Title Page
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Conducted on
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Prepared by
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Location
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Select vehicle?
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Start or End of shift?
Vitals Pouch
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Gloves - Small (Box) - no of:
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Expiry date for box
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Expiry date for box 1
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Expiry date for box 2
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Expiry date for box 1
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Expiry date for box 2
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Expiry date for box 3
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Expiry date for box 1
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Expiry date for box 2
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Expiry date for box 3
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Expiry date for box 4
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Gloves - Medium (Box) - no of?
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Gloves - Large (Box) - no of?
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BP Cuff - Adult?
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BO Cuff - Infant?
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Scissors?
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Stethoscope?
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Glucose meter?