Information
-
Audit Title
-
Document No.
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
Part 1: Course Information
-
Course Sponsor
-
Contact person (Name & Phone #s)
-
Course #s
-
Instructor 1
- Dupree
- Gill
- Best
- Mantz
- Ledford
- Warner
- Reenan
- Montavon
- Lautner
- Sharps
- Nofziger
- Zoz
- Belcher
- Taylor
- Herbert
- Rife
- Hein
- Wycoff
- Walker
- Powell
-
Instructor 2
- Dupree
- Gill
- Best
- Mantz
- Ledford
- Warner
- Reenan
- Montavon
- Lautner
- Sharps
- Nofziger
- Zoz
- Belcher
- Taylor
- Herbert
- Rife
- Hein
- Wycoff
- Walker
- Powell
-
Course Date & Start Time
-
Number of Days
- 1
- 2
- 3
- 4
- 5
- 6
-
Total # of Burns
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 14
- 15
Part 2: Delivery Information
-
Delivery Date & Time
-
Location
-
Delivery Person
- Terry Gill
- Mike Powell
- Shawn Lautner
- John Hopkins
- Scott Smith
- Patrick Beckley
-
Pick-up Person
- Terry Gill
- Mike Powell
- Shawn Lautner
- John Hopkins
- Scott Smith
- Patrick Beckley
-
Person Completing Parts 1 & 2
Part 3: Pre Trip Checklist
-
SCBA / Facepiece / Extra Cylinder(Full)
-
4 SCBAs Cleaned & Assigned
-
SCBA Daily Inspection Performed
-
Person Completing Work (Initials)
-
Helmets / Shields / Aluminized (Cleaned & Checked)
-
Student Helmets # Assigned
-
Instructor Helmets # Assigned
-
Person Completing Work (Initials)
-
Flares
-
Bucket / Cleaning Supplies
-
SCBA Voice Amp
-
Tool Box
-
Wood for Burns
-
Straw for Burns
-
Class A Foam / Pro-Pak (Full)
-
Extra Faceshields / Gloves / Helmet Covers
-
Truck Fuel Levels
-
A/V Equipment
-
Person Verifying Items Completed
Part 4: Additional Information
-
Special Info / Problems Etc.
-
Delivery or Special Instructions
-
Final Sign-off
