Tuesday

Cardiac Monitor

• Adult Dfib Pads (Test)

  YES

  NO

• Comments:

• Expiration Date:

• Pediatric Defibrillation Pads

  YES

  NO

• Comments:

• Expiration Date:

• 4 Lead & 12 Lead Cables

  YES

  NO

• Comments:

• Adult/Peds Electrodes (12ea)

  YES

  NO

• Comments:

• CO2 Cable w/ BVM Adaptor

  YES

  NO

• Comments:

• CO2 Nasal Canula Adapter

  YES

  NO

• Comments:

• Pediatric SpO2

  YES

  NO

• Comments:

• Razor

  YES

  NO

• Comments:

• Spare Monitor Paper

  YES

  NO

• Comments:

• Rotate The Spare Battery

  YES

  NO

• Comments:

Oxygen Levels

• Onboard Main Oxygen >500psi

  YES

  NO

• Comments:

• Oxygen Level:

• Stretcher Oxygen Cylinder >300psi

  YES

  NO

• Comments:

• Oxygen Level:

• CPAP Oxygen Cylinder > 300psi

  YES

  NO

• Comments:

• Oxygen Level:

Jump Bag

• Glucometer

  YES

  NO

• Comments:

• Vitals Equipment

  YES

  NO

• Comments:

• Clipboard & Forms (10ea form)

  YES

  NO

• Comments:

• Drug Bag

  YES

  NO

• Comments:

• IV Roll Up Bag

  YES

  NO

• Comments:

• Pediatric Bag

  YES

  NO

• Comments:

Other Items

• Onboard/Portable Suction

  YES

  NO

• Comments:

• Interior Cabinets Stocked

  YES

  NO

• Comments:

• All Lights Working

  YES

  NO

• Comments:

• All Fluids Full (Fuel >3/4)

  YES

  NO

• Comments:

• Cab/Cot/Patient Areas Cleaned

  YES

  NO

• Comments:

• Radios and Phone Working

  YES

  NO

• Comments:

Driver's Side Outside Cabinet 1

• Pressurized Water Can

  YES

  NO

• Comments:

• Broom

  YES

  NO

• Comments:

• 6' Pike Pole

  YES

  NO

• Comments:

• Peds & Adult Hare Traction

  YES

  NO

• Comments:

• K.E.D.

  YES

  NO

• Comments:

• Vacuum Splints (1Sm, 1M, 1Lg & 1 Pump)

  YES

  NO

• Comments:

Driver's Side Outside Cabinet 2

• Body Bag

  YES

  NO

• Comments:

• Wool Blanket

  YES

  NO

• Comments:

• Transfer Tarp

  YES

  NO

• Comments:

• Safety Blanket

  YES

  NO

• Comments:

• Throw Bag 50' (2)

  YES

  NO

• Comments:

• Noodle

  YES

  NO

• Comments:

• Step Chocks (2)

  YES

  NO

• Comments:

• Caution Tape Roll

  YES

  NO

• Comments:

• Extension Cord

  YES

  NO

• Comments:

• P.F.D.

  YES

  NO

• Comments:

• Water Bottles (1 Case)

  YES

  NO

• Comments:

• Smoke Detctors (3)

  YES

  NO

• Comments:

• Bolt Cutters

  YES

  NO

• Comments:

• Ice Scrapper & Salt Can

  YES

  NO

• Comments:

• Fire Extinguisher

  YES

  NO

• Comments:

• Road Triangles

  YES

  NO

• Comments:

Driver's Side Outside Cabinet 3

• SCBA Bottle (A) >4000psi

  YES

  NO

• Comments:

• Psi Level:

• SCBA Bottle (B) >4000psi

  YES

  NO

• Comments:

• Psi Level:

• Flashlights (2)

  YES

  NO

• Comments:

• Set of Irons

  YES

  NO

• Comments:

• Passport Tag Holders (2)

  YES

  NO

• Comments:

• Helmet Shields (3)

  YES

  NO

• Comments:

Passenger's Side Outside Cabinet 4

• Scoop Stretcher

  YES

  NO

• Comments:

• Backboards with Straps (3)

  YES

  NO

• Comments:

• Peds Backboard

  YES

  NO

• Comments:

• Child Car Seat

  YES

  NO

• Comments:

• Stair Chair

  YES

  NO

• Comments:

• Adult/Peds/Infant Head Bed (2ea)

  YES

  NO

• Comments:

Cervical Collar Bag

• Infant Collar (2)

  YES

  NO

• Comments:

• Peds Collar (2)

  YES

  NO

• Comments:

• Adult Collar (2)

  YES

  NO

• Comments:

• Infant Head Bed

  YES

  NO

• Comments:

• Peds Head Bed

  YES

  NO

• Comments:

• Adult Head Bed

  YES

  NO

• Comments:

Drug Bag Center Compartment

• Old Drug Tag #

• Adult EZ IO Needle

  YES

  NO

• Comments:

• Expiration Date:

• Bariatric EZ IO Needle

  YES

  NO

• Comments:

• Expiration Date:

• Peds EZ IO Needle

  YES

  NO

• Comments:

• Expiration Date:

• EZ IO Gun

  YES

  NO

• Comments:

• Alcohol Wipes

  YES

  NO

• Comments:

• Saline Flush

  YES

  NO

• Comments:

• IV Pressure Infuser

  YES

  NO

• Comments:

Drug Bag Medication Pull Out Flaps

• Aspirin Tabs (4) - 324mg

  YES

  NO

• Comments:

• Expiration Date:

• Amiodarone (2) - 300mg

  YES

  NO

• Comments:

• Expiration Date:

• Adenosine (3) - 18mg

  YES

  NO

• Comments:

• Expiration Date:

• Benadryl (1) - 50mg

  YES

  NO

• Comments:

• Expiration Date:

• Epinephrine 1:1,000 (3) - 3mg

  YES

  NO

• Comments:

• Expiration Date:

• Etomidate (2) - 20mg

  YES

  NO

• Comments:

• Expiration Date:

• Fentanyl (1) - 100mcg

  YES

  NO

• Comments:

• Expiration Date:

• Glucagon (1) - 1mg

  YES

  NO

• Comments:

• Expiration Date:

• Magnesium Sulfate (2) - 2gm

  YES

  NO

• Comments:

• Expiration Date:

• Nitroglycerin (1bottle) - 0.4mg

  YES

  NO

• Comments:

• Expiration Date:

• Vasopressin (2) - 40units

  YES

  NO

• Comments:

• Expiration Date:

• Verapamil (1) - 10mg

  YES

  NO

• Comments:

• Expiration Date:

• Versed 5/5 (1) - 5mg

  YES

  NO

• Comments:

• Expiration Date:

• Versed 5/1 (2) - 10mg

  YES

  NO

• Comments:

• Expiration Date:

• Zofran Tablet (1) - 4mg

  YES

  NO

• Comments:

• Expiration Date:

• Zofran Vial (1) - 4mg

  YES

  NO

• Comments:

• Expiration Date:

Drug Bag Syringe Area

• 1ml Syringe (2)

  YES

  NO

• Comments:

• 3ml and/or 5ml Syringe (3)

  YES

  NO

• Comments:

• 10ml and/or 12ml Syringe (2)

  YES

  NO

• Comments:

• 20ml Syringe (1)

  YES

  NO

• Comments:

• Filter Straws (2)

  YES

  NO

• Comments:

• Filter Needles (2)

  YES

  NO

• Comments:

• 18g and/or 20g Needle (3)

  YES

  NO

• Comments:

• 21g and/or 22g Needle (3)

  YES

  NO

• Comments:

• 23g and/or 25g Needle (3)

  YES

  NO

• Comments:

• MAD Device (2)

  YES

  NO

• Comments:

Drug Bag Boxed Medication Area

• Atropine Pre-Load (1) - 1mg

  YES

  NO

• Comments:

• Expiration Date:

• D50% Pre-Load (1) - 25gm

  YES

  NO

• Comments:

• Expiration Date:

• Epinephrine 1:10,000 Pre-Load (4) - 4mg

  YES

  NO

• Comments:

• Expiration Date:

• Lidocaine Pre-Load (1) - 100mg

  YES

  NO

• Comments:

• Expiration Date:

• Narcan Pre-Load (2) - 4mg

  YES

  NO

• Comments:

• Expiration Date:

• Sodium Bicarbonate (1) - 50meq

  YES

  NO

• Comments:

• Expiration Date:

• Oral Glucose (1) - 15gm

  YES

  NO

• Comments:

• Expiration Date:

• New Drug Tag #

Jump Bag Top

• Albuterol (1) -2.5mg

  YES

  NO

• Comments:

• Expiration Date:

• Atrovent (1) - 0.5mg

  YES

  NO

• Comments:

• Expiration Date:

Interior Cabinet #2

• Albuterol (2) - 5mg

  YES

  NO

• Comments:

• Expiration Date:

• Atrovent (2) - 1mg

  YES

  NO

• Comments:

• Expiration Date:

Narcotic Box

• Old Drug Tag #

• Etomidate (2) - 40mg

  YES

  NO

• Comments:

• Expiration Date:

• Fentanyl (2) - 200mcg

  YES

  NO

• Comments:

• Expiration Date:

• Versed 5/5 (3) - 15mg

  YES

  NO

• Comments:

• Expiration Date:

• Versed 5/1 (2) - 10mg

  YES

  NO

• Comments:

• Expiration Date:

• New Drug Tag #

ALS Drug Box Upper

• Aspirin Tabs 81mg - 12

  YES

  NO

• Comments:

• Expiration Date:

• Albuterol (2) - 5mg

  YES

  NO

• Comments:

• Expiration Date:

• Atrovent (2) - 1mg

  YES

  NO

• Comments:

• Expiration Date:

• Amiodarone (2) - 300mg

  YES

  NO

• Comments:

• Expiration Date:

• Adenosine (3) - 18mg

  YES

  NO

• Comments:

• Expiration Date:

• Benadryl (1) - 50mg

  YES

  NO

• Comments:

• Expiration Date:

• Epinephrine 1:1,000 (3) - 3mg

  YES

  NO

• Comments:

• Expiration Date:

• Glucagon (2) - 2mg

  YES

  NO

• Comments:

• Expiration Date:

• Magnesium Sulfate (2) - 2gm

  YES

  NO

• Comments:

• Expiration Date:

• Nitroglycerin (1 bottle) - 0.4mg

  YES

  NO

• Comments:

• Expiration Date:

• Sodium Chloride Packets (5)

  YES

  NO

• Comments:

• Expiration Date:

• Tetracaine Bottle (1)

  YES

  NO

• Comments:

• Expiration Date:

• Vasopressin (2) - 40units

  YES

  NO

• Comments:

• Expiration Date:

• Zofran Tab (1) - 4mg

  YES

  NO

• Comments:

• Expiration Date:

• Zofran Vial (1) - 4mg

  YES

  NO

• Comments:

• Expiration Date:

• MAD Device (2)

  YES

  NO

• Comments:

ALS Drug Box Lower

• Dopamine (1) - 400mg

  YES

  NO

• Comments:

• Expiration Date:

• 60 Drip Tubing (3)

  YES

  NO

• Comments:

• Filter Straw (2)

  YES

  NO

• Comments:

• Filter Needle (2)

  YES

  NO

• Comments:

• 1ml Syringe (3)

  YES

  NO

• Comments:

• 3ml and/or 5ml Syringe (3)

  YES

  NO

• Comments:

• 10ml and/or 12ml Syringe (3)

  YES

  NO

• Comments:

• 20ml Syringe

  YES

  NO

• Comments:

• Carpojet

  YES

  NO

• Comments:

• Saline Flush (4)

  YES

  NO

• Comments:

• 18g and/or 20g Needle (3)

  YES

  NO

• Comments:

• 21g and/or 22g Needle (3)

  YES

  NO

• Comments:

• 23g and/or 25g Needle (3)

  YES

  NO

• Comments:

ALS Drug Drawer

• Atropine Pre-Load (5) - 5mg

  YES

  NO

• Comments:

• Expiration Date:

• D50% Pre-Load (1) - 25gm

  YES

  NO

• Comments:

• Expiration Date:

• Epinephrine 1:10,000 Pre-Load (6) - 6mg

  YES

  NO

• Comments:

• Expiration Date:

• Lidocaine Pre-Load (5) - 500mg

  YES

  NO

• Comments:

• Expiration Date:

• Narcan Pre-Load (2) - 4mg

  YES

  NO

• Comments:

• Expiration Date:

• Sodium Bicarbonate Pre-Load (1) - 50meq

  YES

  NO

• Comments:

• Expiration Date:

• Oral Glucose (1) - 15gm

  YES

  NO

• Comments:

• Expiration Date:

• Glucometer (spare)

  YES

  NO

• Comments:

• Box of Alcohol Wipes

  YES

  NO

• Comments:

• 60ml Syringe (2)

  YES

  NO

• Comments:

• Tape Roll (3)

  YES

  NO

• Comments:

• Saline Flush (2)

  YES

  NO

• Comments:

• Box of Test Strips

  YES

  NO

• Comments:

• Lancets (10)

  YES

  NO

• Comments:

• Box of Bandaids

  YES

  NO

• Comments:

Officer's Signature

• Add signature

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