Back-Up Squad Long Check

• Personnel Completing Check (Dept. ID Number)

• Conducted on

  Date

Back Up Squad Long Check Wednesday

Basic Information

• Squad Number

  Squad 1 (A)

  Squad 2 (B)

  Squad 3 (C)

• Fuel Level - Refuel If Less Then 1/2

  < 1/2

  1/2

  3/4

  7/8

  F

• Knox Key Present

  Yes

  No

• Lights, Horn, Sirens

  Yes

  No

• Map Book/Clipboard/Run Reports

  Yes

  No

• Check Portable Radios

  Yes

  No

• Check/Charge/Reset Active 9-11 iPad/Clear Active 9-11 Runs<br>(Ensure that the iPad screen is off)

  Yes

  No

• Check/Charge/Reset iPad for Patient Reports

  Yes

  No

• Delete Photos In the Camera Roll

• Clear HIPAA/Refusal Forms

• Close all Apps

• On-board Oxygen Pressure Change at 500psi

  Select <500 psi 600 psi 700 psi 800 psi 900 psi 1000 psi 1100 psi 1200 psi 1300 psi 1400 psi 1500 psi 1600 psi 1700 psi 1800 psi 1900 psi 2000 psi

  • <500 psi
  • 600 psi
  • 700 psi
  • 800 psi
  • 900 psi
  • 1000 psi
  • 1100 psi
  • 1200 psi
  • 1300 psi
  • 1400 psi
  • 1500 psi
  • 1600 psi
  • 1700 psi
  • 1800 psi
  • 1900 psi
  • 2000 psi

• Drug Seal Color

  Green

  Yellow

  Red

• Drug Seal Color

  Green

  Yellow

  Red

• Portable Oxygen Pressure: 1000psi minimum

  Select 1000 psi 1100 psi 1200 psi 1300 psi 1400 psi 1500 psi 1600 psi 1700 psi 1800 psi 1900 psi 2000 psi

  • 1000 psi
  • 1100 psi
  • 1200 psi
  • 1300 psi
  • 1400 psi
  • 1500 psi
  • 1600 psi
  • 1700 psi
  • 1800 psi
  • 1900 psi
  • 2000 psi

• Spare Oxygen Pressure: 1000psi minimum (Located Under Bench Seat)

  Select 1000 psi 1100 psi 1200 psi 1300 psi 1400 psi 1500 psi 1600 psi 1700 psi 1800 psi 1900 psi 2000 psi

  • 1000 psi
  • 1100 psi
  • 1200 psi
  • 1300 psi
  • 1400 psi
  • 1500 psi
  • 1600 psi
  • 1700 psi
  • 1800 psi
  • 1900 psi
  • 2000 psi

• Check/Charge Cell Phone

  Yes

  No

• Check Lucas Device/Batteries x2

  Yes

  No

• Check King Vision<br>(Turn on unit without blade attached and ensure there is a green light in the top left hand corner, change batteries if green light is not present or if there is a red light, ensure there are spare batteries)

  Yes

  No

• Check Laryngoscope<br>(Check both the Adult and Pediatric Laryngoscope. Pediatric handle is located in the Peds Bag)

  Yes

  No

• Check Life-Pak/Batteries

  Yes

  No

• Check Cot Battery

  Yes

  No

• Check SCBA's

  Yes

  No

• Vehicle Equipment In Place

  Yes

  No

Long Check Information

• Vehicle Mileage

• Oil Level (15W40)

  Yes

  No

• Brake Fluid Level

  Yes

  No

• Power Steering Level

  Yes

  No

• Transmission Fluid Level

  Yes

  No

• Radiator Level

  Yes

  No

• Check Rear Heater/Air Cond.

  Yes

  No

• Check On-Board Suction

  Yes

  No

• Check Interior Lights

  Yes

  No

• Check Tire Pressure (110 front/110 rear)

  Yes

  No

• Transmit Test 12-lead

  Yes

  No

• Check Radios

  Yes

  No

• Change Cot Battery

  Yes

  No

• Check Toolbox

  Yes

  No

• Check Extingushers

  Yes

  No

• Check Windshield Wipers/Fluid

  Yes

  No

• Sanitize Squad

  Yes

  No

• Complete Inventory Per Toolbook

  Yes

  No

• Click to View Toolbook

Comments

• Would you like to leave any additional comments regarding defects, damage and/or missing equipment?

  Yes

  No

• Please list any defects, damage and/or missing equipment here.

Personnel Information

• Personnel Completing Check (List the Last Name of All Personnel Completing The Check)

• Conducted On

  Date