Cycle response VDI

• Document No.

• Cycle call sign

• Event name

• Conducted on

  Date

• Completed by :

Air & Tyres

• Tyres inflated to correct pressure

• Tyres in good condition

Brakes

• Wheels spinning freely

• Wheels lock when brakes applied

• Brake discs in good condition

• No movement in brake calliper

Cranks & chain

• Chain Clean & lubricated

• Chain moves freely

• Pedals secure

• Cranks secure

• Gears change up & down freely

• No play in bottom bracket

Quick & Other

• Quick release on wheels tight

• Quick release on seat & adjusted to correct height

• Pannier fixings secure

• Reflectors undamaged

• Bell working

• Lights working and secure

Damage or other comments

Black clinical waste holder pouch

• Empty

Top Pannier

• Patient report forms

• Cycle lock

• Puncture repair kit

• Tyre levers

'D' compartment

• Clinell hand rub

• Clinell wipes

• Clinical waste bags (yellow)

• Examination Gloves

Left pannier

Medication pouch

• Complete and in date

First aid kit

• Plasters - quantity - 20

• Conforming bandages 7.5cm - quantity - 4

• Dressings - low adherent 10x10 - quantity - 5

• Gauze squares 7.5x7.5 - quantity - 5

• Saline steripods - quantity - 6

• Triangular bandage - quantity - 2

• Scissors - quantity -1

Monitoring kit

• Bm machine - quantity 1

• Bm Test strips - quantity - 10

• Bm lancets - quantity - 10

• Manual sphygmomanometer - quantity - 1

• Stethoscope - quantity - 1

• Peak flow meter - quantity - 1

• Peak flow mouth piece - quantity - 2

• Pulse oximeter - quantity - 1

• Tympanic Thermometer - quantity - 1

Oxygen masks

• Adult 100% - quantity - 2

• Paediatric 100% - quantity - 2

• Adult 28% mask - quantity - 1

• Nebuliser pot - quantity - 1

• Paediatric Nebuliser - quantity - 1

Exterior

• Sharps box - quantity - 1

Centre compartment

• Oxygen ZA cylinder - quantity - 1

Right pannier

• AED - quantity - 1

• Spare AED Pads - quantity - 1

• Bag valve mask (adult) - quantity - 1

• Bag valve mask (paediatric) - quantity - 1

• Manual suction - quantity - 1

• Oropharyngeal airway - quantity - 1 of each size (4)

Exterior

• Multi tool in pouch - quantity - 1

• Completed and restocked

  Sign