Squad 801 Check

• Personnel Completing Check (Last Name)

• Conducted on

  Date

Squad 801 Check Sheet

Cab

• Oil Level

  Yes

  No

• Coolant Level

  Yes

  No

• Powering Steering Level

  Yes

  No

• Tires

  Yes

  No

• Vehicle Starts

  Yes

  No

• Lights (All Lights)

  Yes

  No

• Siren

  Yes

  No

• Main Radio

  Yes

  No

• Small Gloves

  Yes

  No

• Medium Gloves

  Yes

  No

• Large Gloves

  Yes

  No

• XL Gloves

  Yes

  No

Outside Cabinets

• Main 0xygen Pressure (Change at 500 psi)

  Select 500 psi 600 psi 700 psi 800 psi 900 psi 1000 psi 1100 psi 1200 psi 1300 psi 1400 psi 1500 psi 1600 psi 1700 psi 1800 psi 1900 psi 2000 psi

  • 500 psi
  • 600 psi
  • 700 psi
  • 800 psi
  • 900 psi
  • 1000 psi
  • 1100 psi
  • 1200 psi
  • 1300 psi
  • 1400 psi
  • 1500 psi
  • 1600 psi
  • 1700 psi
  • 1800 psi
  • 1900 psi
  • 2000 psi

• Small Vacuum Splints

  Yes

  No

• Medium Vacuum Splints

  Yes

  No

• Large Vacuum Splints

  Yes

  No

• Stair Chair/Straps x3

  Yes

  No

• SCBA/Mask/PASS

  Yes

  No

• SCBA PSI

• SCBA/Mask/PASS

  Yes

  No

• SCBA PSI

• Adult Backboard/Straps x3

  Yes

  No

• # of Backboards

  0

  1

  2

  3

  4

• Adult C-Collars x4

  Yes

  No

• Adult Head Blocks x4

  Yes

  No

• Peds Backboard

  Yes

  No

• Baby Seat

  Yes

  No

LifePak 15

• Batteries Fully Charged

  Yes

  No

• Battery #

• Battery #

• BP Cuff

  Yes

  No

• Pulse Ox

  Yes

  No

• 12-Lead Cables

  Yes

  No

• Adult D-fib Pads x2

  Yes

  No

• Peds D-fib Pads x2

  Yes

  No

• EKG Paper

  Yes

  No

• Spare Electrodes

  Yes

  No

Spot 8

• Lucas Batteries Full

  Yes

  No

• Peds Jump Bag

  Yes

  No

• Drug Box Seal #

CPAP Bag

• PSI

• Mask

  Yes

  No

Cot

• O2 Bag PSI (Refill at 500 psi)

  Select 500 psi 600 psi 700 psi 800 psi 900 psi 1000 psi 1100 psi 1200 psi 1300 psi 1400 psi 1500 psi 1600 psi 1700 psi 1800 psi 1900 psi 2000 psi

  • 500 psi
  • 600 psi
  • 700 psi
  • 800 psi
  • 900 psi
  • 1000 psi
  • 1100 psi
  • 1200 psi
  • 1300 psi
  • 1400 psi
  • 1500 psi
  • 1600 psi
  • 1700 psi
  • 1800 psi
  • 1900 psi
  • 2000 psi

• NC

  Yes

  No

• NRB

  Yes

  No

• Nebulizer

  Yes

  No

• Peds NC

  Yes

  No

• Peds NRB

  Yes

  No

• Peds Nebulizer

  Yes

  No

Clipboard

• Patient Signature Forms

  Yes

  No

IV Tray

• Stocked with all supplies to start IV's and organized (Do Not Overstock Supplies)

  Yes

  No

• In House Reports

  Yes

  No

Misc. Equipment

• Safety Vests x3

  Yes

  No

• Map Book

  Yes

  No

• Protocol Book

  Yes

  No

• Cell Phone (Fully Charged)

  Yes

  No

• On Board Suction

  Yes

  No

• Portable Suction (Plugged In/Charged)

  Yes

  No

Adult Jump Bag

• Glucometer

  Yes

  No

• Lancets

  Yes

  No

• Test Strips

  Yes

  No

• Thermometer

  Yes

  No

• Emesis Bag

  Yes

  No

• Pen Light

  Yes

  No

• BP Cuffs x3

  Yes

  No

• Pulse Oximeter

  Yes

  No

• Stethoscope

  Yes

  No

• Misc. Bandages/Dressings

  Yes

  No

• Trauma Shears

  Yes

  No

• Hand Suction

  Yes

  No

• Ring Cutter

  Yes

  No

• King Airway: Yellow (Size 3)

  Yes

  No

• King Airway: Red (Size 4)

  Yes

  No

• King Airway: Purple (Size 5)

  Yes

  No

• EZ IO

  Yes

  No

• EZ IO Supplies

  Yes

  No

• Quick Trach (Sealed Box)

  Yes

  No

• Sharps Container

  Yes

  No

• Adult BVM

  Yes

  No

• IV Start Kit

  Yes

  No

• King Vision (With Extra Batteries)

  Yes

  No

• King Vision Blade

  Yes

  No

Airway Kit

• OPA

  Yes

  No

• NPA

  Yes

  No

• Laryngoscope

  Yes

  No

• Magill Forceps

  Yes

  No

• ET Tubes (Sizes 4 - 8.5 mm)

  Yes

  No

• Stylets

  Yes

  No

• ResQPOD x 1

  Yes

  No

Back Pocket

• Hand E Cuff

  Yes

  No

• OB Kit

  Yes

  No

• Sterile Sheet

  Yes

  No

Spot 1

• Spare Towels

  Yes

  No

• Spare Blankets

  Yes

  No

• OB Kits x2

  Yes

  No

• Isolation PPE

  Yes

  No

Spot 2

• Spare O2 D Tanks x3

  Yes

  No

• Shoe Traction x2

  Yes

  No

Spot 3

• Spare Electrodes

  Yes

  No

• Spare EtCO2 NC

  Yes

  No

• Spare In-Line EtCO2

  Yes

  No

• Spare Razor Blades

  Yes

  No

• Spare EKG Paper

  Yes

  No

Spot 4

• Ice Packs

  Yes

  No

• Heat Packs

  Yes

  No

• Emesis Bags

  Yes

  No

• Face Masks

  Yes

  No

• Soft Restraints x2

  Yes

  No

• MAT Tourniquet

  Yes

  No

• SAM Pelvic Sling x2

  Yes

  No

• Adult NC

  Yes

  No

• Adult NRB

  Yes

  No

• Adult Nebulizer

  Yes

  No

• Spare Peds NC

  Yes

  No

• Spare Peds NRB

  Yes

  No

• Spare Peds Nebulizer

  Yes

  No

Spot 5

• Spare ET Tubes

  Yes

  No

• Yes

  No

• King Airway: Yellow (Size 3)

  Yes

  No

• King Airway: Red (Size 4)

  Yes

  No

• King Airway: Purple (Size 5)

  Yes

  No

• Adult BVM

  Yes

  No

• Peds BVM

  Yes

  No

• Infant BVM

  Yes

  No

• Suction Supplies

  Yes

  No

• OPA

  Yes

  No

• NPA

  Yes

  No

• ResQPOD x1

  Yes

  No

• ResQGARD x1

  Yes

  No

Spot 6

• Overstock Supplies: Extra Tourniquets, Lancets, IV Supplies, Blood Draw Tubes, Syringes, EZ IO Needles, Bandages/Misc. Supplies

  Yes

  No

Spot 7

• CO Detector

  Yes

  No

• Triage Kits

  Yes

  No

• Mark 1 Kit

  Yes

  No

• North Safety Masks x3

  Yes

  No

Spot 9

• Drip Sets 10 (Macro)

  Yes

  No

• Drip Sets 60 (Micro)

  Yes

  No

• Normal Saline 1000 ML x5

  Yes

  No

• Normal Saline 500 ML x5

  Yes

  No

• Sterile Water x2

  Yes

  No

• Bottled Water x2

  Yes

  No

Spot 10

• Spare Bandages

  Yes

  No

• Spare Tape

  Yes

  No

• Spare Dressings

  Yes

  No

• Trauma Dressing

  Yes

  No

Spot 11

• KED Board

  Yes

  No

• Sager Splint

  Yes

  No

• Hare Splint x2

  Yes

  No

• Long Board Splint

  Yes

  No

• Short Arm Splint

  Yes

  No

Comments

• Would you like to leave any additional comments regarding defects, damage and/or missing equipment?

  Yes

  No

• Comments

• Is there visible damage or defects to the vehicle and/or the equipment within the vehicle?

  Yes

  No

• Photo of Damage/Defect

Photo

• Location of Damage/Defect?

• Photo of Damage/Defect

  Media

Personnel Information

• Personnel Completing Check

  Select Christopher Allman Kevin Ball Thomas Cerveny Ryan Cloud Sean Coubrough Brian Desler Justin Eady Christopher Fuentes Scott Jones Daniel Lane Timothy Namy Robert Niehaus William Petro John Rongyos David Rorapaugh Raymond Ruffin Vanessa Sherriff Christopher Stanford David Vance Kelsie Votaw Morgan Walker Mel Weisblatt Ryan Zittkowski

  • Christopher Allman
  • Kevin Ball
  • Thomas Cerveny
  • Ryan Cloud
  • Sean Coubrough
  • Brian Desler
  • Justin Eady
  • Christopher Fuentes
  • Scott Jones
  • Daniel Lane
  • Timothy Namy
  • Robert Niehaus
  • William Petro
  • John Rongyos
  • David Rorapaugh
  • Raymond Ruffin
  • Vanessa Sherriff
  • Christopher Stanford
  • David Vance
  • Kelsie Votaw
  • Morgan Walker
  • Mel Weisblatt
  • Ryan Zittkowski

• Conducted On

  Date