Tool Box & Triage Kit Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Tool Box Checklist

• 1- Large Phillips Screwdriver

  Yes

  No

  N/A

• 1- Large Slotted(Flat) Screwdriver

  Yes

  No

  N/A

• 1- Slip Joint Pliers

  Yes

  No

  N/A

• 1- Lineman's Pliers

  Yes

  No

  N/A

• 1- Needlenose Pliers

  Yes

  No

  N/A

• 1- Arc Joint (water) Pliers

  Yes

  No

  N/A

• 1- Locking Pliers

  Yes

  No

  N/A

• 1- 3lb Sledge Hammer

  Yes

  No

  N/A

• 1- Metal Cutting Tool

  Yes

  No

  N/A

• 1- Short Pry Bar

  Yes

  No

  N/A

• 1- Cold Chisel

  Yes

  No

  N/A

• 1- Hacksaw with 2 spare blades

  Yes

  No

  N/A

• 1- Adjustable Wrench (10")

  Yes

  No

  N/A

• 1- Center Punch

  Yes

  No

  N/A

• 2- Hard Hats

  Yes

  No

  N/A

• 2- Pairs Leather Gloves

  Yes

  No

  N/A

• 2- Pairs Goggles

  Yes

  No

  N/A

• 3- Flares

  Yes

  No

  N/A

• 1- Bottle of Lubrication

  Yes

  No

  N/A

• OLD TAG #

• NEW TAG NUMBER

Triage Kit Checklist

• 1- EMS Command Vest

  Yes

  No

  N/A

• 1- Staging Officer Vest

  Yes

  No

  N/A

• 1- Transportation Officer Vest

  Yes

  No

  N/A

• 1- Rehab Officer Vest

  Yes

  No

  N/A

• 1- Safety Officer Vest

  Yes

  No

  N/A

• 1- Public Information Officer Vest

  Yes

  No

  N/A

• 1- Supply Officer Vest

  Yes

  No

  N/A

• 1- EMT Vest

  Yes

  No

  N/A

• 1- Paramedic Vest

  Yes

  No

  N/A

• 1- Smart Triage PAC

  Yes

  No

  N/A

• Smart Triage PAC Tag#

• 5- Light Sticks

  Yes

  No

  N/A

• 10- Dead Tags

  Yes

  No

  N/A

• 20- Decontamination/Infection Cards

  Yes

  No

  N/A

• 1- Instruction/Usage Card

  Yes

  No

  N/A

• TRIAGE KIT OLD SEAL #

• TRIAGE KIT NEW SEAL #

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