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MEDIC UNIT CHECK SHEET (2300, 2400, or 3206)
MEDIC UNIT CHECK SHEET (2300, 2400, or 3206)
Jerry Howerton

MEDIC UNIT CHECK SHEET (2300, 2400, or 3206)

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Free MEDIC UNIT CHECK SHEET (2300, 2400, or 3206) Checklist

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Information

  • MURRELLS INLET-GARDEN CITY FIRE DISTRICT
    AMBULANCE CHECK-OFF

  • Call Sign

    • M-76
    • M-77
    • M-78
    • M-79
    • N/A

  • LSN#

    • 2300
    • 2400
    • 3206
    • 3710
    • 3811

  • In Service

  • Out Of Service

  • Conducted on

  • Shift on Duty

  • A Shift

  • B Shift

  • C Shift

  • Station where check is being completed.

  • Reason for choosing "other?"

  • Check performed by:

    • Eng J.Dingess
    • S/O J.Kosto
    • EMS 76 J.Howerton
    • C76 N.Knight
    • C77 J.Haney

  • Is this Medic Unit currently staffed?

  • Personnel assigned to this Medic Unit.

    • Eng J.Dingess
    • S/O J.Kosto
    • EMS 76 J.Howerton
    • C76 N.Knight
    • C77 J.Haney

MECHANICAL

  • Current Mileage:

  • Current Hours:

  • Fuel Level:

    • Full
    • 7/8
    • 3/4
    • 1/2
    • 1/4
    • Empty

  • Oil Level:

  • Please be sure to notify your direct supervisor on duty and complete a maintenance request form.

  • Transmission Fluid Level:

  • Please be sure to notify your direct supervisor on duty and complete a maintenance request form.

  • Break Fluid Level:

  • Please be sure to notify your direct supervisor on duty and complete a maintenance request form.

  • Radiator Level:

  • Please be sure to notify your direct supervisor on duty and complete a maintenance request form.

  • Power Steering Fluid:

  • Please be sure to notify your direct supervisor on duty and complete a maintenance request form.

  • Is there windshield washer fluid?

  • Was windshield washer fluid added?

  • Please explain why windshield washer fluid was not added.

  • Do all belts hoses appear to be in good condition?

  • Please be sure to notify your direct supervisor on duty and complete a maintenance request form.

  • Do all tires appear to be in good condition?

  • Please attach a photo of the condition of the tire(s).

  • Please explain the condition of the tire(s).

Cab

  • Clipboard

    • Yes
    • No

  • Map Books

    • Yes
    • No

  • Registration/Insurance Card

    • Yes
    • No

  • Small-X Large Gloves

    • Yes
    • No

  • Cell Phone and Charger

    • Yes
    • No

WARNING

  • "Primary" and "Secondary" warning lights working?

  • Please explain the unsatisfactory condition of the warning light(s).

  • Is there physical damage to the light(s).

  • Please take a photo of the damage.

  • "Intersection" warning lights working and in good condition?

  • Please explain the unsatisfactory condition of the warning light(s).

  • Is there physical damage to the light(s).

  • Please attach a photo of the damage.

  • "Head Lights" working and in good condition?

  • Please explain the unsatisfactory condition of the head light(s).

  • Is there physical damage to the light(s).

  • Please attach a photo of the damage.

  • "Turn Signals"/"Hazards" working and in good condition?

  • Please explain the unsatisfactory condition of the light(s).

  • Is there physical damage to the light(s).

  • Please attach a photo of the damage.

  • "Brake Lights" working and in good condition?

  • Please explain the unsatisfactory condition of the light(s).

  • Is there physical damage to the light(s).

  • Please attach a photo of the damage.

  • "Flood" and "B/U" Lights working and in good condition?

  • Please explain the unsatisfactory condition of the light(s).

  • Is there physical damage to the light(s).

  • Please attach a photo of the damage.

  • "Clearance" Lights working and in good condition?

  • Please explain the unsatisfactory condition of the light(s).

  • Is there physical damage to the light(s).

  • Please attach a photo of the damage.

  • Inside "Dome" Lights working and in good condition?

  • Please explain the unsatisfactory condition of the light(s).

  • Is there physical damage to the light(s).

  • Please attach a photo of the damage.

  • "Horn" and "Siren" working and in good condition?

  • Please explain the unsatisfactory condition of the light(s).

  • Is there physical damage to either?

  • Please attach a photo of the damage.

MAIN O2 COMPARTMENT

  • M-Cylinder

  • Oxygen Cylinder below 500 PSI should be replaced.

  • Was "Oxygen" Cylinder replaced?

  • Please explain why item can not be replaced at time of inspection.

  • Wrecking Bar

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

  • Axe

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

  • Pedi Board

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

  • #4 Hammer

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

  • Adult Traction Splint

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

  • Pediatric Traction Splint

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

  • Wrench for "Oxygen" Clylinder

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

DRIVER REAR COMPARTMENT

  • Is "Fire Extinguisher" Full and in date?

  • If "Fire Extinguisher" is not full or in date please notify your direct supervisor.

  • Was this item replaced at time of this inspection?

  • Please explain why item can not be replaced at time of inspection.

  • Hydrant Bag

  • Was this item replaced or found at time of this inspection?

  • Please explain

  • Stair Chair

  • Was this item replaced or found at time of this inspection?

  • Please explain

BACKBOARD COMPARTMENT

  • 3-Backboards

    • Yes
    • No

  • 9-Quick connect straps

    • Yes
    • No

  • 3-9' Straps

    • Yes
    • No

  • 6-Head beds

    • Yes
    • No

  • Frac-Pack

    • Yes
    • No

  • 3-Adult C Collars

    • Yes
    • No

  • 3-Pedi C Collars

    • Yes
    • No

  • Portable Stretcher

    • Yes
    • No

  • Reeves Sleeve

    • Yes
    • No

  • KED

    • Yes
    • No

Inside Patient Compartment

  • O2 Cabinet

  • 4-Adult NRB

    • Yes
    • No

  • 4-adult NC

    • Yes
    • No

  • 4-Nebulizer

    • Yes
    • No

  • 3-Pedi NRB

    • Yes
    • No

  • 3-Pedi NC

    • Yes
    • No

  • 3-Supply Tubing

    • Yes
    • No

  • 4-Blood Draw Kit

    • Yes
    • No

  • 1-O2 Humidifier

    • Yes
    • No

  • 1- ETCO2 NC and ETT

    • Yes
    • No

  • Airway Cabinet

MEDIC UNIT CHECK SHEET (2300, 2400, or 3206)
Jerry Howerton

MEDIC UNIT CHECK SHEET (2300, 2400, or 3206)

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