Information
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Document No.
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Date (auto filled)
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Duty Type
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Duty / Event
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Location
Driver Checklist
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Milage start:
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Milage End:
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Tax Disc
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Insurance Disc
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CVRT
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Mobile Phone
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Mobile Phone Charger
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Mobile Phone Cradle
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Red Cross 2 Way Radio
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Written Logbook
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Rechargeable Torch
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Torch Charger
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Ambulance Info Terminal Charger
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Ambulance Info Terminal Cradle
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Spare Wheel Set
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Spare Wheel (under vehicle)
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Headlights
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Tail-Lights
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Brake-Lights
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Indicators / Hazards
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Emergency Lighting
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Siren
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Internal Cab Lighting (inc map light)
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Internal Saloon Lighting
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Loading Lights
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Scene Lights
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Auxiliary Power Outlets
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Fuel Level
- Full
- 3/4 - Full
- 1/2 - 3/4
- 1/4 - 1/2
- 1/4 - Empty
- Empty - warning light
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Wiper Blades
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Oil Level
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Coolant Fluids
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Washer Fluids
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Mirrors (external)
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Mirrors (internal)
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Tow Rope
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Water Safety Jackets
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Water Rescue Throw Rope
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Windscreen Hammers
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Fire Extinguishers
- Cab - In Date
- Cab - Faulty
- Saloon - In Date
- Saloon - Faulty
Crew Checklist
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Reflective Jackets
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Safety Helmets
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Handheld Radios
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Trolley Stretcher
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Trolley Stretcher Belts
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Carry Chair and Belts
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Scoop Stretcher
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Scoop Safety Belts
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Utila Folding Stretcher
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Spinal Longboard
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Spider Straps
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Longboard Head Mattress
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Spinal Head Blocks
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Head block velro straps
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Collars (Select Sizes)
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Collars (Individual Sizes)
- Tall
- Regular
- Short
- No Neck
- Paediatric
- Neonate
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Box Splints
- Short
- Medium
- Long
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Box Splint Straps
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Vacuum Splint Set (inc pump)
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Vacuum Mattress (inc pump)
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Vest Extraction Device
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Pelvic Splint
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Powered Suction Unit
- Present
- Missing
- Charged
- Battery Flat
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Suction - Cathaters/Yankers
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Suction - Water for Clearing
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Burns Kit
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Feminine Hygiene Kit
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Obstetrics Kit
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Sharps Bins (1 plus spare)
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Waste Management
- General Waste / Refuse Bags
- Bio-Hazard Yellow Bags
- Emisis Bags (vomit)
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Nitrile Gloves
- Small x2
- Medium x2
- Large x2
- Extra Large x2
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General First Aid Equipment
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First Aid Kit Bags (2)
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Resus Jump Bag
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PHECC Report Cards
- PCR >15
- PCR 10-15
- PCR 5-10
- PCR <5
- ACR > 20
- ACR 15-20
- ACR 10-15
- ACR <10
Medications Checklist
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Oxygen F Cylinders
- Cyl 1: Full - 3/4
- Cyl 2: Full - 3/4
- Cyl 1: 3/4 - 1/2
- Cyl 2: 3/4 - 1/2
- Cyl 1: 1/2 - 1/4
- Cyl 2: 1/2 - 1/4
- Cyl 1: 1/4 - Empty
- Cyl 2: 1/4 - Empty
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Expiry Dates: 1 2
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Oxygen "CD" Cylinders
- Cyl 1: Full - 3/4
- Cyl 2: Full - 3/4
- Cyl 1: 3/4 - 1/2
- Cyl 2: 3/4 - 1/2
- Cyl 1: 1/2 - 1/4
- Cyl 2: 1/2 - 1/4
- Cyl 1: 1/4 - Empty
- Cyl 2: 1/4 - Empty
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Expiry Dates: 1 2
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Oxygen Therapy Equipment
- NRB Masks x 10 (total) "Adult"
- NRB Masks x 4 "Paediatric"
- Simple Face Masks x 6
- Nasal Cannula x6 "Adult"
- Nasal Cannula x4 Paediatric
- BVM Adult
- BVM Child
- BVM Paediatric
- Pocket Face Mask "Adult"
- Pocket Face Mask "Child"
- Oropharyngael Airways x2 Sets (6)
- Supragolottic Airways x2 Sets (3)
- Surgical Lubricant Gel
- Oxygen tubing x4
- Handheld Suction
- F Cylinder Regulator & Key
- Fixed Vehicle Oxygen Flow Valves
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Entonox "D" Cylinders
- Cyl 1: Full - 3/4
- Cyl 2: Full - 3/4
- Cyl 1: 3/4 - 1/2
- Cyl 2: 3/4 - 1/2
- Cyl 1: 1/2 - 1/4
- Cyl 2: 1/2 - 1/4
- Cyl 1: 1/4 - Empty
- Cyl 2: 1/4 - Empty
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Expiry Dates: 1 2
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Entonox Delivery Equipment
- Regulator & Key
- Bodack Washer Seal
- Delivery Tubing
- Demand Valve
- Mouthpieces x5
- Facemasks x5
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Aspirin 300mg
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Expiry Date: Quantity:
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GTN Spray
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Expiry Date: Quantity:
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Salbutamol MDI 0.1mg
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Expiry Date: Quantity:
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Glucose Gel 25g
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Expiry Date: Quantity:
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Paracetamol 500mg tablet
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Expiry Date: Quantity:
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Paracetamol Suspension (120mg/5ml)
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Expiry Date: Quantity:
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Epinephrine 1:1000 - Adult 0.3mg
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Expiry Date: Quantity:
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Epinephrine 1:1000 - Junior 0.15mg
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Expiry Date: Quantity:
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Glucagon 1mg
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Expiry Date: Quantity:
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Ibuprofen 200mg tablet
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Expiry Date: Quantity:
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Ibuprofen Suspension 100mg/5ml
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Expiry Date: Quantity:
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Naloxone 0.8mg inh
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Expiry Date: Quantity:
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10ml Syringes x6
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Water for Injections
AED Checklist
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AED Type:
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Serial No:
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Battery Level
- Full
- 3/4 - Full
- 1/2 - 3/4
- 1/4 - 1/2
- 1/4 - Empty
- Empty - warning light
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Battery Expiry Date
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Pads 1 - Expiry Date
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Pads 2 - Expiry Date
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AED Checklist:
- Status - Ok (green)
- Status - Fault (orange)
- Unit Clean and Undamaged
- Nothing Stored on AED
- Visual Indicators
- Verbal Prompts
- Spare Pads Available
- No Spare Pads Available
- Pads Securely Fixed to AED
- Razor Present
- Shears Present
- Towel Present
- Paediatric Pads Available
- Paediatric Pads Not Available
- Paediatric Pads Not Applicable
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CFR Reports
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Pocket Face Mask
Patient Diagnostics
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Blood Glucose Metering
- Meter
- Test Strips
- Lancets (10 min)
- Spare Batteries
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Patient Monitor
- Present
- Missing
- Charged
- Battery Flat
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Patient Monitor Usables
- Blood Pressure Cuff
- Sp02 Probes x2
- Temperature Probes x2
- ECG Lead
- ECG Dots (12 min)
- ECG Print Roll (plus spare)
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SPo2 Finger Probe
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Sphygmomanometer (b.p, Cuff)
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Digital Blood Pressure
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Stethoscope
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Penlight Torches (5)
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Thermometer (I.R. / in ear)
- Present
- Missing
- Spare Covers (10)
- Spare Batteries
Hygiene & Substance Isolation
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Aprons (6)
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Goggles / Splash Glasses (3)
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Ear Plugs/Defenders (6)
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Heavy Duty Gloves (3 pairs)
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Inco Sheets (10)
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Stretcher Towel Roll
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Body Bag with labels
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Antibacterial Hand Gel
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Antibacterial Wipes
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Bio Hand Gel
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Paper Towels x2
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Toilet Roll x2
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Antibacterial Surface Cleaner/Spray
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Yellow Bio Hazard Waste Bags x4
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General Waste bags (roll)
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Sharps Bins (2)
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Floor Pan & Brush Set
