Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

Checklist

  • Checklist completed daily

Top of Trolley

  • Defibrillator Checked

  • Defibrillator serial number and type

  • Defibrillator pads in date

  • Defibrillator pads connected

Side of Trolley

  • E size Oxygen cylinder at least 3/4 full

  • Box of medium size gloves

  • Suction machine connected and working

  • Yankeur suction catheter (3)

  • Suction catheters size 12fg (4)

  • Suction catheters size 14fg (4)

Intravenous Infusion Pole

  • Bag valve mask

Draw 1 Advanced Airway

  • ET tube size 6,7,8,9

  • Laryngoscopes handle with disposable size 3 blade

  • Laryngoscopes handle with disposable size 4 blade

  • Magills forceps

  • Scissors

  • Catheter Mount

  • 20ml syringe

  • Ribbon Gauze

  • Spare batteries for laryngascope

  • Waters circuit

Draw 2 Airway & Breathing

  • Non-rebreathe oxygen mask (high flow)

  • Oro-pharyngeal airways size 2,3,4

  • Naso-pharyngeal airways size 6,7

  • Laryngeal mask airways size 4,5

  • Pocket mask

  • 50ml syringe

  • Lubricant gel

Draw 3 Circualtion

  • Orange cannula 14g (6)

  • Grey cannula 16g (6)

  • Green cannula 18g (6)

  • Pink cannula 20g (4)

  • Micropore tape (half inch)

  • Micropore tape (one inch)

  • IV dressings (8)

  • 5ml syringe (4)

  • 10ml syringe (8)

  • 20ml syringe (4)

  • Blood gas syringe (4)

  • Pack of gauze swabs (6)

  • Alcohol impregnated swabs (20)

  • Green needles 21g (20)

  • Sodium Chloride 0.9% ampules 10mls (10)

  • Razors (2)

  • Long intravenous line size 14g, 16g

  • Three way tap with extension (2)

Draw 4 Circulation

  • IV giving set (2)

  • Large bore blood giving set (2)

  • Volplex 500mls

  • Normal Saline 500mls

  • Normal Saline 1000mls

Draw 5 Drugs and Miscellaneous

  • Blue cardiac arrest drugs box

  • Pressure infusion bag

  • Pack of ECG electrodes

  • Spare pack of defibrillation pads

  • Sharps bin

Signatures

  • Staff Signature

  • Auditor Signature

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