Shift Check EMS gear

• Audit Title

• Conducted on

  Date

• Document No.

• Client / Site

• Prepared by

BLS Supplies

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  Date

• Red BLS bag

  Yes

  No

  N/A

• Burn bag

  Yes

  No

  N/A

• Orange BLS bag

  Yes

  No

  N/A

• Oxygen tank full

  Yes

  No

  N/A

• Non- rebreather

  Yes

  No

  N/A

• Nasal Cannula

  Yes

  No

  N/A

• Adult BVM

  Yes

  No

  N/A

• Airway kit

  Yes

  No

  N/A

• Suction kit

  Yes

  No

  N/A

• AED

  Yes

  No

  N/A

• Pulse ox

  Yes

  No

  N/A

• Stethescope

  Yes

  No

  N/A

• B/P cuff

  Yes

  No

  N/A

• Stop watch

  Yes

  No

  N/A

• Glucose meter

  Yes

  No

  N/A

• Alcohol prep pad

  Yes

  No

  N/A

• Glucose tube

  Yes

  No

  N/A

• BSI gloves

  Yes

  No

  N/A

• BSI full gown kit

  Yes

  No

  N/A

• Tape

  Yes

  No

  N/A

• Pen light

  Yes

  No

  N/A

• Trauma Scissor

  Yes

  No

  N/A

• Oral thermometer

  Yes

  No

  N/A

• Adhesive bandage

  Yes

  No

  N/A

• Trauma rolls

  Yes

  No

  N/A

• Trauma dressing

  Yes

  No

  N/A

• Bandages

  Yes

  No

  N/A

• Safety glasses

  Yes

  No

  N/A

• Antibiotic ointment

  Yes

  No

  N/A

• Blankets

  Yes

  No

  N/A

• Burn blankets

  Yes

  No

  N/A

• Burn dressing

  Yes

  No

  N/A

• Burn jel

  Yes

  No

  N/A

• Ice packs

  Yes

  No

  N/A

• Irrigation eye wash

  Yes

  No

  N/A

• Scoop, stretcher with straps

  Yes

  No

  N/A

• KED

  Yes

  No

  N/A

• Backboards

  Yes

  No

  N/A

• C-collars

  Yes

  No

  N/A

• Backboard straps

  Yes

  No

  N/A

• Triangle bandage

  Yes

  No

  N/A

• Splints and slings

  Yes

  No

  N/A

• Stair chair

  Yes

  No

  N/A

• Infection control kit ( cleaning supplies )

  Yes

  No

  N/A

• Hand tools

  Yes

  No

  N/A

• Caution tape

  Yes

  No

  N/A

• Towels

  Yes

  No

  N/A

• Safety vest

  Yes

  No

  N/A

• Patient medical form

  Yes

  No

  N/A

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