Sunstar Unit Back-up Check

• Conducted on

  Date

• Prepared by

Cab

• SS Unit Identifyer

• Does the engine start?

  Yes

  No

  N/A

• Mileage

• Fuel Level

  Select Full 7/8 3/4 5/8 1/2 3/8 1/4 1/8 Empty

  • Full
  • 7/8
  • 3/4
  • 5/8
  • 1/2
  • 3/8
  • 1/4
  • 1/8
  • Empty

• Is ACH fuel card and receipt pouch present? (We can't use SS fuel card or county pumps)

  Yes

  No

  N/A

• Is the inside of cab clean?

  Yes

  No

  N/A

Patient care area

• Is patient care area clean?

  Yes

  No

  N/A

• Is trash emptied?

  Yes

  No

  N/A

• Is Sunstar Bag present and sealed? (Direction Book in front pouch)<br><br>Front Compt-<br>Direction Book<br>Paper check sheets<br><br>Top Compt-<br>D5 1/2 NS<br>D5 1/2 NS 20 K<br>D5 1/4 NS<br>D5 1/4 NS 20 K<br>D5 NS (500 mL)<br>1/2 NS<br>Adult vent circuit (22mm)<br>Ped vent circuit (15mm)<br><br>Large and small syringes (zipper pockets 1 & 2), NG,OG syringes<br>Assorted IV adapters, bag spikes, filter needles, alcohol preps, med labels (clear pouch)<br><br>Main Compt-<br>Emesis bags<br>4X4s<br>O2 regulator<br>Diapers (size 1)<br>Hand sanitizer<br>Flushes, syringe tubing, extension tubing<br>Tape, thermometers, pulse-ox, neo leads<br>

  Yes

  No

  N/A

• Is the air tank caddy present and are the tanks over 1500 psi?

  Yes

  No

  N/A

• Neo/Ped immobilizes present?

  Yes

  No

  N/A

• Spare RT bag present?

  Yes

  No

  N/A

• Spare Code Bag (black bag) present and sealed?

  Yes

  No

  N/A

• Code drug bag expiration date.

• Philips monitor present and charging?

  Yes

  No

  N/A

• Are the following items present on the Philips?

  Select ECG cable SpO2 cable NIBP cable IABP cable Temp cable w/ rectal temp probe Therapy Cable w/ test module 2 infant& 2 Ped/adult defibrillator pads Paper

  • ECG cable
  • SpO2 cable
  • NIBP cable
  • IABP cable
  • Temp cable w/ rectal temp probe
  • Therapy Cable w/ test module
  • 2 infant& 2 Ped/adult defibrillator pads
  • Paper

• Is Nitric Bag present and plugged in?

  Yes

  No

  N/A

• Is Turkel chest tube tray present? (Must be present when ISOLETTE loaded)

  Yes

  No

  N/A

• EPCR cable present?

  Yes

  No

  N/A

Exterior

• Is SS Unit clean?

  Yes

  No

  N/A

• Are all emergency and other lights functioning?

  Yes

  No

  N/A

• Onboard O2 psi. (Must be above 1500 psi because of vents)

• Signature of preparer.

  Sign