ComMedics - RV

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

Vehicle/Shift Details

• Vehicle Call sign

  Select RV01 RV02 RV03 RV04 RV05 RV06

  • RV01
  • RV02
  • RV03
  • RV04
  • RV05
  • RV06

• Division

  Atlantic Seaboard

  City Bowl

  Table View

• Shift

  Day

  Night

  Standby

• Standby End Time

  Date

• Standby Start Time

  Date

Crew Details

• Total crew on vehicle

• Senior Crew Full-name Member (1)

• Senior Crew Member Qualification (1)

  Select AEA BAA CCA Doctor ECP ECT NDip

  • AEA
  • BAA
  • CCA
  • Doctor
  • ECP
  • ECT
  • NDip

• Crew Full-name Member (2)

• Crew Member Qualification (2)

  Select AEA BAA CCA Doctor ECP ECT First Respnder NDip Nurse Unqualified

  • AEA
  • BAA
  • CCA
  • Doctor
  • ECP
  • ECT
  • First Respnder
  • NDip
  • Nurse
  • Unqualified

• Crew Full-name Member (3)

• Crew Member Qualification (3)

  Select AEA BAA CCA Doctor ECP ECT First Respnder NDip Nurse Unqualified

  • AEA
  • BAA
  • CCA
  • Doctor
  • ECP
  • ECT
  • First Respnder
  • NDip
  • Nurse
  • Unqualified

• Crew Full-name Member (4)

• Crew Member Qualification (4)

  Select AEA BAA CCA Doctor ECP ECT First Respnder NDip Nurse Unqualified

  • AEA
  • BAA
  • CCA
  • Doctor
  • ECP
  • ECT
  • First Respnder
  • NDip
  • Nurse
  • Unqualified

Any damage to vehicle or signage?

• Front

  Yes

  No

• Left (Passenger Side)

  Yes

  No

• Right (Driver side)

  Yes

  No

  N/A

• Rear

  Yes

  No

• Roof

  Yes

  No

• Undercarriage

  Yes

  No

Standard Lights Operational?

• Headlights Low/High

  Yes

  No

• Turn Signal Front Left/Right

  Yes

  No

• Turn Signal Back Left/Right

  Yes

  No

• Brake Lights Left/Right

  Yes

  No

• Hazard Lights

  Yes

  No

Emergency Lights Operational?

• Lightbar

  Yes

  No

  N/A

• Girl lights

  Yes

  No

  N/A

• Front/Rear Dash lights

  Yes

  No

  N/A

• Strobes

  Yes

  No

  N/A

Tires good condition?

• Front left

  Yes

  No

• Back left

  Yes

  No

  N/A

• Back Right

  Yes

  No

  N/A

• Front Right

  Yes

  No

  N/A

Vehicle adminsitration

• WC DoH Operators disc present and in date?

• Vehicle license disc present and in date?

• Vehicle Fuel card

• GPS & Charging cable

• Vehicle OPS Phone

• Seat belts functional?

• Siren unit functional?

Front seats/glove box area

• ER24 PTT (Charlie Mike ## Callsign)

• DoH EMS Radio (Charlie Victor ## Callsign)

• PRF book (min 10 blank)

• DOA Book (min 3x blank)

• Vehicle trip sheet present

• Medical Gloves

• Map book

Back seats area

• Marketing material present

• 5 or more road cones present?

  Yes

  No

• Total road cones present?

• Barrier tape

• Fire extinguisher present and in date?

Boot compartment

Monitor/AED

• Monitoring device present?

  Yes

  No

• Make of monitoring device?

  Gollway UT6000A

  Philips Heat Start AED

  Philips MRx Monitor

• Defib Pads - Adult (Sealed)

• Defib Pads - Pediatric (Sealed)

• Safety Razor

• Sufficient Battery Power

• Charging Lead

• Defib Test load

• Defib Cables

• BP Cuff (Adult)

• SPO2 Probe & Cable (Adult)

• ECG Cable

• 20x ECG a Electrodes

• Capnography Probe (ET)

• Q-CPR Meter

• 12 Lead ECG Cable

• V-Leads for 12 Lead ECG cable

• Nasal ETC02 filter

Suction Unit

• Charged?

• On/Off & Suction Test

• Bubble Tubing

• 2x Yankauer Suction Catheters

• 1x each - Suction Catheters (Black, Green, Orange & White)

Oxygen

• Cylinder (1000 PSI minimum)

• Regulator

• Bodack Seal (O Ring)

• 1x Spare cylinder (full)

Immobilization Gear

• 3x Long splints

• 3x Short splints

• 1x Spider Harnes

• 1x Blanket Role (prepared with Duct Tape)

• KED (Adult)

• KED (Child)

• Traction Splint

• Scoop

• Zip stretcher

Other

• Restock box (consumables)

• 3x blankets

• Hand brush and scoop

• D-Germ bottle

• Qualification

  BLS

  ILS

  ALS

  BTech

Syringes

• 3x 20ml

• 3x 10ml

• 5x 5ml

• 2x 2ml

• 2x 1ml

• 10x Green Hypodermic Needles

• 10x Pink Hypodermic Needles

• 1x Permanent Market

Analgesia (BLS & Above)

• Entonox bottle & regulator

Glucose (BLS & Above)

• 5x Glucose 25mg

Other

• Saline Mix

• ALS Protocol Book

• SAMF Book

Cardiac (ILS & Above)

• 6x Aspirin (300mg)

Glucose (ILS & Above)

• 2x Dextrose 50%

Respiratory (ILS & Above)

• 5x Ipratropium Bromide

• 1x Salbutamol Inhalant (Bottle)

Resuscitation

• 14x Adrenaline

• 7x Atropine

• 5x Lignocaine

• 3x Amiodarone

• 1x Calcium Chloride

Sedation

• 5x Midazolam

• 2x Diazepam

Analgesia

• 5x Morphine Sulphate

• 5x Metaclopramide

Cardiac (ALS & Above)

• GTN Spray

• 10x Furosemide

Antagonists

• 8x Naloxone

Minerals

• 5x Magnesium Sulphate

Respiratory (ALS & Above)

• 5x Salbutamol (IV)

• 10x Hydrocortisone

Antihistamine

• 2x Promethazine

Other (ALS & Above)

• 2x Sodium Bicarbonate 8.5%

• 1x Glucagon

• Adult MAD Device

• Pediatric MAD Device

• Syringe Driver

Each crew member should have the following:

• Reflective Vest

• Head Torch

• Rescue Gloves

• Rescue Helmet

• Black Pen

Optional Items

• Pepper Spray

• Concelled Bulletproof Vest

Kindly enter Name & Signature

• Senior crew member Name

• Signature

  Sign

• Finish this sheet by hitting the export button in the lower right corner of the screen and emailing it to checklists@communitymedics.org.za
  
  Should there be any Equipment/Vehicle damage, kindly also email to ops@communitymedics.org.za