Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Helicopter
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155
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156
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157
Date & Crew
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Select date
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Crew
In bag remember min # if more okay
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(2) micro tubing (exp date)
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Select date
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(4) macro tubing
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Select date
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(6) kerlix rolls
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(12) 4x4 gauze exp date
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Select date
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Band aids
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(12) alcohol pads
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Pillow
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Tape
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(2) protective gowns
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(1) sterile occlussive gauze Vaseline dressing (exp date)
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Select date
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(2) ice pks (exp dates)
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Select date
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( 6 ) splints
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(1) OB kit
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(1) infant NRBM (exp date)
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Select date
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(2) N95 masks
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( 2 ) head immobilizers
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(2) face shield masks
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(1) set 1-6 size oral airways
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(1) trauma scissors
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(1) sub glottic airway ( combi, king, PTL) (exp date)
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Select date
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(2) burn / sterile dressings
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(1) trauma dressing
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Cervical collars 2-infant, 2 child, 2 adult
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(1) ET 2.5 (exp date)
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Select date
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(1) ET 3.0 (exp date)
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Select date
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(1) ET 3.5 (exp date cuff or uncuff)
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Select date
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(1) ET 4.0 (exp date cuff or uncuff)
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Select date
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(1) ET 4.5 (exp date cuff or uncuff)
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Select date
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(1) ET 5.0 ( exp date cuff or uncuff)
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Select date
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(1) ET 5.5 (exp date cuff or uncuff)
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(1) ET 6.0 cuff (exp date, for state 2 required other one in intubation bag)
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Select date
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(1) ET 7.0 cuff ( exp date, for state 2 required, 1 is in intubation bag)
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Select date
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(1) ET 8.0 cuff (exp date, for state 2 required, 1 is in intubation )
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Select date
