Incident Rehab Checklist

• Document No.

• Rehab Checklist

• White Oak EMS Special Operations Unit

• Conducted on

  Date

• Prepared by

• Personnel

REHAB KIT SO-1

• Old Seal #

• New Seal #

Top (Behind Black Mesh)

• 2 Burn Sheets

• 2 Trauma Dressings

Top Flap (Silver/Gray)

• 1 Pen Light

• 4 Tweezers

• 2 Crash Shears

• 2 Bandage Shears

• 1 First Aid Flip Chart

Center (Left Side)

• 2 Sterile Water Bottles 500ml

• Expiration Date

• 1 Adult BVM

• 15 2x2's

• Expiration Date

• 15 4x4's

• Expiration Date

• 2 Digital Thermometers

• 1 Box of Probe Covers

• 1 SAM Splint

• 1 Eye Patch Kit

• 5 Emesis Bags

• 1 Bag of Large Gloves

• 1 Box of Particle Masks

• 10 Red Bio Hazard Bags

• 5 Non-Adhering Dressings

• 2 Eye Irrigation Kits (2 NC, 2-20 Drips & 2 1000 NSS)

Center Right Side

• 8 Cold Packs

• 8 Hot Packs

• 5 - 1" Rolls of Tape

• 5 Large rolls of Kling

• Expiration Date

• 4 Small rolls of Kling

• Expiration Date

• 5 Triangle Bandages

• 1 Bag of assorted Band Aids

• 2 CPR Masks (1 egg shell plastic & 1 orange bag)

REHAB GREEN BAG SO-1

• Old Tag #

• New Tag #

• 3 Nasal Cannulas

• 3 Non-Rebreather Masks

• 1 Bottle of Oxygen

• Oxygen psi

• 2 Stethoscopes

• 1 Finger Tip PulseOx with case & spare battery

• 1 BP Cuff with case

• 1 Glucometer with case

ADDITIONAL NOTES

MEDIA IF NEEDED

• Add media

  Media

CREW SIGNATURES

• Add signature

  Sign

• Add signature

  Sign