Yes

  No

  N/A

• 3 lbs Sledge

  Yes

  No

  N/A

• Bolt Cutters

  Yes

  No

  N/A

• Window Punch

  Yes

  No

  N/A

• Is the case in good condition?

  Yes

  No

  N/A

• AED turns on and is functional

  Yes

  No

  N/A

• Electrode Pads (2)

  Yes

  No

  N/A

• Pediatric Mode Key

  Yes

  No

  N/A

• Disposable Razor (2)

  Yes

  No

  N/A

• Trauma Shears

  Yes

  No

  N/A

• Spare Battery

  Yes

  No

  N/A

• Are the bags in good condition?

  Yes

  No

  N/A

• Unplug unit and run it while inspecting Start time

  Date

• End time

  Date

Inventory

• 6 French Catheter (2)

  Yes

  No

  N/A

• 8 French Catheter (1)

  Yes

  No

  N/A

• 10 French Catheter (1)

  Yes

  No

  N/A

• 12 French Catheter (1)

  Yes

  No

  N/A

• 14 French Catheter (1)

  Yes

  No

  N/A

• 16 French Catheter (1)

  Yes

  No

  N/A

• 18 French Catheter (1)

  Yes

  No

  N/A

• Yankeur (3)

  Yes

  No

  N/A

• Large Bore Yankeur (3)

  Yes

  No

  N/A

• Sterile Water (note expiration date)

  Yes

  No

  N/A

• Is the bag in good condition?

  Yes

  No

  N/A

Inventory

• Adult Adjustable (2)

  Yes

  No

  N/A

• Tall (1)

  Yes

  No

  N/A

• Short (1)

  Yes

  No

  N/A

• No Neck (1)

  Yes

  No

  N/A

• Regular (1)

  Yes

  No

  N/A

• Pediatric Adjustable (1)

  Yes

  No

  N/A

• Pediatric (1)

  Yes

  No

  N/A

• Infant (1)

  Yes

  No

  N/A

• Baby No Neck (1)

  Yes

  No

  N/A

• Spider Straps (2) (in good condition)

  Yes

  No

  N/A

• Is the clipboard in good condition?

  Yes

  No

  N/A

Inventory

• PCR Page 1 (10)

  Yes

  No

  N/A

• PCR Page 2 (10)

  Yes

  No

  N/A

• RMA (10)

  Yes

  No

  N/A

• Pens (4)

  Yes

  No

  N/A

• Is the bag in good condition?

  Yes

  No

  N/A

Inventory

• Short (2)

  Yes

  No

  N/A

• Medium (2)

  Yes

  No

  N/A

• Long (2)

  Yes

  No

  N/A

• Is the box in good condition?

  Yes

  No

  N/A

• Wrenches (1 set)

  Yes

  No

  N/A

• Screwdrivers Standard & Phillips (1 ea)

  Yes

  No

  N/A

• Bolt Cutters (1)

  Yes

  No

  N/A

• Small Adjustable Wrench (1)

  Yes

  No

  N/A

• Large Adjustable Wrench (1)

  Yes

  No

  N/A

• Center Punch (1)

  Yes

  No

  N/A

• Channel Locks (1)

  Yes

  No

  N/A

• Vise Grips (1)

  Yes

  No

  N/A

• Wire Cutters (1)

  Yes

  No

  N/A

• Linoleum Knife (1)

  Yes

  No

  N/A

• Small Sledge Hammer (1)

  Yes

  No

  N/A