Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Name:

• Signature

  Sign

Driver side long

• Drivers side long all items in this category are present

• O2 main tank above 500

• Fire extinguisher

• O2 tank wrench

Driver side middle

• Drivers side middle all items in this category are present

• Ball peen hammer

• Bolt cutter

• Crash axe x3

• Flathead axe

• Generator

• Haligan tool

• Mallet x3

• Pry bar

• Rabbit tool

• Road flares x5

• Road triangles

• Shovel

• Sledge hammer

• Tarp

• Tool box

Passenger side rear

• All items in this category are present

• Backboards with straps x3

• KED

• Peds board

• Reeves stretcher

• Splint boards

Passenger side small

• All items in this category are present

• Head boards x3

• C-Collars (adult) x3

• C-Collars (Peds) x3

• C-Collar bag

Front cab

• All items in this category are present

• Binoculars

• Crate

• Hazmat guide

• Radios x2

Exterior lighting and inspection

• All items in this category are present

• Fuel level above 3/4

• Oil

• Brake fluid

• Transmission fluid

• Windshield washing fluid

• Engine coolant level

• Headlights wig wag

• Front light bar

• Rear light bar

• Back up alarm

• Scene lights left

• Scene lights right

• Scene lights rear

• Red strobe lights front

• Red strobe lights left

• Red strobe lights right side

• Red strobe lights rear

• Tires

• Mirrors

Bench seat

• All items in this category are present

• Sager splint

• Sam pelvic slings

• MAT tourniquet

• Linen (packaged)

• Linen (cabinets 12 and 13)

• Burn kit and blankets

Miscellaneous in back of squad

• All items in this category are present

• Gloves small

• Gloves medium

• Gloves large

• Gloves extra large

Cabinet 11

• All Items in this category are present

• Peds bag

• Bull horn

• O2 D tanks x3

• Drug box#

• Drug seal #

• Replacement drug box #

• Replacement box seal #

Cabinet 1 (airway)

• All items in this category are present

• Adult N/C x2

• Adult NRB x2

• ET tube ties x2

• ET tubes (6.0-8.5)

• Infant NRB x2

• Nebulizer x2

• Peds N/C x2

• Peds NRB x2

• RES Q GARD x2

• RES Q POD x2

• Stylets x2

• Emergency Crich kit

Cabinet 2

• All items in this category are present

• CPAP

• CPAP masks x3 S/M/L

• O2 D tank

• Suction canister

• Suction tubing x2

• Yankauer x2

• Suction catheter x7

• Meconium aspirator

• Tongue depresor

• Thermometer covers

• Ring cutter

• Soft restraints

• Trauma shears

• All items in this category are present

• Stethoscopes x2

• Cell phone

• Cell phone charger

• Pen light

• Suction canister

• Suction tubing

• Alcohol preps

• Lancets

• Glucometer

• Glucometer strips

• Thermometer

• Band aids

• Trauma shears

• Tape

Cabinet 5 (monitor supplies)

• All items in this category are present

• Electrodes

• Combo pads (adult) x2

• Combo pads (Peds) x2

• EZ IO

Life pak 15

• All items in this category are present

• Batteries (fully charged)

• BP cuff (S/M/L)

• 3 lead cables

• 12 lead cables

• SPO2 cord

• Electrodes

• EKG paper

• Combo pads adult x2

• Combo pads Peds x2

• Defib cable

• Capnography (nasal)

• Capnography (oral)

• EKG test/transmit test

Cabinet 3 (trauma supplies)

• All items in this category are present

• 4 x 4

• 2 x 2

• Abd. Dressing

• Kling

• Trauma dressing

• Ice packs x4

• Heat packs x4

• MAT tourniquet

• SAM sling

• Triangle bandage

• OB kit x2

• Sling x2

Cabinet 4 (IV supplies)

• All items in this category are present

• IV tray

• Tourniquets

• Tegaderms

• 24g

• 22g

• 20g

• 18g

• 16g

• Pressure infuser

• 10 gtts drip set

• 60 gtts drip sets

Cabinets 6 (infection control)

• All items in this category are present

• Infection control kit

• Foil

• Masks (n95)

• Bed pan

• Chucks x3

Cabinet 8 (secured cabinet)

• All items in this category are present

• SCBA x2

• SCBA tanks psi 4000 or greater

• Masks x2

• Stair chair

• LUCAS CPR

Cabinet 9 (VAC splints)

• All items in this category are present

• Fire line tape

• Safety vests x2

• MCI triage pack

• Vacuum splint bag

• Vacuum splint pump

• Vacuum splint small

• Vacuum splint medium

• Vacuum splint large

Jump bag (blue-intubation kit)

• All items in this category are present

• 2.5

• 3.0

• 3.5

• 4.0

• 4.5

• 5.0

• 5.5

• 6.0

• 6.5

• 7.0

• 7.5

• 8.0

• 8.5

• 9.0

• 9.5

• 10 cc syringe x2

• Bite stick

• Lubricating jelly

• MAC 4 blade

• MAC 3 blade

• MAC 2 blade

• MAC 1 blade

• Miller 4 blade

• Miller 3 blade

• Miller 2 blade

• Miller 1 blade

• Miller 0 blade

• Oral airways (diff sizes) 5 total

• Nasal airways (diff sizes) 4 total

• Magill forsceps 2

• ETCO

• ET tube ties

• RES Q POD

• Laryngyscope (adult)

• Laryngyscope (Peds)

• IV NS 1000 ml x5

• IV NS 500 x5

• Mark kit

Cabinet 10

• All items in this category are present

• Vial of life

• Clip board

• Trauma shears

• O2 metal key

• Cabinet 8 keys

• Spare set of keys

• 9 volt batteries x2

• EKG monitor battery

• UH protocol book

• ACCU check book

Jump bag (blue)

• All items in this category are present

• Pressure infuser

• Trauma shears

• SPO2 meter

• Glide scope and attachment

• Glucometer

• King airways x3

• Normal saline bottle

• Sterile water 1 bottle

• Manual suction

• BVM

• EZ IO w/3 needles

• Quicktrach

• King vision laryngyscope

• King vision screen

Trauma bag (green)

• All items in this category are present

• Pen light

• Tape

• Bite stick

• Trauma shears

• 24g x2

• 22g x2

• 20g x2

• 18g x2

• 16g x2

• Alligator clips x2

• Tegaderms

• Alcohol preps

• 10 ml syringe x2

• 3 ml syringe x4

• IV flush x2

• Nebulizer

• Aerosol mask

• NRB

• N/C

• Glucometer and strips

• IV NS 500 ml

• IV drip gtts

• EZ IO and needles

• SPO2 meter

• IV kit

• BP cuff

• Stethoscope

• Sharps container

Peds bag (red)

• All items in this category are present

• Pedi wheel

• CO2 detector

• Sharps container

• Peds SPO2

• Neonatal (green) bag

• 4-7 kg (red) bag

• 8-11 kg (purple)

• 12-14 kg (yellow) bag

• 14-17 kg (white) bag

• 18-22 kg (blue) bag

• 24-30 kg (orange) bag

• Peds BVM left side

• Peds BVM right side

• Laryngyscope (Peds)

• EKG patches (3 pak)

• C-batteries x2

• Oral airway

• Magill forsceps

• Bulb syringe x2

• N/C x2

• ET tubes 3.0

• ET tubes 4.0

• ET tubes 5.0

• ET tubes 6.0

• Note any missing/damaged items and date