Title Page
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Site conducted
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Conducted on
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Prepared by
General Crash Cart Inspection
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Crash cart is in place and accessible
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Crash cart is locked with number of the lock recorded on the checklist per checking- integrity of locked checked
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Drawers are properly labeled (airway, medication, breathing, circulation)
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Crash cart is clean and functional
Crash Cart Equipment Checking
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Defibrillator available, clean and disinfected- functionality checked in accordance with operator's manual-PPM up to date
- Fully Met
- Partially Met
- Not Met
- Not Applicable
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Defibrillator plugged into an emergency power
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Portable suction machine available, functionality checked-plugged into emergency power- PPM up to date
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Oxygen cylinders checked- have at least 1000 psi
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Resuscitation bag connected to oxygen cylinder's flow meter using clean oxygen tubing-resuscitation bag connected to a mask
External Crash Cart Content
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Pressure bag available and functional
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ECG Electrodes complete pack available and not expired (1 pack)
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Extra ECG paper available- 1 Roll
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Defibrillator Pads available and not expired (Adult- 2 packs)
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Sharps container available and not more than 3/4 full
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KY Jelly available- 2 sachets
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Stethoscope (1)
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Non-sterile gloves (Large, 1 box)
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Clip board (1 pc) & Checklist (5pcs,)
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Code BLue & Quality Audit Forms available (5 each)
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Cardiac Arrest Board (1)
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Skin -Des Antiseptic Hand Spray (1 bottle)
- Fully Met
- Partially Met
- Not Met
- Not Applicable
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Xylocaine/Lidocaine Spray or Gel (1 either)
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